Hello and welcome to season two of our new podcast, healthcare Horizons. I'm your host, Steven Collins. The CEO of Matter Matter is a healthcare technology incubator and innovation hub with a mission to accelerate the pace of change of healthcare. In addition to accelerating the growth of healthcare startups and helping large companies innovate more effectively, we highlight innovative thinkers who are solving healthcare's biggest challenges. This season of Healthcare Horizons features multiple guests who are using innovative technologies to support mental health. Last episode I spoke with Omar Golan, the founder of my What If a Not-for-profit technology startup. He's building with a vision of helping millions of people manage the after effects of trauma. Today I'm joined by Dr. Sarah Pierce, co-founder and chief Clinical Officer of Joystick Life, a powerful and efficient mind-body training tool that helps to regulate the nervous system. Sarah, thank you so much for joining us. I'm really looking forward to the conversation and learning more about what you're building and why you're building it. Well, thank you so much for having me. So I want to spend most of the time focusing on the problem that you're solving and how it is that you're solving it with your company. I would first love to better understand how you got into this. You've been a physician your whole career. You went to college, you went to medical school, you practiced medicine for 15 years, and I think you still practice. Yes, I do. But then a couple of years ago you decided to start a company, which isn't sort of the normal trajectory of a physician. Obviously not unheard of, but it's not what most physicians do. So why and how did that happen? Absolutely. So I have to give a lot of credit to my co-founder, Christian STO, for starting the company. But as far as how it happened, my background is as a family medicine doctor, and I practiced outpatient medicine for a number of years and really during that time came to realize through interacting with a lot of different patients, that many people lead stressful lives, which doesn't sound like a profound revelation, but when you hear it over and over again in your daily practice and you see how much that impacts people with whatever it may be, whether it's their blood pressure, their diabetes, their ability to take a vacation or step away from work or the stress in their relationships, it really does impact so many aspects of our physical and mental health. And I felt like the tools that I had learned in conventional medicine were really good at allowing me to prescribe someone a medication to help them feel better with that stress, but not really being able to truly advise them on maybe how do you set boundaries work or how do you change some of these things that aren't medication based? So that led me to do additional training in integrative medicine and integrative medicine has been known by various names throughout the years, but essentially it is the non-Western approach to medical care. And that could be supplement use or that could be botanical products or that could be acupuncture. But that particular technique combined with Western medicine, so not instead of, and not as an alternative to but with it. So during that training I learned about what's called Mind Body Medicine. And Mind Body Medicine is a series of techniques that essentially allow people to feel more relaxed, feel calmer, have lower stress levels, and that impacts how they feel both physically and emotionally and mentally. So I was always really interested in that as a technique. And there was one technique that stood out to me that's called autogenics, and it's a very time efficient technique. And being a physician, I'm super focused on efficiency and trying to get things done as quickly as you can while still doing them well. So I've always kind of inherently been drawn to this technique. And a few years into my integrative medicine journey, I met Christian who's my co-founder for Joystick. He is the only person I've ever met who knew what autogens was without having to explain it. So he already knew what it was. He thought it was a super cool technique. And together we sort of talked about this idea that there's so many people who are stressed, there's so many people who need resources or tools, but maybe they don't meet the criteria for having a diagnosis. They don't necessarily need or want to see a therapist. They don't need or want to see a psychiatrist, but And we felt like we heard feedback from a lot of people that some of the traditional offerings out there just didn't resonate with them. They maybe liked yoga but didn't have the time or didn't want to go to a studio multiple times a week, or they tried meditation and thought the concept was really cool, but just couldn't get into it or couldn't quite understand how to do it. So we really felt like there was a subset of people that needed a stress management technique that could be super easy, didn't require a lot of thought, a lot of time, or a lot of money. And that was our impetus behind developing joystick. So for those of us, those listeners who don't know what Autogenics is, which also includes myself, can you define what that is and how it works? And maybe also there are a lot of tactics out there to reduce stress and improve wellbeing. And how does Autogenics compare to what else is out there? Absolutely, and you are definitely a majority. Most people have not heard it so very, basically auto is just self and the gens is generated. But autogens is a series of phrases that you repeat to yourself, and those phrases are specifically designed to have an impact on the nervous system. So the part of the nervous system that most of us are familiar with is going to be the sympathetic or the fight or flight part of the nervous system. The other side of that is the parasympathetic. And in medical school, we learn it as the rest and digest part of the nervous system. Most of us don't inherently know how to activate that rest or digest part. There's very few people that I've met in my career that are just kind of set up to be relaxed and chill about everything. I can count 'em on one hand, but there's a few people out there that are wired that way. Most of us just aren't. And so we have to learn how to tap into that side of our nervous system and that ability to relax. And autogenics is a series of phrases that you repeat to yourself and those phrases will actually activate that part of the nervous system that allows you to feel more relaxed. So the changes that can come with that include things like breathing slows down a little bit, heart rate slows down a little bit. Blood pressure can actually go down slightly, and people have a general sense of calm or wellbeing when that part of the nervous system is activated. So I've done very little bit, but a little bit of guided meditation. And the guy that I was doing that with would ask me to repeat things and then repeat them over and over. I wonder if it was a similar thing. Is this a concept that shows up in meditation? Is it something completely different? It's a very similar concept. There are probably some people who would say that, I'm not going to explain this quite right, but I sort of view it as all branches of the same tree. So the idea with any sort of mind body technique is that you're ultimately activating that calming part of the nervous system. And that can be achieved through something like mindfulness where you're just paying attention to your thoughts in a nonjudgmental manner that can be achieved through a guided meditation where you're just directing the way that your thoughts are with the help of a calming voice. And often music visualization for some people mantras where you're repeating the same thing over and over again. So all of those are along the same lines. We're just trying to get the nervous system to calm down a little bit. And Autogenics is a particular way of doing that. Does it work? I think it works, but other than my opinion, there's actually a decent amount of data and research behind it. So one of the most interesting things I have found is that Autogens was used several decades ago now by NASA because they needed to have astronauts be able to control motion sickness in space without giving them medications. And the majority of medications for motion sickness are going to make you tired or just little bit cognitively fuzzy, which we really don't want our astronauts to be fatigued or mentally fuzzy. So they taught them autogenics essentially to control nausea and motion sickness without needing the use of medications. So that's a super cool application of it. And then there's a lot of data showing that autogenics can slightly help reduce your blood pressure if you're crazy high blood pressure, can you do autogenics and not take medication? Probably not. If you're a little bit elevated and really want to avoid medication, can you do autogenics and get it down? Yeah, I definitely think that's doable. It can help improve sleep so that you're sleeping a little bit better at nighttime. It's been shown to decrease stress. Specific studies have looked at nursing students that it lowers the stress associated with school and exams. So there's a lot of different applications of it. So interesting. So it is a bit of a tangent, but just for people who are listening who are also myself have family members or people they know well who struggle with motion sickness all the time, where can people learn more about that? Or is that a well-defined aspect of autogenics? I don't necessarily know that. I suspect that NASA use some, I don't know if they were proprietary phrases, but they probably use some specific phrases. But the idea in general is just to kind of calm down the part of the nervous system that is overly activated that may be causing that nausea or motion sickness. So autogenics is typically a series of set phrases, and then after you practice with it for a while, you can add in, there's a location to add in phrases that are specific to what you are trying to work on. So that'd be something where you could certainly add in a phrase that sort of speaks to that feeling of the nausea. Yeah. Alright, so going back, so you're practicing medicine, you're seeing that so many of your patients are stressed and their sort of mental wellbeing is affecting their physical health. And you study integrative medicine and you get some more tools you discover and then you go a step further and you create a company. I mean, that's yet another leap that again, most people aren't doing that. What was the impetus for actually starting a company and what does Joystick Life do? So the impetus for starting a company was a little bit of the, not so much that we started in the garage story, but we were in a coffee shop and just that talking about autogenics and how it was really helpful and how we both found it to be a technique that has so much potential to help people in a very time efficient manner and that, hey, there's not really a lot of resources. We should create one. That'd be really cool. And then that conversation ultimately evolved into a company. For me, part of the reason to take it to that next step was I found that I really enjoy the practice of medicine, and I like that critical thinking piece and the problem solving piece of things. And when you perform the same job for a long time, it's not that you don't solve new problems, but your brain does get used to how that works. And I was just looking for a new intellectual challenge and I found that that creating a company was that intellectual challenge. It was not a skillset that I had that I thought I wanted, but it's fun to figure out how to do new stuff. So that was a big part of it. So you're two years in, most entrepreneurs will talk about the highs and the lows. They'll talk about how their passion aligns with what it is that they're doing and how excited they are. How's it going so far? Yeah, I think that we definitely have had those highs and lows overall, I think it's going really well and I am super proud to say that we are still alive in the current environment for entrepreneurs and small businesses. I know just economically, it's been hard to get funding and I am happy to say that we're still here. So I think that's a good sign. I do have to give a lot of credit to Christian. He works full-time with joystick and does a lot of the work on the backend to make the day-to-day stuff run. So I'm very privileged to be able to say I'm a little bit insulated from some of those highs and lows because I am still practicing medicine and kind of have my time split between the two things. But I will say that the struggle to stay alive is very real. We are excited that by the time this podcast airs, we have been accepted to one of the cohorts for Techstars. Congratulations. Thank you. Yeah, that's super cool for us. So that has been a really exciting opportunity. So we're just continuing to move forward a little bit at a time. Like anything, it seems to come like you make three steps forward and you have two back, but you get those moments where a lot of positive things happen at once, and that just provides the energy to keep going. So what does the company do? How does it provide autogenics to people? Absolutely. So the company is joystick life. And so what we've done is actually create an app where you will be taken through what the series of phrases are. So you put the app on your phone, and now I can say that we are available both on Google and Apple, which is awesome. For a while it was just Apple. So you put the app on your phone and we take you through what the phrases are so that you learn how to do those phrases. So each day you've got a little bit of time in the morning and a little bit of time in the evening ideally. And you go through that two times a day. After one week, you are able to do the entire series of phrases. We kind of teach you them gradually and then you continue to practice with it on a daily basis. One of the things I love about it is that it's just like I've said a few times, it's very time efficient. Our longest session is eight minutes, so there isn't anything that is going to be longer than that. We have incorporated a few features into it. We have what's called a power up meter. So if you're practicing regularly with the phrases, you'll start to just feel relaxed purely by beginning the sequence of phrases. So when you practice on a regular basis, you're more likely to feel that relaxation technique more immediately and not necessarily just at the end of the phrases. If you're ever about to head into a meeting or you've need feel a little bit calmer and only have a few seconds, that power up meter, you just hit that and you get a ten second snippet of the beginning of the audio, which can help you feel a little bit more calm in the moment. It sounds, and excuse me if this is a bad analogy, but it sounds a little bit like a sort of headspace concept, but not for meditation, but rather for autogenics. Yeah, no, I think that's a fair analogy. And I think we have gotten a lot of questions as far as like, well, how are you different? How is that different? To me, the biggest things that set us apart is the simplicity of it. So I know that I've used certain meditation apps and found them to be overwhelming because there are so many choices. So I distinctly remember a couple years ago I could not sleep because my boyfriend was snoring, and I thought, okay, I'm going to do one of these sleep meditation ones and mood and then I'll be able to fall asleep and this will be great. And I probably spent 15 minutes listening to the beginning of 10 different ones without finishing any of them, which wasn't at all helpful. And I just kind of faced that decision fatigue and decision overload. So with joystick, you don't have to decide which of 20 or 30 or 40 paths you're going to go down. You have one option and it's just right there. So that I think is something that sets us apart. And then just the science behind the technique is slightly different. So the series of phrases and how it impacts the autonomic nervous system is a little bit different than a meditation or a guided imagery. And the practical side, a lot of that is semantics. I mean, I don't know this for sure, but I think one of the things that companies like Headspace or Calm or these other meditation ones do to create value for their subscribers and sort of justify what people are paying to subscribe to it, is that they keep creating new content, which creates the situation that you described where you go onto some of those and there's hundreds of choices of what to do. Is your business model going, is it, or will it be similar to those companies, or do you have a different approach? Is it a subscriber model where somebody goes on and you pay for the app? We do have a subscriber model, so you're able to get a monthly subscription or subscription. So where we think we set ourselves apart is that our price point is lower than for those apps that have a really huge content library behind them. And I personally think that there is value in simplicity and value in not having to make 15 different choices because I don't find that to be relaxing. So part of it is a lower price point, and part of it is that our value is the fact that it's simple to use and that it is super time efficient. You're never going to spend more than eight minutes doing it. Data. You. Can if you want to. You're publishing that, but you never have to. Is there an archetype where you think your solution is most appropriate? And I see that in the context of when you look at mental health generally. Yes. In the United States, around the world, we're not doing great and we seem to continue to be doing worse. I suspect that's probably true. True. It's everything from teens and preteens all the way through to the reaches of adulthood and into older adults. There is a huge amount of demand for therapists and psychiatrists. There seems to be often a mismatch between where they're located and where people are. So accesses can be challenging. There's lots of different kind of techniques out there. Is there a profile that you think. So, to answer the first part of your question, we do have people who are using the app. I don't know the exact numbers off the top of my head. I think that Christian probably has a better sense of that than I do. But yes, we certainly do have people who are downloading it, which is always exciting for us. And then as far as are we able to show the same things that some of the published research studies have? Not yet, but I think we're trending in that direction. So we do, at the beginning of the app, we actually have you answer four questions that are about stress. There's a validated tool that's used in medicine, it's called the PSS four or the Perceived Stress Scale. The four stands for the fact that there are four questions, and when you answer those questions, it correlates to a numerical score. The higher the number, the higher the stress score. So once a month we present the questions to you, and then you can track over time and see, this was my score last month, this is my score this month. This is what my score was four months ago. So you can get a general sense for yourself if that time or if you're seeing any changes in it. We ultimately do want to take a look at that data, not on an individual basis, but on an aggregate basis and see what trends we're seeing. And then we've also done a small study with a local university with student athletes. And so we had them do actually the longer version of the perceived stress scale as well as a sleep questionnaire as that's designed for athletes. And we did find some statistically significant differences with lower stress levels and improved sleep. So not to the point that we're publishing papers, but we want to be able to get there at some point because for me, with a medical background, it's not only it's important to say what it is that you're going to do and what you're solving for, but then it's also important to show that you're actually doing that. Is sort of most suited for this technique, or could it really benefit just about anybody across that whole spectrum? In theory, it can benefit anyone. It really hasn't been looked at in children under the age of five. So we don't recommend it unless you're six or older on the app store. We're not available for kids. There's some additional safety protections that have to be taken. And not that we're unwilling to take those, we're just not at a point where that's at with app development. But just broadly speaking, not recommended for Kids Spy or under because we just don't have that data or information about Autogenics in general. And yes, I think it is applicable for pretty much anyone, but specifically from a business standpoint, what we are marketing to is Gen Z, where there is I think a better awareness and ability to talk about mental health and reference mental health than we've had in older generations. Also, a lot more interest in that ownership of mental health or that self-care piece and that ability to quickly and easily and routinely use digital tools. So we are really looking at that particular market. We know that people want to take ownership of their own wellbeing and we feel that this is a great way to do that. You're absolutely right. There just isn't enough therapists, there aren't enough psychiatrists, and we are not a replacement for those things. We're not going to diagnose you or treat a condition, but we are a support tool that can be used when people have high stress levels. And to my way of thinking, some of the best ways to prevent anxiety or depression or prevent worsening of that are to have skills in place to be able to support your own mental health. And then to that end, we are one of those skills or one of those tools. Interesting what you said about Gen Z being more willing to talk about and take ownership of their mental health and maybe the generations that came before. Is that something that you've observed in your clinical practice? It definitely is from multiple perspectives, from interacting with patients and willingness to talk about things or address questions or ask questions that related to mental health. And it does seem like there's higher stress and anxiety levels among everyone. So I think some of that we're just seeing, sorry, I'm not answering this question very well. No, it's great. It's interesting. I hadn't really thought about it exactly in the way that you phrased it. I mean, I think there's plenty of evidence and data about what you said, but I think it's an interesting insight and sort of makes sense that that would be the population that you're going after. So what's on the horizon? So you're starting soon or you're already started Techstars, or what's the timing there? Yes. So that starts or we'll have started the second week of September and then that goes through December. So we are anticipating doing a seed round for fundraising once we're done with Techstars. And for right now, what we are really focusing on is just getting the word out about joystick. And as I'm sure everyone's aware, there's so many social media platforms and opportunities and there's really a lot of competing interests for people's time and attention. And so our focus these next few months is going to be really refining how we reach the people that we want to reach with the message that we're out there. Great. Well, congratulations again on getting into Techstars. I think that'll be a really great, terrific experience for other clinicians who are thinking about or interested in forming a company. Any advice for them? You're a little over two years into the journey. You've probably have a few scars and a few learnings that you've had over those couple of years. What advice would you give to other aspiring physician founders who might be listening? I think probably the advice that I would've liked to have heard was to just kind of take stock of how you want to incorporate what you're trying to develop into your practice of medicine in the sense of are you looking to leave medicine because that's no longer a career that you find fulfilling and you want to develop something else, or are you looking to enhance what you're already doing? Because when you're in that environment, you're really aware of what is and isn't available or what tools or techniques would really help you to do your job. And I think that's certainly a question that I have been asked along the way is, well, how much time are you going to work on your business? How much time are you going to practice medicine? And I don't know that I was fully prepared to answer that question. For me, the practice of medicine is it is not just a job. It really is a calling and it isn't something that I want to leave. I worked really hard for my training and I really like what I do and I don't want to give that up. So being able to articulate that and just I think help sometimes the fundraising world or VC world to realize it's okay to have duality to your career path. And if you're not working every waking hour on your entrepreneurial aspect, it doesn't mean that you're not invested in it and don't care about it. That sounds like great advice. We have a number of physician entrepreneurs we've worked with as part of matter, and I always think they bring a really interesting perspective to it, and I'm always impressed with the ones like yourself who are able to balance the clinical practice with entrepreneurship. Well, thank you. I think for me, it's a clinical helps me to stay relevant in what it is that we're doing with Joystick and why we're doing it because I have that frequent reminder of there's a need that's not met. Thank you, Sarah, for joining us to discuss how we can use innovative technologies to alleviate stress and support MINDBODY Health. Thanks to our listeners for tuning into this episode of Healthcare Horizons, a matter production, learn more about how we're accelerating the pace of change of healthcare at Matter Health. I'm Steven Collins. Thanks for listening.