Mental Health #6: The Digital Therapist

What's up, everyone. This is Alex Lieberman, co-founder and Executive Chairman of Morning Brew. Welcome back to Founder’s Journal, my personal audio diary, where I give you, the business builder, the tools you need to think better in order to build better, whether that's building a business, a team, or a new product. This week on Founder’s Journal, we're doing things a little differently. We're dropping a mini series focused on mental health. I'll talk about my own battle with anxiety, the effects social media has on our psyche, and break down my own mental health routines. That means instead of just one episode Monday, Wednesday, and Friday, this week we're giving you two: a new show that you won't want to miss, plus a classic episode you maybe haven't heard before. If you haven't listened to today's classic episode, go back and check it out. Now I am bringing back startup CrossFit where I take a business idea through the ringer. And because it's mini series week, the business idea I'm breaking down relates to the topic of mental health. Let's hop into it. 

Release: The digital therapist

So let me set the stage first. This type of episode is called Startup CrossFit. And the whole purpose of this format is not to start a new business. It is for all of us to exercise our creativity and our critical thinking at once through the lens of a startup idea. I'm going to start by introducing the idea and then I'll break it down. So let me get in character. And I'm going to talk to you like a, you're an investor at a16z or Sequoia. Here we go. I am so excited to introduce you to Release, The Digital Therapist. Everyone is talking about mental health these days, and for good reason. Just with anxiety alone, 40 million adult Americans are diagnosed with an anxiety disorder, yet just 36% of those diagnosed seek treatment. Release will take its patients along the path to progress. Using hardware and software,this product will bring awareness, insights, and intervention to those with anxiety. Close scene.

Five questions to answer for Startup CrossFit

That's the 30-second pitch. And my goal with this pitch was to tell a compelling story that showed a big, clear problem, a really clear nagging problem. It played into the emotions of my audience, in this case, the investor, and articulated a clear solution for the problem with a cliffhanger. So now let's break down the idea, and when it comes to any product idea, from a startup I'm thinking of building to one I'm thinking of investing in, to a new product in an existing business, I always ask the same five crucial questions: What's the problem? Can it be solved? Is it worth solving? Can I cheaply test the idea as soon as possible? And what are the biggest risks? Let's go through each one.

#1: What is the problem? 

What is the problem? The problem here is simple: A lot of people have anxiety, diagnosed anxiety, and even more people have acute anxiety based on situational things in life. And it creates a lot of suffering and people don't have great, accessible tools to identify it or treat it. Some people are aware of their anxieties, fewer people know what causes their anxieties, and even fewer people than that have a system for managing their anxiety. That is the problem we're solving. 

#2: Can the problem be solved well? 

Next question: Can the problem be solved well? And I'm going to caveat this with, this is the question where I have the biggest blind spots, because it's going to take a lot of research and talking to people to get answers. So the solution, before we dive into, can the problem be solved well? The solution would be something that offers the trifecta to manage anxiety well: awareness of anxiety, insight into why anxiety is happening, and intervention or strategies for tackling your anxiety proactively or reactively. So basically the concept here is, Release would measure anxiety through biomarkers, which are basically tells by your body that you are experiencing anxiety and it would compare biomarkers to moments in your day, so you can get educated on what creates anxiety or stress for you chronically versus acutely. And then the idea is Release would then offer you recommendations for things you can do to prevent acute stressors, like say something that happened in a meeting that creates stress. There are a few big questions here though, right? Because I'm making a ton of assumptions that the product will be able to solve the problem in this way. The first big question is, from a medical perspective, are there measurable biomarkers that accurately monitor your stress levels or your anxiety levels? So examples of this are like, is measuring cortisol reliable? Cortisol is known as, you know, the anxiety chemical, but can you measure it? And can you measure it constantly? And I would assume that it would have to be a monitor, like a glucose monitor that goes beneath the skin. Another question would be, could you measure heart rate variability reliably? And does HRV or heart rate variability, is it correlated with stress or anxiety? Now a crazy idea I had was, imagine there was a world where you actually don't have to build new hardware, right? Where you don't have to build something that goes on, say your wrist, like a Fitbit or a Whoop, or on your finger like an Oura Ring. What if you could actually use existing hardware, like an iPhone or an Android, and you would just have to create software or an app for release? So the example here would be, could you actually look at something like pupil dilation or face color, and change in pupil size or face color, could that be actually a highly correlated biomarker for your stress or anxiety levels? Again, this is a hypothesis that would have to be tested significantly before answering the question.

Another big question I have around solving the problem is, okay, let's say we do find a biomarker, like cortisol or HRV or pupil dilation that accurately tells you when your body is experiencing stress or anxiety. The question then is, how effectively can you take insights that become worthwhile to people if you're collecting all this data? Because, while I believe data is powerful, we live in an age where we're taught to collect as much as possible, we're taught to hoard it, I also believe that all data you collect should have a very clear purpose and collecting data for data's sake doesn't make sense unless you can draw insights from it. But let's just for a second, let's just say that you find a biomarker that works, that, and then you can draw insights from constantly monitoring that biomarker, here are my ideas for applications of release in practice. Or one example would be that the software notices your stress is increasing during a meeting, and it tells you to take a breath and pause when you have the next chance to do so. Or it finds that the last 14 days that you have slept less than seven hours, your daily stress has been 15% higher, so it asks if you'll commit to get in bed by 9:00 PM tonight. Or one other example would be, it finds that your anxiety levels are higher for no external reasons and it prompts to ask you questions about if there's something internally you've been dealing with and it gives you the option to journal with prompts, or it asks you if you'd be interested in talking to someone like a life coach or a therapist. Again, this is purely hypothetical until we can really get answers to these questions.

#3: Is it a problem worth solving? 

Now, the next big question to take us through Startup CrossFit is, is this a problem worth solving? And there's a few ways I look at that question. The first is, is it already being solved? Something that I've noticed about my own business ideas is I am almost always not the first person to think of the idea, which means actually the best case scenario is someone has already solved the problem you're experiencing really well and you'd rather learn that early so you don't focus on building something where you're years behind an already great solution. The second sub-question here is, is this a really nagging problem? You want to solve a problem that is really painful to a group of people. So on a scale of one to 10, how painful is the problem? The more painful, the more likely you'll have a customer for life. From my personal experience, I think the problem of anxiety and not knowing what causes it or how to navigate or prevent it from taking over your life is a very painful problem. 

The next question is, is it a large audience or does it have the potential of being a large audience? Like I said, 40 million adults in the US have an anxiety disorder. That doesn't include people younger than 18. And it doesn't include people that are either undiagnosed or don't have an anxiety disorder, but experience acute anxiety because of situational or external factors in life. So yes, I would say it is a large audience and it doesn't have to be one today, right? The best example is Airbnb. Airbnb started as Air Bed and Breakfast, having people sleep on your couch for events, but it grew into a massive market because it became a new behavior for lodging and hospitality. 

And the final sub-question around is this a problem we're solving is, is it personally fulfilling to solve this problem? And this is the biggest draw to this idea for me. As someone who has experienced anxiety and OCD since middle school, as someone who literally just started another podcast called Imposters, which you should check out by the way, all about personal challenges and mental health, it would be the most fulfilling thing to help millions of people manage or rid themselves of such a plaguing and debilitating experience.

#4: Can I cheaply test appetite for this solution ASAP? 

Now, the fourth question related to testing any startup idea: How can I cheaply test appetite for the solution ASAP? And my answer to this question is I would have to get creative with this,  because capturing the data, so capturing data around, are you feeling anxious or stressed? It would be really expensive because I would have to end up developing hardware that goes on someone's body to measure these biomarkers that I was talking about. So my thought would be to test this quickly and cheaply, I wouldn't start by measuring the data. I'd focus on the two other parts of Release, which are insights and intervention, basically, what can we learn from your stress and how do you intervene with your stress and anxiety? And I'd focus on having a group of people self-report whenever they feel increased levels of stress via a survey I sent out to them. And then I would ask them qualifying questions, like, what is the severity of your stress? Where do you feel your stress? And are there any external events that you know are causing the stress? And based on the answers, I would curate resources for them to decrease the stress immediately and also offer them things to practice, read, or listen to as a preventative measure for next time. And so my goal would be to track completion of the survey, engagement rates on our recommendation, so basically when someone says they have stress and I make a recommendation, how often does someone follow through and take my recommendation? And I'd want to create a quantifiable measure to decide whether there is enough proof that we are successfully solving the insight or intervention problem in order to justify spending resources and a lot of money on the awareness and monitoring part of the equation.

#5: What are the biggest risks? 

And that leads us to the fifth and final question on Startup CrossFit, which is, what are the biggest risks? And there are a lot of them, if I'm being totally honest. The first one, which is the number one risk when I sent this idea out to friends that people came back with, which is a big tech company who is focused on the wearables or health tech space, couldn't they just build this and put us out of business before we hit critical mass? So the, the, the, you know, in real life example here would be someone like Apple who has stated that health technology is a huge focus of theirs, and they already have massive distribution of their Apple Watch, why couldn't they just do this? And honestly, it's a great question. They could do this. The question is, how much of a priority is this to them right now? Are stress and anxiety things that they can measure with the technology in Apple Watch right now? And so I don't have the answer to that question, but it is absolutely a risk to building any new business. The second biggest risk is sloppy thinking. And sloppy thinking, you know, it doesn't just refer to anything we try to think critically about, how clean are we, how precise are we in our way of thinking? The reason I think I run the risk of sloppy thinking here is because I'm so passionate and emotional about the problem. Because I have been plagued by anxiety in my life, I'm naturally really excited by the prospect of helping people work through it, but because there's emotion baked into that excitement, that can lead to sloppy thinking. And so the question is, how do I remove emotion when it is a problem I am so emotional about? The third is the unintended consequences that come from capturing data. So I, anytime I’ve talked to my medical friends and I talk about, you know, why don't we capture this data about people or patients? The biggest thing they'll say is you're not necessarily going to learn a lot from the data and you actually can have all these unintended consequences of capturing it. So the example here would be, well, if we're capturing data about stress and anxiety, and then we're letting people know that they have heightened anxiety and stress, if they're not actually aware of that stress, will it actually cause more stress and anxiety, because now they're aware of something that actually wasn't stressing them out before? And then the last big risk, which, again, is a huge risk I would have to look into are the ethical and regulatory concerns and questions. Are you even allowed to have a non-licensed therapist offer strategies for coping with anxiety? And even if you are, is it appropriate to have a solution like this as an alternative to seeing a therapist, like, is it a bad thing that this is a solution that I want to offer to the world when therapists are literally trained for years and helping people with anxiety disorders? 

Recap

So that is my quick breakdown of my most recent business idea. Is it a good idea or a bad idea? I honestly think it's far too early to know. There are simply too many unanswered questions that I need to get to in order to know whether to push forward or pull back. And there are a few specific questions that I'll call high-risk questions. Basically, these are the questions that I need answers to in order to know whether this business is a no-go from the start. The first is, can you monitor stress and anxiety accurately? Right? So I was talking about all these biomarker things earlier. Those are simply just thoughts and hypotheses, but I have no idea if things like cortisol, heart rate variability, or pupil dilation actually can tell someone if they're experiencing heightened stress or anxiety. And the second question I definitely need to answer, is how at risk is this idea to be crushed by competition before I even have a fighting chance? Once I can answer those questions, I'll have a better idea. So to sum up my business idea is Release, the intelligent anxiety coach. It is going to bring awareness, insights, and intervention to 40 million Americans who have anxiety disorders. And there are five crucial questions I need to answer to effectively evaluate the idea. 

I want to hear from you

Now I'd love to hear from you. What do you think of this idea? And are there any startup ideas that you want me to take through the Startup CrossFit ringer? Shoot me an email to alex@morningbrew.com and let me know. And while you do that, please subscribe to Founder's Journal on the podcast player of your choice. It is the number one way we grow the show. It's how we get to the top 10 on the podcast charts. And it's how new people find out about Founder's Journal. One last thing: I'd be remiss to not thank our team. They do incredible work. Our show is produced and engineered by Dan Bouza. Our associate producer is Bella Hutchins. Brian Henry is our executive producer. Alan Haburchak is Morning Brew’s director of audio. Holly Van Leuven is our fact checker. Noah Friedman is our video producer and editor. And I'm your host, Alex Lieberman. As always, thank you so much for listening and I'll catch you next episode.