A few days after San Francisco's shelter-in-place order began on March 17, Mathilde Collin awoke to an anxiety attack. She felt a pain in her chest. That little ball of tension in her stomach ballooned into full-on nausea. Still groggy from sleep, she could barely gather her thoughts enough to roll out of bed, let alone face the sheer volume of decisions in front of her. Her brain just locked up.

As co-founder and CEO of the software startup Front, Collin was responsible for 180 employees across three offices. Her company, which had raised $138 million in venture capital, brought in $34 million in revenue last year, as estimated by research firm PrivCo--and in the early days of the pandemic, business was cratering. The 31-year-old was also three-and-a-half-months pregnant with her first child, and she was isolated from family in her native France for the foreseeable future. It was as if the most important threads in her life were unspooling and piling up on the floor faster than she could figure out what to do with them.

In that moment, she wasn't alone: The pandemic quickly sent startup founders across the country into panic mode. In an April Inc. survey of more than 250 U.S. small-business leaders, 74 percent of respondents reported higher levels of stress than usual--including nearly a third who said they felt "extremely distressed." That's a mindset that can lead to serious problems rippling across personal and professional life: Studies have linked poor decision-making, procrastination, insomnia, migraines, and even irritable bowel syndrome to high stress. Left unchecked, extreme stress in an entrepreneur can sink her ability to lead. It can even sink a company.

Collin knows this all too well: Beginning in late 2016, she and her co-founder, Laurent Perrin, battled more stress in a year than most people do in a lifetime. They emerged with new leadership tools that flipped Front's growth trajectory from dangerously unhealthy to well-prepared for this year's unpredictability.

So when Collin awoke to that unsettlingly familiar sense of panic this spring, she knew exactly what to do. Rather than forcing herself to start setting priorities, she did the opposite and allowed herself to think about nothing. She found a chair, put on headphones, and pulled up a guided meditation. That evening, after returning from work, she did another one. "I was lucky enough to have the tools I'd used before," she says, smiling slightly. "They worked again."

Collin and Perrin, Front's CTO, joined the world of high-octane entrepreneurship in the summer of 2014, when they moved to San Francisco to join Y Combinator, the startup accelerator famous for its seven-day workweeks and hypercompetitive culture. They'd met only a year prior, at a Paris-based incubator called eFounders, where they'd hit upon the idea for their company. Front would help businesses organize customer service messages from different platforms--email, social media, text--into a single inbox for teams to share. They'd identified a clear pain point for businesses, but executing their plan was going to be especially hard. Much larger tech players had tried already to solve the problem--and failed.

For Collin and Perrin, that first summer was particularly challenging: The long hours were drawn out even more by the time zone difference between San Francisco and Front's European customers. And the founders missed their friends and family--Collin had never left Europe before. But that September, they secured $3.3 million in seed and angel funding, including an investment from Reddit co-founder Alexis Ohanian, so they pressed on.

Perrin, 39, whose black hair has gone silver at the temples, calls the pace they set that summer "embarrassingly impossible." They continued it for the next two years, until November 2016, when a company offsite was held in the Mexican resort town Puerto Vallarta. ("Keep working, but around a swimming pool," Perrin deadpans.) During a break, Perrin went freediving--like scuba, but you hold your breath. Between dives, he held onto a rope attached to a buoy. Afterward, he developed a large rash on his hands and forearms. An allergic reaction, doctors at a Mexican hospital said.

Perrin wasn't so sure. He'd also recently found himself needing to use the restroom much more frequently than usual. The two concerns seemed unrelated on the surface, but to Perrin they sounded disturbingly familiar: A friend who had experienced similar symptoms five years before learned he had testicular cancer. When Perrin returned to his studio apartment in San Francisco, he checked himself for lumps and found one. Exhausted, he fell asleep--and woke up wondering if he'd dreamed the whole experience. The lump was still there. He called for an immediate doctor's appointment and threw on his clothes to head out.

The next day, he got the phone call: It was indeed testicular cancer. Though he was prepared for the news, Perrin had to frantically reach for a chair as his legs buckled. At 6 the next morning, just before Thanksgiving, a surgeon removed a 1.5-inch tumor. Then, in follow-up appointments, doctors found that the cancer had spread to Perrin's abdomen and lungs. His chances of survival were good--he was relatively young, and they'd caught it early--but he'd need to start chemotherapy right away.

At the time, the company had 23 employees, roughly 1,000 customers, $2 million in annual recurring revenue, and $10 million in Series A funding. Collin had cried when Perrin first told her about the diagnosis, but as she returned to the office from her Christmas break, she settled on a new strategy: compartmentalize. She got organized about attacking her biggest business challenges, hiring aggressively to meet ambitious growth goals for 2017 and making sure Front's engineering team could function without its CTO.

And Front's entire staff got organized about coping with Perrin's situation. They built a spreadsheet to coordinate daily visits to the hospital or, later, to Perrin's home. Collin was a frequent visitor. "You cannot imagine what being co-founders means," she says. "We'd literally spent the past two and a half years, every single day, together. It's not a relationship of just being friends or colleagues."

She found herself ceaselessly repeating a cycle: home, work, hospital, work, home, work, and over again. At work, she'd wear a happy face, telling colleagues Perrin was fine. With Perrin, she'd say the business was fine--as she worked from her laptop and phone at his bedside--while listening to him share the kind of unfiltered hopes and fears he didn't tell even his parents. She didn't have time for breaks. Rest was an inconvenience. She ran the business at the only pace she knew how.

On a chilly morning in late May 2017, Collin broke down. Looking at her laptop made her dizzy and turned her stomach. She tried to force herself out the door, but her feet wouldn't follow her commands. Panicked, she called her parents. She called a close friend. "Life is horrible," she told her doctor. "I have this deep anxiety that makes me hate life."

The company needed the founders' vision to grow, but it didn't require their constant presence to get things done.

She couldn't recall taking a sick day at Front before. Yet a few days later, she wasn't even in the country anymore: She had flown to Paris and spent the next few weeks lying on the couch. Recovery was slow and full of varying strategies, from therapy and hypnosis to meditation and new dietary habits. Gradually, she built herself back to a fragile state of functionality and took the 11-hour flight to San Francisco, armed with a realization: If she wanted to return to the office, she'd need to drastically change the way she worked.

A startup without its co-founders. A tech startup without its CEO and CTO. It sounded like such a disaster that Perrin--still loopy on painkillers and unable to handle more than one meeting and a few hours of work per day--rushed back to the office as soon as he realized Collin was struggling.

He arrived to find that everything was fine.

His five-person coding team had a product road map, and they were diligently working their way through it. It was much the same on the business side: The co-founders had built a strong enough team that operations largely continued like normal. "I don't remember us working harder than what we were already doing," says Jeremy Bogatirsky, a software engineer and one of Front's first employees. "We were already at the max we could do, so it was: 'OK, let's just prioritize what we need to do, and let's keep working hard.' "

Although the company continued to move in roughly the same speed and direction without its founders fully engaged, it also didn't grow much: There were no major new sales, product innovations, or other significant breakthroughs. The stability was surprising to Perrin, who hated taking sick days and had expected to feel guilty about missing work.

He had spent a lot of time during his months off for chemotherapy self-reflecting, partially because he had no other choice. "[Chemo] is like a big hangover that lasts for weeks," he says. "You're very sick. You can't really focus. You can't even read." Cancer survivors often speak of a crystallizing moment when, in a life-or-death reckoning, they understand what it is that they really want to do with their lives. Perrin couldn't believe how easily he could have walked away from the company.

It was the people, really, who brought him back. He cared about his co-founder, Collin. He cared about his employees. He cared about Front's customers. So he was heartened to see that Front hadn't fallen apart while he was gone. Everything was fine. It wasn't that he was expendable; rather, his presence mattered in the big picture but less so in the small. Collin had the same realization when she returned. The company needed the founders' vision and leadership to grow, but it didn't require their constant presence to get things done. It was a realization that lit the way forward for Front.

The founders introduced a new element to their vision for the company: to be a fast-growing business that didn't work its leaders--or employees--to the bone. That started with Collin, who had initially set out to untether only herself from the 24/7 work grind. She had removed all work-related apps from her phone, refused to bring her laptop on vacations, and started working from home with only a notebook and a pen on Thursday afternoons. But those tactics ended up inspiring some companywide perks and incentives as well, from regularly scheduled three-day weekends to $200 monthly bonuses for employees who average less than two hours per day on their phones, as shown through screen-time tracking apps.

Experts say these kinds of strategies--meant to break the Silicon Valley-inspired hyper-work cycle that has governed startup culture everywhere in recent years--can be vastly healthier for both founders and their businesses. They're just not that common. Last year, London-based founder-coaching firm Weare3Sixty enlisted more than 270 startup leaders in a study on founder well-being. Ninety percent of respondents reported signs of mental strain, yet 93 percent said they were distinctly happy in their roles. Put another way, a whole lot of founders should be more worried about mental strain--their own and that of their teams. Instead, they push through and risk the kind of breakdown Collin experienced.

"It's a double-edged sword, being a founder, because we're so driven to succeed," observes Christina Richardson, Weare3Sixty's founder and an ex-burned-out tech entrepreneur herself. Founder stress can also harm a company's bottom line, she notes: "If a founder is burned out, they become erratic, moody, unproductive, unconstructive--and that's when you start seeing employees quitting or becoming incredibly stressed themselves."

There's no magic solution; everyone is different. "Step one is to know yourself," says Brad Feld, co-founder of Boulder, Colorado-based accelerator Techstars and VC firm Foundry Group. For Feld, whose own battle with depression has led him to write often about mental health and entrepreneurship on his blog, self-awareness means learning where to set boundaries, understanding what makes you anxious, knowing where you can always go for help, and rejecting the idea that you need to behave a certain way to be successful. "Only then can you really be effective with your team in a sustainable way," he says.

If you admit vulnerability to your team, you can build a more trusting, higher-performing workplace.

Collin incorporated her new meditation and hypnosis practices into her regular mental-health toolkit; she found they could function as a kind of reset button for her brain in moments of overload. Perrin, still reeling from chemotherapy's physical and mental trials months after being declared cancer-free, found relief and perspective by changing his physical environment: In January 2018, he moved back to Paris to lead Front's new European office. It was a business decision, he says--Front had just closed a Series B fundraising round, and operating a new office in a different time zone could expand the engineering and customer support teams' operating hours--but that summer, surrounded by family and friends, he finally felt like himself again.

It's hard not to notice the timing: The healthier Collin and Perrin became, and the more they encouraged their employees to follow their lead, the more Front grew. By the time of Perrin's big move, Front was already up to 53 employees and almost $10 million in annual recurring revenue. Collin made Inc.'s 30 Under 30 list in 2018 and Female Founders 100 list in 2019. The company signed notable clients including Airbnb, Hulu, Lyft, and Columbia University. By February 2020, Front had over 5,500 clients, and its annual revenue was on track to grow 60 percent year over year.

Until Covid-19 hit.

Front's clients span a wide range of industries, and the vast majority of them cinched up their purse strings at the first sign of trouble in March. When Collin woke to her anxiety attack, she hadn't just spotted a worrying blip on a spreadsheet: The company was losing active users for the first time in its history, at the rate of 5 to 10 percent per week, and revenue was dropping accordingly.

Yet Collin's first step that morning had nothing to do with money or with helping her nearly 200 employees go remote. After she rose from her meditation chair, she made a virtual appointment to see her therapist and scheduled a hypnosis session. She uninstalled the Twitter app from her phone. At her next sales meeting, she made it a point to talk about her experience waking up in a cold sweat--and then shared the story with the whole company via Zoom.

Richardson says this last step is crucial: If you can admit vulnerability to your team, even when conventional wisdom might tell you to project strength, you can build a more trusting, higher-performing workplace. Employees ask for help, instead of stewing in their problems. It costs you little in the short term, and it's a healthier long-term model.

Front pulled out of its nosedive. While Collin and Perrin were powerless to halt losses from travel and hospitality clients, they were quickly able to refocus their team on the burgeoning e-commerce sector. The revenue drop lasted about six weeks, and then started to reverse itself; Collin says Front's revenue is back on track to grow at least 40 percent year over year.

On September 1, Collin became a mother. The old version of her would have panicked about leaving the company for maternity leave. Instead, she had spent the summer preparing for Front to function without her. Her predominant emotion wasn't one of fear. "I'm so happy [the breakdown] happened to me," she told her husband a week before the big day. She had a growing company, co-workers she cared about, and an understanding of what she could and couldn't do herself. And now she was going to have a daughter, Anna. Mathilde Collin was grateful.


Stress Managers

Christina Richardson of founder-coaching firm Weare3Sixty recommends building these three tactics into your daily schedule to keep stress in check.

  1. Stop thinking. Build a habit around a single activity--a five-minute walk, making coffee, taking a shower, meditation--that gets your mind off your current stressors.
  2. Celebrate your wins. Each night, write down at least three positive moments for you and your team that day--like a gratitude journal, but for wins.
  3. Narrow your focus. Stay dedicated to one big goal per day. Three big goals per week. Don't get trapped by your never-ending to-do list.