As everyone who has tried to build a business will know, the early days are a constant hustle, and the last thing you’re thinking about is taking care of yourself.

You’ve got plans to make, budgets to draw up, products to develop and a team to manage – not to mention the fact that startup culture is rife with the glorification of overwork. But the consequences of not taking care of yourself can be serious.

Stress and anxiety are endemic among entrepreneurs, with 72% reporting mental health struggles of some kind, according to research by UCSF School of Medicine.

Stuart Hillston, a psychotherapist and coach who specializes in working with entrepreneurs, describes entrepreneurship as “deliberately putting yourself in harm’s way from a psychological perspective”. But why are entrepreneurs so vulnerable to mental health struggles? And what can they do to protect themselves from the impact of neglecting mental health?

For some founders, their wellbeing takes a visible hit soon after starting their business, but for others, it takes a while for the effects of the strain to become apparent. This was the case for Paul Pallas, founder of hardware company SWISCO: “For years I was ignoring the struggles I was having with the pressure of having a business and finally the anxiety really caught up with me. At work I felt like I put my best self forward, but I would get home from work and just shut down.”

Stuart says that the most common things his clients are dealing with are anxiety, stress and the breakdown of personal relationships, resulting in typical symptoms of burnout: “Loss of energy, loss of drive, loss of motivation, and loss of passion” – all pretty serious concerns when you’re trying to build a thriving business.

For Diana Ganz, co-founder of SuitShop, the consequences of overwork haven’t taken the form of acute mental health struggles, but she’s still feeling the pressure: “We’re neck-deep in five years of grinding for this company and I feel like I’ve lost a little bit of my own identity. I don’t even know what I like to do outside of work anymore!”

Mental health expert Yolanda Saez Castello advises her clients on what to look out for: “Poor memory, lack of concentration, excessive worrying, continuously feeling down or overwhelmed, sleeping too much or too little, overeating or over-drinking,” can all take their toll, as well as being early warning signs of a potentially more serious issue.

PAUL ON THE COST OF SUCCESS

“If you do start seeing some success, you think it’s because you worked hard, and therefore you’ve got to keep working at this crazy momentum forever.”

It might seem like the reason that entrepreneurs are so vulnerable to mental health struggles is obvious – the stresses associated with setting up your own business are well-acknowledged – but it’s a little bit more complicated than that.

The idea of having to grind for your success is pretty central to the majority of founders’ belief systems. Diana says, “I truly feel like it’s a time that all founders go through – this feeling of constant overwhelm.” For Stuart, it’s partially to do with selfimage: “Entrepreneurs build a mental image of what it means to be an entrepreneur and that involves a lot of getting things done, driving forward, pushing a lot harder than an ordinary person might do in an ordinary job”.

But running on passion alone can be an emotionally exhausting ride: “Once the excitement starts wearing off and you realize that success doesn’t come as easy as you thought, a lot of people start blaming themselves,” says Paul. “And then, if you do start seeing some success, you think it’s because you worked hard, and therefore you’ve got to keep working at this crazy momentum forever.”

And, finally, there are the external pressures of being a business leader – from investors, from co-founders and from employees, all of whom have their own needs and agenda. In the case of investors, this pressure can include the constant fear of being replaced if you’re perceived to be underperforming.

This cocktail of pressures makes it inevitable that a lot of founders struggle with their wellbeing – in fact, maybe it’s surprising that some manage to go so long without visible signs of struggle.

For Stuart, many of the things that will set you up for success – or at least for minimal stress – are things that you need to do right at the beginning. One of the key things is making informed decisions about who you’re going into business with. This is particularly relevant for co-founder relationships: “When you jump into a business with a co-founder, how well do you really know them? Did you make them a cofounder because they’ve got some skills that the business needs? Great! But what kind of person are they? What are their values? What’s their communication style, their decision style and their appetite for risk?”

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And the same goes for being careful when you’re choosing who to take money from. “Most entrepreneurs are so desperate to raise capital that whoever offers them the money is now their best friend. They don’t take the time to investigate what kind of investor they are,” says Stuart. “Everyone knows that investors do due diligence on the companies they invest in. But do you do due diligence on your investors? And if not, why not?”

This is a pitfall that Diana managed to avoid and she’s pretty happy with her decision: “We have the most fabulous team of investors. They want us to grow, but we are growing. Some companies grow faster, but they’re also capitally funded. The pressure from taking institutional money is something we just didn’t want to deal with.”

One of the key things recommended for stress management is maintaining a healthy lifestyle. Paul agrees, listing it as one of the main contributors, along with professional therapy, in allowing him to get to a better place mentally: “I’m feeling great – I’m exercising, I’m eating well, but I can’t start skipping on some of that stuff because it will start adding up and I’m going to slip back into a darker place where I’m feeling anxious.”

DIANA ON CULTIVATING INTERESTS

“If I can spend a couple of hours a week in my garden, listening to a podcast, that’s great!”

But, according to Stuart, telling people to make lifestyle changes is a double-edged sword: “Have you ever met anyone who gets enough sleep, eats properly, exercises properly and makes mental space all of the time? I call it psychological shaming because the implication is that if you’re not doing these things, you’re harming yourself – it’s your fault.”

Instead, Stuart says the biggest safeguard against mental health struggles for entrepreneurs is to build resilience: “You become resilient by exposing yourself to things that feel negative, to demonstrate to yourself that you can get through them.” In order to build resilience, he recommends reflective practice: “Write down what went well, every day. And then what didn’t go so well. What would you do differently next time? What lessons have you learned?”

Stuart also encourages his clients to focus on “nourishing activities” – the things you really enjoy doing, whether it’s socializing, going to the cinema or reading – and to make sure you keep doing them. This is borne out by both Paul’s and Diana’s experiences. Paul says, “it’s easy to think that anything you need to do for the business is more important than taking care of yourself, but don’t feel guilty about taking time for yourself.” Diana, who realized she’d gone a long time without cultivating any interests outside of work, took up gardening this year: “If I can spend a couple of hours a week in my garden, listening to a podcast, that’s great!”.

Another useful tool is to begin seeing a therapist during the early days of your journey as a founder – before you’re really struggling. “Treat therapy not as the last resort. Treat it as something valuable to support you through the process,” suggests Stuart.

The most important thing if you’re struggling with your mental health is getting professional support as soon as possible, starting with your doctor or seeking out a therapist privately – whichever route you take, tackling problems early is the best way to look after yourself.

There are also a number of evidence-based techniques you can practice at home, including mindfulness, as advocated by Paul: “Five minutes of being quiet and being in the present – really trying to shut down that little voice in the back of your mind that’s saying ‘you should be doing this, you should be doing that’ – really makes a difference.”

Meanwhile, Yolanda advocates the Emotional Freedom Technique, also known as Tapping: “EFT is acupuncture-based, but without the needles and can help anyone at any time as it's self-administered. The solid science behind it is my favorite part: EFT is proven to significantly reduce cortisol, a main stress hormone that can cause havoc when raised on a continuous basis. Unsurprisingly, scientific studies show that it produces statistically significant reductions in stress, anxiety, fears and overwhelm.”

Finally, remember that mental health and wellness support techniques can only take you so far: at some point you’ve also got to tackle your actual workload and reduce the amount of pressure you’re under. This can be through delegating tasks that you find particularly stressful, finding more effective ways to communicate with your cofounders, or just recognizing that getting your business off the ground isn’t a race, and you’ve probably got a bit more time to get everything done than you think.