Stacey Horton's obsessive compulsive disorder first emerged during a stressful period in her junior year of college about 25 years ago. She found a dead bug and couldn't throw it away. "I had to know its destiny," she said.
Horton began to collect strange items in a bag in her dorm room, and soon other compulsions kicked in.
"I had to memorize dollar bill serial numbers before I gave them away -- and license plate numbers," said Horton, 47, from South Yarmouth Mass. Horton had come from a family of 10, and she feared that if she didn't count to 10 on her fingers, "someone in the family would get hurt."
"It was a weird form of control," she said.
OCD is a disorder of the brain and behavior, affecting about 4 million Americans, according to the OCD Foundation.
Horton, who has been in and out of therapy for the disorder, hopes to get some relief from a new mobile therapy application -- Live OCD Free.
The app guides obsessive-compulsives through exposure and response therapy, the most widely accepted treatment for OCD. Patients create their own treatment plans that map out challenges and exercises, known as "exposures."
Live OCD Free, which costs $79.99 and is available on iTunes, was created by Kristen Mulcahy, director of the Cognitive Behavioral Institute in Falmouth, Mass. It comes with a 30-page user guide and works in tandem with a therapist.
Mulcahy said she had developed the app in collaboration with leading professionals and had done rigorous pilot testing to support its effectiveness.
"I love that she is collecting data," said Jeff Szymanski, executive director of the OCD Foundation, which is the nation's biggest resource for those with the disorder.
The foundation has shown an interest in Internet-based therapies for patients. Its annual convention in July will include workshops on two such programs -- BT Steps and OCD Challenge.
"These tech-based programs are good if you don't have access to a provider," he said. "We don't recommend them in lieu of therapy, but a lot of people don't have a therapist."
The number of therapists trained in behavioral therapy for OCD is "very, very low," he said.
Horton's obsessions center on contamination, and she especially fears touching sweaters or bed sheets, where germs or insects might lurk.
"My heart rate goes completely out of whack, and my palms are sweaty," said Horton. "I am not breathing at all, and I'm all hunched holding the tension in my back.
Using the new app, she can set up her own rewards, such as a day of shopping, "or getting my nails or hair done," said Horton. "For me, it's just knowing that the app is there. It sounds cliched, but it's like a therapist in your pocket. It's portable, and so accessible."
Washing hands or using hand sanitizer after touching something dirty "works really well in the short term," Mulcahy said. "But in the long-term, the compulsion becomes more consuming and it takes more time and energy."
The app allows patients to monitor their anxiety levels. Once they go down, they can challenge themselves to new tasks.
Exposure therapy works through "habituation," said Mulcahy. Patients learn they are "not going to be anxious forever -- it always comes down."
The app also provides a progress report, which can be shared with the therapist. "That's motivating to see," said Mulcahy. "It holds them accountable and increases their consistency."
"The app allows a set practice time and a calendar to remind them to practice daily," said Mulcahy. "They set a timer -- not to give in to the compulsion."
The app is also designed for children, a game inspired by one of Mulcahy's three children, 7-year-old Bree. Users battle the Worry Wizard, and every time they master a challenge, the loses a part of his costume.
As for Horton, she said her fantasy goal is to live a life without OCD, which she said has disrupted her life and caused her untold anxiety. Horton is a teacher but said she could barely face working because of her fear of contracting head lice from her students.
"The whole thing is driving me nuts," she said. "It's tough on my profession. The universe is always giving me things to challenge me."
Her crippling fears affect not only her own life but that of her two children, who are 8 and 10. "I can't go to a hotel because of bed bugs," said Horton, who's divorced. "I can't travel."
All her furniture is white, to make it easier for her to spot lice. Horton rotates bed sheets, compulsively washing them. She also washes her hands constantly.
"I live in a real small box, and when people come into my box, I don't appreciate it," said Horton. "I freak out. I am so limited and restricted. I used to go to Boston and stay at a hotel -- now all that is gone."
Working with Horton and the app, Mulcahy set up a hierarchy of Horton's fears, so she can practice facing them.
The app challenges Horton to first expose herself to the least fearful activity, such as touching dirty bed sheets, working toward eventually staying at a hotel.
Using a public restroom, curtailing her hand washing, not washing sheets and wearing sweaters are all on Horton's task list.
But the longer a patient has had OCD, the more "difficult and challenging it is to break," said Mulcahy.
"A thought causes a lot of distress, and you can't get rid of it," said Mulcahy. "Then the compulsion is anything that you do to get rid of ... and diminish the anxiety. It could be physical or mental."
"Sometimes I feel sorry for myself and think, why do I have it," Horton said. "But maybe it makes me more empathetic toward others.
"It's absolute hell on earth," she said. "My dream is to be at peace and not having to be so vigilant every minute, awaiting the next germ or bug I might come upon. I'd like to relax and get into life and enjoy my children."