Ensuring strong evidence leads to strong delivery

Every year for the past two decades, Eric Storch, PhD, has received an email from the mother of a former patient he treated for obsessive-compulsive disorder (OCD). The messages arrive on her son’s birthday with a brief update on the young man’s life: graduations, a first job, and other milestones since therapy ended. For Storch, a clinical psychologist who specializes in OCD and anxiety disorders across the lifespan, those notes reflect what effective treatment can look like over time. “That kind of ongoing connection is a meaningful outcome in itself, alongside any clinical improvements,” he said.

Storch’s career has focused on improving how OCD and anxiety are understood and treated, particularly in children and adolescents. These conditions are among the most prevalent mental health disorders worldwide, yet misconceptions about them remain common in both public and clinical settings. OCD, for example, is often reduced to being a desire for order or cleanliness. In reality, many patients struggle with intrusive thoughts about harm or danger that bear little resemblance to those stereotypes. When clinicians misread those symptoms, patients can be misdiagnosed or receive ineffective treatments, said Storch, who is the McIngvale Presidential Endowed Chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine.

We spoke with Storch about his work to strengthen the evidence base for treating OCD and anxiety, and asked how clinicians can deliver more consistent, effective care.

How do we evaluate treatment efficacy—particularly for OCD and anxiety—and then implement what we learn in the real world? That’s the core question. Our field is seeing a wave of new interventions, and some are being applied before they’ve been fully evaluated. It’s easy to get caught up in the brightest, shiniest new approach, but we need to pause and consider the ethical implications. For instance, what does it mean to use noninvasive neurostimulation, which is novel but time intensive and yields much more modest effects relative to standard care therapies? Those decisions require careful thought, not just enthusiasm for innovation.

There are also areas—OCD is a good example—where we already know which treatments tend to work best. In those cases, the challenge isn’t discovery so much as delivery. Researchers and clinicians need to think seriously about how to reduce variation in care. Whether within the United States or globally, we often fail to get effective treatments to the people who need them. And when the quality and availability of care is inconsistent, patients continue to struggle, and confidence in the profession erodes, even when we have strong evidence about what helps.

Most people with OCD and anxiety experience onset before adulthoodopens in new window, so early life is a crucial window for intervention. This period also offers a chance to address problems before they become more entrenched and difficult to treat.

I’m also deeply committed to involving parents in treatment. When working with children, parents can become partners—almost cotherapists—who support their child’s engagement and progress. When that collaboration works well, outcomes improve. Hopefully, that means reduced symptoms, but improved outcomes can also include greater acceptability and sustainability of treatment gains because the whole family is involved.

One of our ongoing projects—the Promoting OCD Wellness and Resilience (POWER) studyopens in new window—is grounded in a practical question: Can children who are taking medication for OCD safely discontinue it with the support of a specific type of talk therapy, namely cognitive behavioral therapy with exposure and response prevention?

Long before it became standard to ask stakeholders what matters most to them, our team was already listening closely to families. Two questions came up again and again. The first was, “How do I help my kid?” The least helpful answer is: “Sit in the waiting room while I work with your child, and I’ll summarize the session in 5 minutes at the end.” A more effective approach is to bring parents into the process and teach them the same skills we’re using in therapy so they can reinforce them day to day in the household.

The second question we heard constantly was, “Will my child have to be on this medicine forever?” The honest answer is that we often don’t know. POWER is designed to generate an evidence-based answer to that question, but it also aims to strengthen a child’s capacity and family support system for long-term resilience. Put simply, we want kids to feel better so they don’t need to keep coming back to hang out with—let’s be honest—a bunch of boring clinicians!

Psychiatric genomics holds out the possibility of more precise, individualized care. You see this already in fields like oncology, where a patient’s genetic profile can guide treatment decisions, whether that’s assessing risk or selecting therapies that are more likely to be effective.

Historically, though, most genetic studies have focused on individuals of European ancestry. That creates a problem if our goal is precision medicine. When the underlying data come largely from one population, the resulting insights and treatments may not generalize well to others. The question, then, is how do we build samples that better reflect the diversity of the world? Without that diversity, the promise of precision medicine remains unevenly distributed.

Because this work involves sensitive topics and communities that have often been excluded or mistreated in research, building trust is essential. We’ve focused on developing genuine partnerships with collaborators and communities, treating them as peers throughout. In the LATINO study, for example, we found that community stigma surrounding OCD can discourage people from participating. One of our first steps was to create a social media campaign focused on education—what OCD is, what it isn’t, and how it can be treated. We’ve also organized local conferences and workshops across Latin America to train practitioners in behavioral therapy. The goal is to approach this work as a shared effort to improve care.

First, stay grounded in what we know works. There’s a strong evidence base for certain interventions—such as cognitive behavioral therapy with exposure and response prevention, where people gradually face their fears and refrain from typical rituals to break a compulsive cycle—and it’s worth being thoughtful about where you focus your professional energy. It’s difficult to do many things exceptionally well; most of us are better off developing real depth in a smaller number of areas. I know I’m quite good at treating OCD and anxiety. I’m not the best person to treat a wide range of other conditions, and that’s okay. In medicine, we don’t expect a cardiologist to be the point person for treating a broken toe, even if they have general medical knowledge. Psychology can benefit from a similar appreciation for specialization. When clinicians lean into what they do best and refer out when appropriate, patients are more likely to receive high-quality care.

The second takeaway is that there is an enormous amount of thoughtful, rigorous work happening across the field of psychology—we are a whole bunch of motivated, passionate nerds! Many dedicated researchers and clinicians are pushing to keep science at the center of practice, with the shared goal of improving patients’ lives. For clinicians, staying connected to that work—through continuing education, collaboration, and a willingness to adapt—helps ensure that the care we provide keeps moving forward alongside the evidence.