A pragmatic mental health guide for managing anxiety

The life of an entrepreneur is not all Forbes covers and unicorns. In fact, the opposite is true; most days are riddled with stress, anxiety, and doubt. The highs are high and brief, the lows are low and tend to stretch out. Managing your psychology during these long periods is the hardest part of a founder's job, and over the years I've developed a methodology that seems to work for me. I hope it helps you as well.

Physical health

I believe physical health is upward of mental health. It's hard to focus on your mind when your body is weak or in pain. I've briefly written about my workout routine in my longevity guide, but in short: I do 3 barbell weightlifting workouts per week (squats, deadlifts, bench press, overhead press), and 2-3 runs per week (one or two 45-min zone 2 sessions, and one 40-min zone 4/5 session).

For periods of deep anxiety or depression, I've found that working out more helps. Two workouts per day seems to do the trick for me during trying times - one in the morning, one in the afternoon. Cardio is especially helpful as it increases the levels of endocannabinoids in the bloodstream, promoting short-term psychoactive effects such as reduced anxiety and feelings of calm.

I have also found that going for a long walk helps decrease my anxiety levels. Research shows that, on average, low intensity (zone 2) cardio such as walking decreases baseline stress hormone levels more than resistance or high intensity exercise. In the summer, I go for a 90-minute walk with my wife almost every evening (after dinner). It’s a great way to decompress after a day in front of the screen, and an opportunity to spend time with Sabina.

If you can afford it, I strongly recommend you find a good trainer. Working with Grant Broggi at The Strength Co. has completely changed my body. I've gone from chubby to 15% body-fat while being able to lift 350lbs (2.2x my body weight) off the floor within 2 years. A great trainer will keep you accountable and push you to your limits while minimizing risk for injury. Plus, you’re much less likely to skip a workout if you have someone waiting for you.

Tip: I live by my calendar, so I have set all my workout sessions as recurring calendar events, and have shared them with my trainer.

Morning meditation and journaling

I've been a mindfulness practitioner for more than a decade (story for another post, but the meditation app Calm was founded in my living room). I meditate for 10 minutes every morning. For new practitioners, I recommend the Sam Harris Waking Up 60-day introduction to meditation.

I've also journaled for as long as I can remember. I have entire boxes stacked with Moleskine Classic Notebooks. I switched to journaling on a computer for a while, but I find putting pen to paper has a different effect on my brain that typing on a keyboard. My hypothesis is that taking notes by hand forces me to synthesize information better because writing by hand is slower than typing. I’m now back to journaling in a Moleskine notebook and the 5-minute journal.

My journal has 5 questions every morning:

1. What's causing my anxiety? Make a list of everything that comes to mind.
2. What can I do to reduce my anxiety from (1) that's fully in my control?
3. What are 3 things I'm grateful for today?
4. What would make today great?
5. A daily affirmation.

Tip: a useful practice I learned from a Tim Ferriss podcast with Jack Kornfield is to "talk to my anxiety" in the journal. It may sound a bit woo woo, but I've found it useful to ask my anxiety, on paper, things like: "What can I learn from you today?". I strongly recommend you listen to the episode - it's almost like a meditation itself.

Meditation and journaling have had the biggest impact on my anxiety. My current routine is to wake up, have an espresso, write down in my journals, and meditate. The whole practice takes about 20 minutes and it sets the foundation for my day.

Finally on the mental health front, a recent randomized clinical trial has shown that athletes who practice mindfulness perform better than those who don't. I believe that's true for everyone.

Therapy and coaching

Aside from my personal trainer, I also work with an executive coach. I'm fortunate to be able to work with Kim Scott, author of Radical Candor, as my coach. Kim is an incredible human, and has helped me grow immensely in my role as CEO at Ezra. It's really hard to find a great coach, but it's invaluable once you find one.

I also started working with a therapist after my mother passed away from cancer last year. It's been a hard but necessary process, and I always feel better after each of my therapy sessions. One recommendation I have is to find a therapist with a similar background to you. Research shows that the quality of the therapist-client relationship is the best predictor of success in therapy, and it’s easier to build rapport when you come from a shared context.  In my case, I work with a Romanian therapist from Bucharest.

Psychedelics

This one is not for everyone, and I do not advocate that anyone does psychedelics without medical supervision. Plus, psychedelics are illegal in most states in the US, and you shouldn't do anything illegal.

But for those who are able to do psychedelics under medical supervision, studies have shown that psilocybin mushrooms can help process trauma, reduce depression, addiction, and much more. Personally, I wasn't able to fully grieve my mother passing away until I started doing therapy paired with psychedelics.

If you're in the US, it is now legal for adults to take psilocybin mushrooms under supervision in the state of Oregon.

Supplements

The final tool I have in my toolbox for managing anxiety is supplements. I'm an investor and customer of Fount. I do blood tests every quarter, and they design a personalized supplement protocol for me. What do supplements have to do with anxiety? First, there are supplements that can reduce feelings of anxiousness and stress hormone levels for some people, like 5-HTP, GABA, and L-theanine, and even cocoa flavanols, which can decrease the cortisol (stress hormone) response to stress.

Through my work with Fount, I've experimented with all of these and more. 5-HTP, L-theanine, and GABA made me a bit mellow, and I didn't like the feeling. I did find that cocoa flavanols give me an energy boost without increasing jitters or anxiousness, which is a nice add-on to coffee.

The second way that supplements can affect anxiety is by reducing inflammation. Inflammation can actually cause you to feel more anxious, so I have a protocol for recovering from hard workouts faster and managing my overall levels of inflammation.

I’ve covered a lot in the paragraphs above and it can all seem daunting, especially under the mental paralysis that comes with anxiety and depression. If you're struggling with anxiety right now and are looking for the path of least resistance, you should start with exercise, a morning journaling & meditation practice, and therapy. The rest will evolve from there.

To end, I think it's important to set expectations for what success looks like when it comes to mental health and anxiety. I had the unrealistic expectation that I can "fix" my anxiety and move onto the next thing to optimize. Unfortunately, that's not how things work. A muscle that's not used will atrophy over time. Same goes for our mind.

Good luck, and email or DM me if I can be helpful.

Thanks to Sabina Gal and Andrew Herr for reviewing drafts of this.