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Estelle Garcia Of LivaFortis: 5 Ways That Businesses Can Help Promote The Mental Wellness Of Their Employees

An Interview With David Liu

Mindfulness and meditation are essential in helping me manage my hectic schedule — especially with everything that comes from running a startup. On the weekends I love to go hiking with friends, and my always-enthusiastic labrador-husky mix, Lucy. I feel so lucky to live in Austin, Texas, where the weather is often amazing and there are so many beautiful places to hike.

As a part of my series about the “5 Ways That Businesses Can Help Promote The Mental Wellness Of Their Employees” I had the pleasure of interviewing Estelle Garcia.

Estelle Garcia is the Founder and CEO of LivaFortis Inc., a company that is taking on the low back pain market with a unique solution that combines an innovative wearable biofeedback device with a digital physical therapy clinic app. Estelle holds master’s Degrees in Translational Medicine (UCSF and Berkeley) and Advanced Mechanical Engineering (University of Bristol, UK). Passionate about bringing innovative and accessible healthcare solutions to the market, her company’s telehealth enabled app is the first of its kind to explore concerns such as mental health, stress, and the physical and social environments when helping customers manage their chronic lower back pain.

Thank you so much for doing this with us! Before we dive into our discussion, our readers would love to “get to know you” a bit better. Can you share with us the backstory about what brought you to your specific career path?

Growing up in France I was always fascinated with science and technology, so I decided to become a mechanical engineer and ended up specializing in medical technologies. I had the amazing opportunity to join UCSF and UC Berkeley where there is a rousing atmosphere of innovation and entrepreneurship. I was inspired to see what I could do for back pain sufferers beyond the somewhat frustrating, traditional implant and surgical options.

Can you share the most interesting story that happened to you since you started your career?

There is so much pressure in the Startup industry to be the next big thing — the next Unicorn — and if you aren’t striving for that then what are you doing? One day I happened to be speaking with another startup CEO and, like it was the most natural thing in the world, he told me that if I wanted to have a successful company that I should be working 24/7. “There is no time for downtime” he told me with an earnest look on his face. “Definitely no time for relationships, or anything like that”.

This was something that I would hear over and over. If I wanted a successful company I would have to give up all my leisure time and give up seeing friends or family. Definitely no time for romantic relationships. Thankfully there are some wise and well-balanced entrepreneurs out there, like Sara Blakely, who have paved the way for other women and who have shown the world that you can have a life outside of your company. When I heard that she never missed the carpool for her kids I felt validated that I could, in fact, have more.

While managing a business is definitely time consuming, there has to be balance. I choose to live my life to the fullest in every way possible. How can you support your mental wellbeing if you have cut off all your friends and family? How do you get inspired if you don’t make time for travel and time off? It is disturbing to me that this type of advice is being given to young entrepreneurs when there is so much evidence to show that time away from work can actually increase creativity and productivity. If a CEO can’t recognize this and embrace a good work-life balance, how can we expect employees to do it?

What advice would you suggest to your colleagues in your industry to thrive and avoid burnout?

Even before the pandemic, burnout was a big concern to tech companies — especially in the startup world. Burnout is a major contributor to health issues both in, and outside of, the workplace. Managing stress and burnout is a core component of our product so naturally this is something that I wanted to share with my team as well.

The statistics around burnout in the biotech industry and within startups are alarming. Most of us in the healthcare industry enter into the field because we are passionate about helping people and improving their quality of life, but we shouldn’t forget to take care of our own quality of life, or ignore that of our employees, along the way.

If you have tragically high turnover rates and exhausted employees, you aren’t going to be able to provide the best products and services to your customers in the long run.

I believe in living the values that we are trying to pass on to our customers. It’s like when you are on an airplane and they tell you to put on your own oxygen mask before you try to help others. When we feel energized and passionate about what we do, that’s when the creativity can flow and we can find new solutions in unexpected places.

While many startups can’t afford the same programs that more established companies can, there are numerous resources out there that can be implemented and that will have huge benefits for employee wellbeing. Digital health solutions such as fitness apps, meditation apps, and health trackers can help to manage symptoms as well as notify you of any changes in your health that you should be aware of.

The most important thing to keep in mind, however, is to create an environment where mental health is discussed in the same terms as you would talk about any other health condition. Some people even prefer to use the term “brain health” rather than mental health.

If I can support my colleagues and employees through times of stress and burnout, we can build resilience and come through it even stronger. My team will feel seen, heard, and supported. In my experience, when this type of environment exists, I have happier, healthier employees and together we can do amazing things for our customers.

What advice would you give to other leaders about how to create a fantastic work culture?

Workplace culture is about a shared belief system with shared values and attitudes. In the past this has mostly been confined to the office environment. With so many people working remotely, I think it is even more essential to ensure that our staff embody our values and beliefs in — and outside — of a physical office.

At LivaFortis we walk the walk and we talk the talk. Everything we do around workplace culture is intentional. When our daily actions truly reflect the values, beliefs, and mission of our company then there is a reassurance and a comfort level that permeates throughout the company. Instead of our values being written down on a sheet of paper, our employees see these values being lived and breathed every day.

I believe that it is the responsibility of leaders and managers to ensure that this type of authenticity is happening and that employees don’t see contradictory behaviors coming from management. When there is consistency and predictability, trust is created, and when trust is created between managers and employees, productivity, creativity, and profits soar. Recent research has shown that ‘companies with high levels of trust beat the average annualized returns of the S&P 500 by a factor of three’.

Another key aspect to creating a fantastic work culture is to create an environment that doesn’t stigmatize mental health. As the head of the company I set the tone and create this type of environment by openly talking about mental health matters and creating an environment where employees feel safe to do the same.

When my team sees me making my mental health a priority, it gives them permission to do the same. Brene Brown speaks about daring to be brave leaders by leading your company with ‘wholehearted leadership and self-awareness’. With this in mind I strive to embrace a culture of vulnerability and courage. Offering regular mental health days to employees, without any specific reason, just a day to catch up and breathe, can make a massive difference.

One last thing that has been key to our culture at LivaFortis has been flexibility. Just a few months ago many companies were starting to require employees to return to the workplace. Now, with the Omicron variant being a new potential concern, many of those plans are being revisited.

I think that the workplace of the future must first, and foremost, be one that provides flexibility for employees. There is no “one size fits all” solution for workers anymore, and it is so important for companies to recognize that. I believe that events such as the “great resignation” have only highlighted these issues even more. At LivaFortis we are so fortunate to have had 100% employee retention throughout the pandemic and even throughout 2021 and I attribute a lot of this to our flexibility.

Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?

Tell me and I forget. Teach me and I remember. Involve me and I learn. -Benjamin Franklin

When I first started the company I was a bit of a micromanager. Okay, maybe a lot of a micromanager. It wasn’t that I didn’t trust my employees to do the job well, it was just hard to let go of certain aspects of the company — it was like trusting someone with your pet, or child, for the first time! I quickly learned that micromanaging creates an environment of distrust and stress which was the exact opposite of what I was trying to achieve with the company culture. It leads to lower productivity and poor mental health outcomes for everyone.

When I started taking more of a coaching approach to working with my team things really started to change for all of us. By providing my team with the tools and training to be able to excel in what they were doing, I was able to be involved to some extent, but not be controlling everything.

Coaching and teaching is a much better way to help your employees grow and, unlike micromanaging, it doesn’t create a stressful environment. Coaching leads to higher levels of satisfaction, career growth opportunities and increased happiness. So much better than the alternative!

Ok thank you for all that. Now let’s move to the main focus of our interview. As you know, the collective mental health of our country is facing extreme pressure. In recent years many companies have begun offering mental health programs for their employees. For the sake of inspiring others, we would love to hear about five steps or initiatives that companies have taken to help improve or optimize their employees’ mental wellness. Can you please share a story or example for each?

  1. Remove the stigma around mental health in the workplace.

To remove workplace stigma around mental health I share some of my own struggles with our employees. Brene Brown’s research shows that there can be no meaningful connection without vulnerability. I believe in leading by example. By sharing some of the things that I struggle with I believe that it sets the tone and creates a safe space for others to do the same. So often we hear the message that it is ok to talk about mental health issues, but many people still feel the stigma and are afraid that they might be discriminated against.

2. Truly embracing the work-life balance.

Being born in France and moving here to attend university gave me a unique perspective and the experience to see two very different cultures at play in the workplace. My goal is to take the best of the American workplace ethic, combine it with the best of the French approach, and hopefully come up with something unique and amazing!

Ensuring that employees use their PTO is so important. I want to make sure my employees are rested and engaged and that they don’t get burnt out. Burnout in the workplace is on the rise and I want to protect my employees from that as much as possible. Respecting my employees’ time when they are with their families is another major concern for me. It makes it hard for people to focus on their home life when work is always interrupting.

3. Education around Cognitive Behavioral Therapy (CBT).

CBT is a type of therapeutic treatment based on the understanding that your thoughts affect your feelings, which in turn affect your actions.

CBT is a core component of our product so it was perfectly logical to me that I should provide it to my team, as well! By actively practicing CBT and by providing education around it to the team I hope to help my employees achieve their highest potential and live their best lives through the power of positive thinking.

4. Create Opportunities for Authentic Connection.

Remote work is something that many employees would like to keep and it is something that we still do a lot of at LivaFortis. It is important, however, to recognize that while there are many benefits to remote work, there are challenges that come with it, too.

By being aware of those challenges, and understanding that it can be tough on people’s mental health, I purposefully allocate time during meetings for social exchanges and to catch up on what has been happening in everyone’s lives. By doing this we have managed to cultivate a feeling of connectedness and a true sense of belonging to the group.

While our company has employees that are based in Europe, as well as different cities in the US, amazingly enough, this special time for socializing has made the world feel smaller, and has helped us develop some special relationships even across the globe. It has also been a great way to learn about other cultures!

5. Flexible Working Schedules.

Even before the pandemic, I recognized that in order to attract more women (and men) to the workforce, we needed to do things a little differently. A Metlife report found that 78% of women are looking for increased flexibility in the workforce. During the pandemic many women bore the brunt of childcare as well as other family responsibilities.

By allowing flexible working schedules I have been able to hire (and retain) talented individuals that needed flexibility to work with their families’ schedules. Whether employees need to take time for parents, children, pets, or other obligations, when we see employees as whole individuals with their own lives outside of the office, they feel respected, supported and safe. When employees feel safe they are able to produce some of their best work as they aren’t always worrying about how to meet other obligations or feel like they are sacrificing family for work.

These ideas are wonderful, but sadly they are not yet commonplace. What strategies would you suggest to raise awareness about the importance of supporting the mental wellness of employees?

Be intentional. Be an example. As CEOs and leaders we need to set the tone for other businesses. The more businesses that embrace these ideals, the more other companies will also have to offer these benefits to employees in order to attract and retain top workers. Years ago many people were lured to tech companies by snazzy snack bars, table tennis tables, and giant bean bags. It made it comfortable and fun, and encouraged collaboration, but in many instances, some of these measures were put in place to keep people at the office longer. Millennials are no longer lured in by these shiny perks. Now they want a supportive, flexible workplace that respects their work life balance and supports their health, both mental and physical.

From your experience or research, what are different steps that each of us as individuals, as a community and as a society, can take to effectively offer support to those around us who are feeling stressed, depressed, anxious and having other mental health issues? Can you explain?

Listen. Listening is one of the most important things we can do for each other. When we are able to sit with one another during times of stress and difficulty we create important connections (leading to further trust and collaboration) and we help others feel seen. We can’t always fix things for people, and often people don’t want you to fix things for them. They just want you to listen.

Empathy. Empathy is tied into the listening component. Empathy allows us to feel safe and supported. When employees feel safe they feel more confident to try new things. They are not afraid to fail or be judged for their failures. Taking calculated risks can result in many new discoveries and advances for companies that employees would otherwise not have accomplished. There are so many studies that have been done on how empathy can benefit employees and companies. The results are actually quite amazing!

Remove the stigma surrounding mental health. Different cultures and communities still find it challenging to talk about mental health issues. There are employees who continue to feel as if they will be penalized for admitting that they struggle with mental health issues.

When we show employees that it is truly okay to talk about these issues, the same way as we would with any other medical condition, we help people feel like they are accepted for who they are. This openness then creates an environment where people feel comfortable utilizing the resources that companies make available to them. We wouldn’t stop someone with diabetes from getting a promotion. It should be the same way with mental health conditions.

Habits can play a huge role in mental wellness. What are the best strategies you would suggest to develop good healthy habits for optimal mental wellness that can replace any poor habits?

Healthy habits are something that we talk a lot about in our weekly blogs. There are lots of healthy habits that help support mental wellness . Many of these we already know we should be doing, but for some reason it can be really challenging to execute them (did we hear someone say Netflix binge?!) The mind and body are so intricately connected — another thing that we address with our product for low back pain. When we take care of our physical health it can have a tremendous impact on our mental wellbeing.

Some key healthy habits that can make a huge difference to our mental health are: :

  1. Practicing good nutrition.

Serotonin is a key hormone that stabilizes our mood and helps to promote feelings of well-being and happiness. Many people may be familiar with serotonin in the brain but they may not be aware of the fact that 95% of serotonin actually comes from our gut.

Eating anti-inflammatory foods (such as berries and nuts) can have a positive impact on both your health and your mood, while inflammatory foods (such as sugar and processed foods) can have a negative effect on your mood and your health.

Giving your employees time to eat a healthy and nutritious lunch (not at their desks) can help ensure energy and mood levels stay steady throughout the day. Think less “hangry-ness” at the office!

2. Sleep. I think Thrive Magazine and Ariana Huffington have been talking about the importance of good sleep hygiene for some time now. We can’t support this enough. Good sleep is essential for helping us regulate our emotions, as well as preventing a host of medical issues such as heart disease and diabetes.

Companies can help with this by ensuring that they don’t send emails at all hours of the night or requesting reports at the last minute (obviously this isn’t always possible but it should be the exception, not the norm).

3. Exercise. There are several ways that exercise can help with mental wellbeing. Firstly it can help us regulate our emotions when we feel dysregulated or stressed. The rhythmic aspect of walking, especially in nature, can help lower your heart rate and soothe anxiety. Secondly, walking increases blood flow and circulation to both your body and your brain, helping to reduce stress.

Exercise helps reduce stress by causing endorphins to be released throughout your body. Endorphins are your body’s natural “feel-good” chemicals that are highly effective in boosting mood and reducing feelings of pain and stress. While the rhythm of walking is good, really any type of exercise can have these benefits for your body.

Encouraging your employees to go for walks outside (or even just on a treadmill at work) can have major health benefits and help increase energy levels. Want to take it up a notch? Take a friend with you, listen to some uplifting music, or check out your favorite podcast while you do it. Watch that afternoon creativity flow!

Do you use any meditation, breathing or mind-calming practices that promote your mental wellbeing? We’d love to hear about all of them. How have they impacted your own life?

Mindfulness and meditation are essential in helping me manage my hectic schedule — especially with everything that comes from running a startup. On the weekends I love to go hiking with friends, and my always-enthusiastic labrador-husky mix, Lucy. I feel so lucky to live in Austin, Texas, where the weather is often amazing and there are so many beautiful places to hike.

I also could not survive without Pilates — it has changed my life! Pilates gives me one hour each day to focus on myself. It allows me to disconnect from technology, and helps me to be present in the moment. Not only does it work my muscles for physical health but we also focus a lot on breathing and breath control which helps to calm my busy brain. I always feel so much better after a Pilates session — it really does wonders for me, both physically and emotionally.

Is there a particular book that made a significant impact on you? Can you share a story?

The 4 Agreements, by Don Miguel Ruiz. The 4 agreements are:

  1. Always do your best.
  2. Don’t take anything personally.
  3. Don’t make assumptions.
  4. Be impeccable with your words.

I stumbled across this book during a time when I was feeling disconnected and was lacking motivation. I was beginning to feel very stressed about everything that I needed to accomplish. These feelings were starting to interfere with my ability to do my best work.

When I read The 4 Agreements it was like something in me just clicked! I realized that doing my best doesn’t mean being perfect. It simply means that as long as I did my best today, it doesn’t have to be my best day ever — just the best with what I could do today. Our energy levels ebb and flow on a daily basis. No two days are the same. We deal with different stressors and situations. My best today will probably look very different from my best yesterday, or even from my best tomorrow. This does not diminish the fact that it was still my best for today.

Not making assumptions about things or people is huge for me! It also links to not taking things personally. It is easy to think everything is about me — we all have a tendency to think this way. When a colleague doesn’t ask for my help it is not necessarily because he doesn’t think I can help — he might be trying to not bother me with too many things. We all know what assumptions can do!

Lastly, be impeccable with your words. This is extremely important to me. Being a person of my word gives my team a level of security and predictability which then leads to increased trust and connection. When those are present, productivity and creativity soar.

I believe that our words hold so much power over our lives. We speak either negative or affirming words over ourselves, and others, every day. If something doesn’t work out the way I had hoped, instead of saying “I failed” or “I am a failure” I choose to say “How can I learn from this experience?”. I take the same approach with my employees. There can be no success without failure. If you aren’t failing, you aren’t trying. I want to speak words of affirmation as much as I possibly can!

I keep these four agreements in my mind as I move throughout my day.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

This is actually something that we are trying to do with our product for low back pain. For so long people have viewed illness and injury as isolated physical conditions. Our biopsychosocial approach to pain aims to educate people around the idea that our minds and bodies are intricately connected. Explaining the science behind how our emotions and environments contribute to our experience of pain (and chronic diseases) is something that we are passionate about. Pain, and chronic pain, affects so many people, and has serious negative effects on both physical and mental health. We believe that this unique approach to pain management can really make a difference to people’s quality of life.

What is the best way our readers can further follow your work online?

Every week we post a blog on different aspects of the biopsychosocial model for managing low back pain and we talk about everything from stress and mental wellness, to reviews of the latest treatments and top exercises for the condition.

People can follow us on social media (Instagram and Facebook), register for updates on our website (, or subscribe to our blog on Medium. We would love to connect with you and hear from you!

Thank you for the time you spent sharing these fantastic insights. We wish you only continued success in your great work!



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David Liu

David Liu


David is the founder and CEO of Deltapath, a unified communications company that liberates organizations from the barriers of effective communication