What Would You Tell a Therapist If You Were Anonymous? A Lot, This Founder Realized, and It Helped Her Raise $53 Million. Zeera's audio app has the same clinical outcomes as one-on-one therapy, but is done anonymously, which makes more people want to seek out help.
By Kim Kavin
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This story appears in the November 2024 issue of Entrepreneur. Subscribe »
Ariela Safira was studying at Stanford University when a friend attempted to take her own life. It was 2013, and visiting her friend at a facility left Safira feeling scared. "It was the first time I had ever seen mental health care," she says, recounting how she heard some of the other patients screaming. "The system made no sense to me. Even more than that, I was horrified by it. How was she supposed to get better here?"
Her friend was far from alone. In the first half of one year that Safira spent at Stanford, 44 students in the high school across the street were hospitalized for suicidal thoughts.
"My perception then is what it is now: We should all be stopping what we're doing and screaming at the thought that people are struggling so much, they don't want to live," she says.
Safira worked with the design and consulting firm Ideo on ways to design mental-health care, and then at CityBlock, which spun off from Google's subsidiary Sidewalk Labs to design healthcare for the Medicare population. She also trained in Columbia University's clinical psychology program.
"I dropped out when I thought I'd seen it all, and it was not going to solve our mental-health crisis for a million reasons," she says. "My point of view ultimately came down to the fact that one-on-one therapy could not be scaled to address this crisis."
That experience led Safira to open a brick-and-mortar therapy business in 2019 called Real, which offered one-on-one and group therapy. But in June 2024, Safira had pivoted Real to become Zeera, a mental healthcare company with audio-only content.
She started Zeera to combine the type of anonymously accessed group therapy that people sought out during the pandemic with therapist tools and lessons, real people's stories and podcast-style technology. Users can listen to a two-minute session or to collections of content that go on for hours, with an algorithm serving up suggestions based on the user's choices. In the first year, 100,000 people have joined the app — which is achieving the same clinical outcomes as one-on-one therapy with audio-only content. All of this made Safira a finalist on our Entrepreneur of 2024 list of 20 innovative leaders.
So you founded this company in 2019, but between then and June 2023, you rebranded as Zeera and business took off. What happened?
We started as a brick-and-mortar model called Real where you pay for monthly membership and can receive one-on-one or group therapy.. Then Covid hit, and we learned things that we never expected to learn. Everybody wanted group therapy, but with video off and their names hidden. When we followed up with surveys, people said they wanted to hear how other people were dealing with the issue, and they wanted a therapist to tell them what to do for the problem, but they didn't want people to know they are in the group.
And people were requesting recordings. We were not marketing any of this, but people said they wanted the recordings because on Thursday at 4 p.m. when this group was happening, they were fine, but they needed it at midnight on Saturday when they had something to deal with.
Those are some big insights into what people actually want from therapy.
This was a phenomenal insight. The question was whether it could be clinically effective, to build an app with audio-only content that drove outcomes similar to one-on-one therapy. We brought in experts from Spotify and Netflix and paired them with clinicians to figure out this model.
Related: Shifting the Narrative: Entrepreneurs and Mental Health
So the way Zeera works is with an algorithm?
Yes. On the back end, we track what each person is doing in the app, and then personalize the experience, just like Instagram or Netflix do. These platforms can predict what you need or want better than you can yourself.
We can say, "Ariela is in a medium place with body dysmorphia, but a severe place with anxiety related to relationships." We can identify that based on the content you're engaging with, and we can recommend sessions that move Ariela from this state of mental health to a healthier state.
People can sign up from anywhere?
Yes, but we also started selling Zeera as an employee health benefit. That evolved our company business model entirely. Statistically speaking, 72% of working adults today have a symptom of mental illness, and yet fewer than 3% of employees even use their mental-health benefits. CEOs knew it was an issue. Our first partner was a big four accounting firm.
How did that boost your business?
In our first year, we have 100,000 people on the app. We've exceeded the previous engagement rates for company mental health services by 14X, and 100% of our customers have renewed their contracts.
What made you believe there should be a new way to deliver mental health services?
Can you imagine if the first time anyone ever met a physical-care doctor was in their 50s? We would find that absurd. But that's the case with mental health care. Research tells us that people wait 11 years on average to get care. Most spend their entire lives suffering in silence. The system is broken. We need to rethink it.
Related: Why Mental Health and Well-Being Should Be Your Top Recruitment and Retention Priority
