Silja Litvin of eQuoo says founders should prioritize their mental health

'The life of an entrepreneur is often very isolated and comes with a lot of pressure'

Entrepreneurs — particularly tech entrepreneurs — face the uphill struggle of building something new in the world. Sometimes that struggle can exact a heavy mental toll. As much as everyone knows they should be sleeping, exercising and meditating, it’s hard to keep all that up when you are trying to build a company.

As an entrepreneur whose startup is literally about maintaining good mental health, Silja Litvin is well aware of the pitfalls. And more so because she’s also a trained family therapist.

She attained her master’s in Clinical Psychology and Systemic Family Therapy in 2013 from Ludwig Maximilian University (LMU) in Munich and became a Systemic Family Therapist. In 2015, she began her PhD in Clinical Psychology at LMU with the help of Oxford University College.

Born in Germany but living around the world, including California, Litvin encountered many countries and cultures as a professional model, along the way developing an interest in the human condition. This inspired her to go on to look at mental health issues as an entrepreneur.

Her mental health startup eQuoo recently became the only game in the U.K.’s National Health Service App Library and is set to shortly close its seed funding round. More recently, she’s been speaking to tech accelerators, most notably Techstars Berlin, about staying mentally healthy in tech startups.

EQuoo is an emotional fitness game that aims to teach healthy psychological skills. A U.K. doctor can formally refer eQuoo to their patients to improve their mental health and well-being. The startup has gained scientific backing for its app, going through a “three-arm,” five-week, randomized control trial with more than 350 participants with Bosch U.K. Indeed, eQuoo has also now achieved a top rating at leading health app assessment platform ORCHA and counts Barmer, Germany’s largest insurance company, among its clients.

TechCrunch: Everyone is familiar with normal work stress. What is different about being a tech entrepreneur in relation to the issue of mental health?

Silja Litvin: I think as an entrepreneur you completely identify with your job with your company; it’s very closely linked to your self-worth and how you value yourself. And so, if you fail in a normal job environment it’s just you being human, but if you fail as a startup it feels like you aren’t being the best you could be and I think that really puts a completely different pressure on people. And then you have the problem — as well as being a startup founder — that you are kind of the “lead horse,” you’re pulling the cart, and you have to have this appearance of strength towards your employees else they or your investors might freak out. And if you show any weakness, then, you know, it’ll all start to crumble. That’s the difference.

Is there something about the nature of entrepreneurs themselves? You mentioned a study where founders are 30% more likely to have depression, 12% more likely to foster addiction, etc. Is it something that just comes with the territory?

I think it’s a mix of the surroundings, as well as the predisposition, I think. It’s not like your average person wouldn’t start a company, right? You’re doing a million things at once, it’s so extremely stressful. You have to have certain personality traits already and I would say it is very similar to the kinds of traits surgeons and bankers have. You have higher traits of sociopathy and these come with vulnerabilities towards mental illness.

In the high stress of a startup environment, these traits compound together. And the second thing is that the life of an entrepreneur is often very isolated and comes with a lot of pressure. So problems can become exaggerated and exacerbated in the context of mental illness.

So what are the coping mechanisms and tactics that people should think about in their daily lives? And secondly what is the big picture stuff that they need to be aware of?

I think the big picture thing in a way is that entrepreneurs are running a marathon and a lot of time when people hear they’re running a marathon, it means it’s slower than a sprint. Well maybe, but it’s a lot longer and it’s still faster than your average stroll or average jog, right? So, you have to in a way live the life of an Olympic sports person because you’re getting up early, you’re going out or working late, you’re under pressure constantly. And that means you have to, in a way, to make sure that you’re healthy. You have to eat like an athlete, you have to sleep like an athlete. You need to watch your nutrition and you have to exercise.

And I think that’s very hard to do because people become hyper-focused on their work and that work is often at the desk or at the laptop. So, these things get pushed to the back but they are actually the basis for being a successful entrepreneur. If you speak to a lot of entrepreneurs that have really made it, you find they go jogging early in the morning — and I’m not talking about the people that get up at four or five o’clock and jog for an hour and then you know do an hour meditation or everything that’s not sustainable for most people — but they are aware that they have to move, that they have to eat healthy and not drink too much alcohol.

You also suggest people delete their social media. Tell me more about that.

If you’re in a lot of social media groups, you get to see what everybody’s doing and of course, it looks very good because they only post the good things. Nobody is posting: “I woke up this morning and an investor just canceled and my wife is leaving me.” You only get the highlight reel. So you often make this constant comparison of yourself against other entrepreneurs. And second of all, it really pulls you in, so everything on social media has been made and engineered in a way that it goes straight to your dopamine receptors. How many times do you just want to answer a message on Facebook and an hour and a half later you’re like looking at somebody’s new baby or something?

So I think that being able to resist those comparisons that challenge your self-worth and not getting lost in the addictive traits of social media is important. Often social media algorithms are based to support our natural negativity. So you will be blasted with things that you’re already concerned about. So if you know if you’re worried about Trump, it will be pressed in your face and that will strengthen already existing anxieties.

You talk a lot about sleep hygiene and stress detection and management. Could you expand on those?

Sleep hygiene is an interesting thing because what people aren’t aware of is that sleep is linked to most of the mental illnesses and physical illnesses that are out there. So, the moment your sleep pattern becomes interrupted, during the day we process information and our neurons produce a neurotoxin. This has to be decomposed over the night and if we don’t sleep enough, we will still have those neurotoxins and of course all the other functions of our body won’t be able to recoup. So keeping up a strict sleep schedule is key. Of course, there’s going to be times that every entrepreneur is just going to have to do an all nighter or something, but that should be the exception.

Everybody needs a certain amount of sleep, and if they don’t get it they will get sick and it will have a huge effect on your mood. Sleep hygiene just means that you sleep in a room that’s dark; try to keep noise out of the room; turn off the screen at least an hour before going to bed; try not to have stimulating drinks or like coffee or alcohol before going to bed; and just make sure you sleep well because that has such a big impact on all your cognitive and emotional functions.

What about detecting stress early. What are the early-warning signals?

Burnout creeps up on most people because we think that being absent-minded, not being able to breathe properly, having migraines [and] not being able to sleep are just kind of normal. So we don’t detect them in time. We have to start listening to our bodies, if we are not aware of our surroundings. With myself, for example, if I’m working hard and I find I can’t breathe deeply enough, I realize that I’m stressing too much. Everybody has different symptoms, such as gastric issues. Some people have to go to the restroom all the time. Some people get lower back pain. These are very often connected to stress where our body’s just saying: “Dude, you know, you’re overstressed, take a break.”

We talked about some preventative issues. What happens if something hits you like a truck and you realize that actually you’re having a breakdown? What is some advice for that scenario?

The best advice probably, is if you have access to one, to first see your general medical practitioner. Tell your GP about all the symptoms and don’t sugarcoat it. They will probably do some kind of test with you and then refer you to either a psychiatrist or a psychologist. If you can afford it, see a personal psychologist, because usually if you’re using a national or public health system it’s going to take a long time before you get to see someone. The faster you see one, the better, and it’s an investment into the company, into yourself and into your family. So, find a therapist.

Cognitive behavioral therapy has been proven to work very well and will help you also manage symptoms in the future. Talking therapies are really good and depending on how bad it is, a mix of psychological care from a psychologist and drugs from a psychiatrist could be the ideal solution.

Do you think that investors should be sympathetic to founders in this predicament? What kinds of things would you advise investors to do to support founders who might be experiencing difficulties with mental health?

There are very few VC firms right now that are starting to put aside well-being and mental health funds for their entrepreneurs. For me, it is an absolute no-brainer to invest in the mental health of your founders, because investors generally invest in the founder before they invest in the company, because at the early stage the company might change but the founder won’t. So they should invest in the founder’s mental health.

If you were a VC and saw your founder having issues, what should they say?

Investors should make sure their firm is actually a safe place for entrepreneurs. Make sure that everybody in the firm is on board with a mental health strategy that everybody’s aware of their stigmas and their biases. If I was an investor, I would have someone come into my VC firm and do a Mental Health First Aid course. The VC world itself is very pressurized. Bragging about having founders “who don’t sleep” is toxic. Luckily there’s been a backlash against that culture of “hustle porn.”

Admittedly, there is still low awareness of mental health, but I think now there are growing links between mental health and return on investment. And this is one of the things that we’re doing right now with corporations. Employers don’t care much about mental health until you show them that if your employee is happier you end up with a bigger return on investment.

You will see that the companies that have the best mental health structure set up are going to be the ones that perform the best. And it gives you that edge that other people just don’t have.

Right now we’re developing a program with some accelerators about mental health for founders that starts at the beginning of the program. If you engage in mental illness prevention, then you have the boost of resilience that no one else gets in this space.