How to stay calm when stressed

I broke into my own home a few years ago.

It was around midnight in the middle of Montreal's winter, and I had just returned from seeing my friend Jeff across town. The thermometer on the front porch read minus 40 degrees, which is extremely cold. Don't worry about asking if that's in Celsius or Fahrenheit; minus 40 is the point where the two scales meet.

I dug around in my pockets as I stood on the front porch and realized I was missing my keys.

In fact, I could see them on the dining room table where I had left them through the glass.

I hurriedly raced around and tried the other windows and doors, but they were all tightly closed.

I considered phoning a locksmith because at least I had my phone, but it was late and it might take a while for one to arrive, plus it was chilly.

I had an early departure the next morning to Europe, so I had to acquire my passport and my suitcase before I could spend the night at my friend Jeff's house.

So, out of desperation and due to the extreme cold, I used a large rock to smash through the basement window, clearing out the glass shards as I went.

In the morning, on the way to the airport, I thought I would phone my contractor and ask him to fix it, so I found a piece of cardboard and taped it over the opening.

I reasoned that even though this would be pricey, it wouldn't be any more expensive than calling a locksmith in the middle of the night.

As a trained neuroscientist, I do know a little bit about how the brain functions when under stress.

It causes the release of cortisol, which increases heart rate, modifies adrenaline levels, and impairs thinking.

the following morning,

when I woke up with too little sleep,

My thinking was cloudy due to anxiety over the hole in the window, a reminder that I needed to call my contractor, the freezing temperatures, upcoming meetings in Europe, and, you know, all the cortisol in my system. However, I wasn't aware that my thinking was cloudy because it was cloudy.

I didn't realize I was traveling without my passport until I reached the airport check-in desk.

I hurried back to the airport in a 40-minute dash after racing home through the snow and ice to get my passport, but they had already given my seat to someone else, so I was forced to sit next to the toilet.

ht-hour flight, in a seat that wouldn't recline, close to the restrooms.

Well, with only eight hours of sleep, I had plenty of time to think.

Then I began to wonder whether there were anything I could do or measures I could take to stop bad things from happening.

Or, at the very least, will reduce the possibility that a catastrophe will occur.

I began to think about that, but it took a month or so for my ideas to come to a clear conclusion.

Danny Kahneman, the Nobel Prize winner and my colleague, and I were eating dinner.

Upon telling Danny that I had smashed my window and, you know, misplaced my passport in a somewhat embarrassed manner, Danny revealed that he had been practicing a technique known as prospective hindsight.

He had learned about it from psychologist Gary Klein, who had written about it in a book a few years prior. It is also known as the pre-mortem.

You are all aware of what a postmortem is today.

Every time there is a catastrophe, a group of experts is called in to try to determine what went wrong.

Danny clarified that during the pre-mortem, you look ahead and try to anticipate all the potential problems.

then you try to determine what you can do to stop those things from occurring or to lessen the harm.

Therefore, I want to discuss with you some of the things we can do in the form of a pre-mortem today.

Some of them are plain to see, while others are less so.

I'll start with the simple examples.

Establish a location for items that are prone to getting lost around the house.

This may seem like basic sense, and it certainly is, but it is supported by a wealth of scientific evidence due to the way our spatial memory functions.

The hippocampus is a brain region that has evolved over tens of thousands of years to keep track of essential locations, such as where the well is, where fish may be found, that stand of fruit trees, and where friendly and hostile tribes are located.

The area of the brain that enlarges in London taxi drivers is the hippocampus.

The area of the brain responsible for enabling squirrels to locate their nuts.

And in case you're curious, someone actually conducted the experiment in which the squirrels' ability to smell was removed, and the animals were still able to locate their nuts.

Instead of using smell to find objects, they were use the hippocampus, a beautifully designed system in the brain.

However, it's much better for objects with little movement than for those with a lot of movement.

This is the reason why we misplace our passports, reading glasses, and car keys.

As a result, set aside a location in the house for your keys, such as a hook near the door or even a pretty dish.

A specific drawer for your passport.

A specific table for your reading glasses.

Your belongings will always be there when you need them if you set out a location for them and are diligent about keeping it clean.

What about travel?

Take a photo of your passport, credit cards, and driver's license on your phone, then mail it to yourself to store it in the cloud.

You can help with replacement in the event that these items are lost or stolen.

These things are now quite evident.

Keep in mind that the brain releases cortisol when you are stressed.

Because cortisol is toxic, it impairs judgment.

Recognizing that you won't perform at your best under stress and that you should set up mechanisms is part of the pre-mortem procedure.

And probably no situation is more nerve-wracking than being forced to make a medical choice.

And eventually, we're all going to find ourselves there.

Where we must make a crucial choice regarding our or a loved one's future medical care, in order to assist them in making a choice.

I want to talk about that, therefore.

I'll also discuss a very specific medical condition.

However, this serves as a stand-in for all types of medical decision-making, as well as financial and social decisions, and any other kind of decision that would benefit from a logical analysis of the available information.

Let's say your doctor informs you that your cholesterol is a touch elevated after reviewing your lab results.

You are all aware that having high cholesterol raises your risk of heart disease, a heart attack, and a stroke.

Because you believe having high cholesterol is not a good thing, the doctor offers you a statin, a medication that will help you lower your cholesterol.

And you've likely heard of statins and are aware that they're one of the most commonly prescribed medications.

ver, there is a question you ought to pose at this point and a statistic you ought to request that the majority of physicians find uncomfortable to discuss and that pharmaceutical firms find even less agreeable.

It's for the quantity that must be treated.

What is this NNT, exactly?

It's the number of people who must take a medication, have surgery, or go through any other type of medical operation before one person is helped.

What kind of absurd statistic is that, you wonder?

The answer must be one.

If a medication won't help, my doctor won't prescribe it to me.

However, that isn't how medical practice actually operates.

Furthermore, if there is anyone to blame, it is scientists like me, not the doctor.

The fundamental mechanisms are not fully understood.

However, according to GlaxoSmithKline, only 30 to 50 percent of people respond to 90% of the drugs.

What do you think the number needed to treat is for the most often prescribed statin?

How many individuals must consume it before one person receives assistance?

300.

Jerome Groopman and Pamela Hartzband's research, which was independently verified by Bloomberg.com, supports this.

I personally ran the figures.

For a year, 300 people must take the medication.

before a single heart attack, stroke, or other unfavorable occurrence is avoided.

"Well, OK, one in 300 chance of lowering my cholesterol," you're probably thinking right about now.

If not, doctor? However, please give me the prescription.

But at this point, you ought to inquire about another statistic, namely, "Tell me about the side effects." Right?

In light of this, for this medicine,

Five percent of patients have the side effects.

You may be thinking, "Five percent, not very likely it's going to happen to me, I'll still take the drug," despite the fact that they include dreadful things like crippling muscular and joint pain and gastrointestinal distress.

But hold on a second.

Keep in mind that you cannot think clearly when under stress.

In order to avoid having to create the chain of reasoning on the moment, plan out how you're going to approach this in advance.

I believe 300 people use the medicine. Of the 300 people helped, 5% experience side effects.

there are 15 of them.

There is a 15-fold greater chance that the medicine will damage you than that it would benefit you.

Currently, I'm not recommending that you take a statin or not.

I'm merely recommending that you discuss this with your doctor.

It is a requirement of medical ethics and an element of the informed consent concept.

You have a right to this knowledge so that you may start thinking about whether you want to accept risks or not.

Now, you might be thinking that I made up this number to be shocking.

However, the need to treat this number is actually quite common.

The number needed to treat is 49 for prostate cancer removal surgery, the most popular procedure for men over 50.

Yes, 49 surgeries are performed for every person who receives assistance.

And in that situation, 50% of the patients experience the adverse effects.

They include fecal incontinence, rectal tearing, urinary incontinence, and erectile dysfunction.

And if you're fortunate and one of the 50% that have these,

They only have a one to two year lifespan.

Therefore, the purpose of the pre-mortem is to prepare questions that you might be able to ask to advance the conversation.

You shouldn't need to make everything on the moment.

Additionally, you should consider factors like life quality.

Do you prefer a shorter life that is pain-free or a longer life that can have a lot of agony toward the end since you frequently have a choice?

These are issues that you should discuss and consider right away with your family and other close friends.

In a rush, you can decide to modify your opinion.

However, you have experience with this type of thinking.

Remember that when we are stressed, our brain releases cortisol, which among other things causes a number of processes to shut down.

This has an evolutionary explanation.

You don't need your digestive system, libido, or immune system when you're up against a predator because if your body is using metabolism on those functions and you don't act quickly, you could wind up as the lion's supper, in which case none of those functions are important.

Unfortunately,

As Danny Kahneman and his colleagues have demonstrated, rational, logical thinking is among the things that falters under pressure.

We must therefore practice planning ahead for these kinds of circumstances.

Realizing that we are all flawed is, in my opinion, the key point in this situation.

Everybody will experience failure occasionally.

The goal is to plan for such failures and put in place the necessary measures to either lessen the harm or stop it from happening in the first place.

When I returned from my trip, I had my contractor install a combination lock next to the door, remembering that snowy night in Montreal.

Under stress, rational, logical thinking can break down, as Danny Kahneman and his colleagues have shown.

Therefore, we need to get into the habit of anticipating these kinds of situations.

The important thing in this circumstance, in my opinion, is to recognize that we are all fallible.

Failure will happen to everyone occasionally.

Planning for such failures and implementing the appropriate countermeasures to either mitigate the impact or prevent it from occurring in the first place are the objectives.

Remembering that frigid night in Montreal, I had my contractor install a combination lock next to the door when I got home from my trip.