Why I Turned to Podcasts to Study OCD Therapy
ERP is backed by data. But what about the stories behind the data?
If you’ve ever read about OCD treatment, you’ll have seen the statistics: Exposure and Response Prevention (ERP) is the gold-standard therapy. It’s effective. It’s evidence-based. And for many people, it’s life-changing.
But numbers don’t tell the whole story.
While ERP is considered highly effective in clinical trials, many people find it hard to start, stick with, or benefit from in real-world practice. Studies have consistently reported that around 25–30% of individuals drop out of ERP before completing it, and as many as 25–30% refuse to begin at all (Farris et al., 2013; Öst et al., 2015; Abramowitz et al., 2018).
Why is this happening? The literature gives some clues—but it’s often limited by sample size, clinical settings, and a narrow demographic reach.
So I turned to a different source: the lived experiences shared on The OCD Stories podcast (Ralph, 2015-present).
Why Podcasts?
Podcasts offer something that traditional research often can’t: depth, diversity, and raw emotional honesty. Since 2015, The OCD Stories has released hundreds of long-form interviews with people from all walks of life who have experienced OCD. Many of these episodes include in-depth reflections on therapy—what helped, what didn’t, and what nearly broke them along the way.
These weren’t clinical case notes or survey responses. They were personal stories, full of nuance and contradiction. And they raised a powerful question: What could we learn if we treated these voices as data?
The Study
My research used a reflexive thematic analysis to explore 103 episodes of The OCD Stories that discussed ERP engagement challenges. The aim was to identify recurring patterns in how people described their difficulties starting, staying with, or benefiting from ERP.
This approach was unusual—but necessary. Existing qualitative research on ERP engagement tends to focus on small samples drawn from treatment settings, often lacking demographic and experiential diversity. By contrast, the podcast featured people across a wide range of ages, cultures, OCD subtypes, and recovery stages.
Of course, analysing podcast material came with its own limitations—it was unscripted, unstructured, and varied in quality. But the richness and variety of the accounts made it a powerful source of insight.
Why This Matters
ERP is still the most effective treatment we have for OCD. But if we want more people to benefit from it, we need to understand why it doesn’t work for everyone. That means listening to those who have lived through it—not just in clinics, but in bedrooms, on buses, at family dinners, and during panic attacks on the bathroom floor.
By turning to the stories people shared on their own terms, this research aimed to put the human experience back at the centre of the conversation.
In the next post, I’ll share the first major theme that emerged from this analysis: The Inner Tug-of-War.
References
Abramowitz, J. S., Blakey, S. M., Reuman, L., & Buchholz, J. L. (2018). New Directions in the Cognitive-Behavioral Treatment of OCD: Theory, Research, and Practice. Behavior therapy, 49(3), 311–322. https://doi.org/10.1016/j.beth.2017.09.002
Farris, S. G., McLean, C. P., Van Meter, P. E., Simpson, H. B., & Foa, E. B. (2013). Treatment response, symptom remission, and wellness in obsessive-compulsive disorder. The Journal of clinical psychiatry, 74(7), 685–690. https://doi.org/10.4088/JCP.12m07789
Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014. Clinical psychology review, 40, 156–169. https://doi.org/10.1016/j.cpr.2015.06.003
Ralph, S. (Host). (2015-present). The OCD stories [Audio podcast]. The OCD Stories. https://theocdstories.com
