Tiatros CEO Kimberlie Cerrone: Why I founded a digital therapeutics startup

I've lived and worked in Silicon Valley my entire career. I'm a technology and patent attorney who comes out of two of the Valley's top law firms. I spent most of my career as part of top executive teams, specializing in structuring and negotiating the business deals that help startups grow into mega firms. I co-founded a neuropeptide company that went public in 1994. I was part of the executive team that took an internet company public in the late 90s. I have graduate degrees in neuroscience, business and law.

My entrepreneurial focus on behavioral health began after my sons returned from military service struggling with PTSD, or post-traumatic stress disorder. They both enlisted shortly after 9/11. My older boy went into the Army, where he led combat platoons during two tours in Iraq. My younger son joined the Navy, where he spent more than five years on a fast attack submarine, circling the globe.

It's important to understand that my sons came home with PTSD under arguably the best possible circumstances. They are intelligent, competent, brave young men who came home to an intact, loving, educated, affluent family and lots of friends who were able to support them. They came home to San Francisco, where excellent healthcare services are available and superior insurance to cover it. My husband is a psychiatrist. With all of the odds in their favor, it took us two years to get our sons the help they needed.

Both have fully recovered now and gone on to have happy and successful lives, but our family's experience taught me how hard it is for most Americans to access effective behavioral healthcare services. I can offer some facts to think about: 

  • Treatable, but untreated, mental illness adds as much as $1 trillion dollars to the annual U.S. healthcare budget;
  • Lost productivity and healthcare utilization costs for employees with treatable, but untreated, stress, anxiety, depression and trauma costs U.S. companies $400 billion annually. The indirect healthcare utilization costs of untreated mental illness co-occurring with chronic diseases are much higher;
  • There are no skilled therapists in more than half of U.S. counties — no psychiatrists, no psychologists, no licensed clinical social workers; and
  • Ninety percent of people suffering from drug use disorders in America cannot access specialty treatment because of shortages in the supply of care.

Before you can solve a problem, you must define it correctly. The problem is not that we don't have a good treatment for the most common mental illnesses, because we do: cognitive behavioral therapy, or CBT, is the primary, scientifically proven treatment for the most common mental health disorders. It's used all over the world to treat anxiety, depression, trauma, stress, panic, addiction, and even eating and sleep disorders. Fifty years of research studies confirm that CBT is very safe and highly effective, with 80 percent of people who complete a CBT program to the best of their ability having a complete and sustained recovery. That result is pretty much as good as it gets in medicine. The real problem is not the availability of a good treatment; it is that more than 100 million Americans cannot access the safe and highly effective treatment that is available.

Another important lesson that I learned from my family's experience is that healing is a social activity. The only people that my sons would share their stories with were other veterans, who shared their military values and understood their situations. They needed the community and support of other veterans even though they were surrounded by caring family and friends. This understanding is critical, because it is a scientific fact that people who feel isolated do not heal.

Once I understood that the challenge and opportunity for Tiatros was to provide access to existing, evidence-based treatment and social support, the idea emerged that we could leverage the therapeutic power of peer groups using social media-styled tools inside secure private social networks to teach CBT skills and to build psychological resilience. From its very beginning, Tiatros' mission was to make safe and highly effective behavioral health treatment available to the 100 million Americans who cannot otherwise access it, and to reduce its cost by 90 percent compared to traditional in-person psychotherapy.

Today, participants access Tiatros' portfolio of online psychotherapeutic and psychological resilience programs on their personal devices, in the comfort of their own homes, when it is most convenient for their individual schedules. Our programs use evidence-based narrative therapy, mindfulness training, psychoeducation and CBT exercises that are tailored by experts to be highly relatable to the specific audience. Participants in Tiatros programs work together to build psychological resilience skills and to acquire new, more effective behaviors that lead to success at home and at work.

Our proprietary platform and programs use social media-styled interfaces to leverage the power of peer groups of 12 to 15 participants who share the same health challenges and life goals. We use these tools to encourage participants to form a supportive and nurturing community that is itself therapeutic — acting to encourage every participant to actively engage in and to complete their Tiatros program. In effect, Tiatros' approach makes the peer group the "guide" in "guided self-help." Because the user experience is social, engaging and relatable, 75 percent of participants who enroll in Tiatros programs complete and benefit from them. That's an extraordinary success rate, of which we are very proud.

Tiatros programs deliver eight sessions with a weekly cadence over eight weeks. Completing the work for a session takes about 90 minutes per week. Participants access their Tiatros programs asynchronously, from anywhere. This approach greatly increasing the number of therapeutic touch points with most participants engaging daily, and some up to several times per day, which creates a psycho-therapeutic milieu with more frequent and active engagement compared to traditional in-person and telemedicine styled psychotherapies. Each peer group is moderated by a trained facilitator under the oversight of an expert CBT therapist and, for some applications, a "physician of medical record." After completing their primary program, participants continue to have access to all of their program materials, their peer group and the larger user community, and to original content as part of the Tiatros' "After" program.

We study and empirically validate everything that we do, working with independent clinical researchers at top academic medical centers. This is very important to me as a scientist; everything that Tiatros does needs to be based on good science, good medicine and good design. We measure the clinical outcomes of Tiatros programs using validated measures that are in widespread use in medicine. We're proud of our results. Clinical outcomes in a recent peer-reviewed study show that Tiatros achieved a 40.5 percent reduction in perceived stress (1.8 effect size) as measured by the PSS-10; a 41.2 percent reduction in anxiety (1.2 effect size) as measured by the GAD-7; a 33.6 percent reduction in depression (1.2 effect size) as measured by the PHQ-9; and a 30.6 percent reduction in somatic symptoms (0.9 effect size) as measured by the PHQ-15.

We partnered with IBM and other leading AI companies to integrate advanced analytics and artificial intelligence technologies to personalize the participant experience and to increase participant engagement. AI data consistently show dramatic increases in positive behavioral traits associated with improved employee productivity and improved patient compliance, like dutifulness, trust, cheerfulness, and self-discipline, while unhelpful traits like worry, susceptibility to stress, melancholy, and immoderation consistently decrease. We're collaborating with our business partners to leverage cognitive computing and AI to make effective peer group psychotherapeutics available to tens of millions of Americans and ultimately to hundreds of millions of people around the world who have treatable mental illnesses. That's a big ambition, but we believe it's possible to achieve over the next few years.

To my generation's great shame, we still have Vietnam War-era veterans who are homeless and lack mental healthcare services 45 years after their conflict ended. My big fear after my sons came home from their military service was that we would soon have another generation of homeless veterans from current warfare. Not surprisingly, we targeted the first Tiatros programs to help veterans. We are now collaborating with the U.S. Department of Veterans Affairs, NYU Langone Health in New York City and the UCSF Department of Psychiatry in San Francisco and IBM Watson Health to empirically evaluate our impact on three different populations of struggling veterans at high risk of suicide and opioid addiction. We're also distributing the Tiatros "Military Leadership Development and Resilience Skills for Transitioning Veterans" program to employers who want their veteran hires to use their military training and values to become the next generation of corporate leaders.

We're also distributing Tiatros programs to U.S. companies that collectively are responsible for the healthcare of more than half of Americans. For example, Salesforce, San Francisco's largest employer and the fourth largest software company in the world, is rolling out the Tiatros "Personal Growth and Psychological Resilience at Work and at Home" program nationally. Salesforce's human resources team saw in Tiatros an evidence-based solution that was able to reach and help their entire workforce. We see that employers want solutions like ours that take a holistic approach to promoting wellness of the mind, body and spirit. They need usage and clinical outcomes data that show their workforce becoming healthier, more psychologically resilient and more productive.

We're also partnering with clinical experts and large providers to tackle the impact of behavioral health on chronic disease care. Last year, we partnered with the Allina Health in Minneapolis to create and empirically validate Tiatros programs targeted toward cancer patients who experience anxiety, depression and trauma. Oncologists are now prescribing the Tiatros "Coping with Brain Cancer" program to patients across Allina's thirteen hospitals and offering the Tiatros "Coping with Brain Cancer for Caregivers" programs to their family caregivers.

We have similar initiatives in progress for heart disease, stroke and diabetes patients. I'm currently looking for a clinical partner who wants to tackle chronic pain management with us. This strategy is critically important to reduce the pain and suffering and the enormous cost of the treatable, but currently untreated, mental illness that co-occurs with chronic disease care. I recently asked an executive at the American Heart Association what percentage of people who have a heart attack also experience anxiety, trauma and depression. His answer was: "100 percent do."

We recently began collaborating with expert clinicians at UCSF Medical Center in San Francisco and several California public school districts to develop and distribute Tiatros programs to the K-12 and higher education sector. This work is very important because schools have taken on the role of being the primary point-of-service for healthcare services for millions of children and young people.

I saw in my own family's struggles that effective behavioral health interventions are life-changing. We founded Tiatros to ensure that every American who is struggling with stress, anxiety, depression and trauma can get the expert quality, evidence-based psychotherapeutic and psychological resilience skills training that helped my sons.

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