How to Remain Relaxed in a Stressful Situation

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 realised I was missing my keys.In fact, I could see them laying on the dining room table where I had left them through the glass. I hurriedly checked all the other doors and windows, but they were all tightly shut. I considered phoning a locksmith because at least I had a mobile, 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 extreme cold, I used a big rock to smash through the basement window, clearing out the glass shards as I went. Then, after crawling through, I found a piece of cardboard and taped it over the gap, thinking that in the morning, on the way to the airport, I could call my contractor and ask him to fix it.I reasoned that even if this was going to 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. Therefore, the following morning when I woke up on too little sleep, worrying about the hole in the window, and making a mental note that I needed to call my contractor, as well as the freezing temperatures and the meetings I had scheduled in Europe, my thinking was cloudy but I was unaware of it because it was cloudy.

I didn't realise I was missing my passport until I reached the airport check-in desk. I hurried home in the snow and ice for 40 minutes, grabbed my passport, and then hurried back to the airport. I arrived just in time, but they had already given my seat to someone else, so I was forced to sit near to the bathrooms in the back of the plane for the duration of the eight-hour flight. My seat also wouldn't recline. Well, with only eight hours of sleep, I had plenty of time to contemplate.

I then began to wonder whether there were anything I could do or mechanisms I could set up to stop bad things from happening. Or, at the very least, will reduce the possibility that a disaster will occur. I began to think about that, but it took a month or so for my ideas to come to a clear conclusion. I shattered my window and, you know, forgot my passport while out to dinner with my colleague, Nobel Prize winner Danny Kahneman. Danny then revealed with me that he had been practising a technique known as prospective hindsight. He had learned about it from psychologist Gary Klein, who had written about it a few years earlier and went by the name of 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, after which you try to determine what you can do to minimise the harm or prevent those problems from occurring. 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 throughout 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 known as the hippocampus

that the number of taxicab drivers in London has increased. 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 they removed the squirrels' ability to smell, and they were still able to locate their nuts. Instead of using smell to find objects, they were utilising the hippocampus, a beautifully designed system in the brain. However, it's far 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. Therefore, 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 meticulous about keeping it that way. Travel, what about it? Take a photo of your passport, credit cards, and driver's licence 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 harmful, it impairs judgement. Recognising that you won't perform at your best under stress and putting systems in place is part of the pre-mortem procedure. And probably no circumstance is more stressful than being forced to make a medical choice.And at some point, everyone of us will find ourselves in the position of having to assist a loved one with a decision regarding the future of their medical care or our own. 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 might 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. You reason that having high cholesterol is not ideal, and the doctor responds, "You know, I'd like to give you a drug that will help you lower your cholesterol, a statin."You may even know someone who uses statins. Statins are among the most often prescribed medications in the world today, and you have probably heard of them.

You consequently say, "Yeah, give me the statin."However, there is a statistic that you should request at this point that most doctors don't like to discuss and pharmaceutical firms don't like to discuss at all. It's for the quantity that must be treated.What is this NNT, exactly?

It's the quantity of people who must take a medication, go through surgery, or experience 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 practise truly 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 patients benefit from most medications. 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. Before one heart attack, stroke, or other adverse event is avoided, 300 patients must take the medication for a full year. "Well, OK, one in 300 chances of lowering my cholesterol," you're probably thinking right about now. If not, doctor? However, please give me the prescription. But at this time, you ought to inquire about another statistic, namely, "Tell me about the side effects." Right? Therefore, 5% of patients who use this particular medication experience side effects.

And they include severe side effects like crippling muscular and joint pain and gastrointestinal upset, but you're thinking, "Five percent, not very likely it's going to happen to me, I'll still take the drug."

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. One individual was assisted, while 15 people, or 5% of the 300 persons, experienced ill effects. 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. You might be thinking that I made up this number for shock value, but in reality, it's rather typical and required to be treated.

The number needed to treat is 49 for prostate cancer removal surgery, the most popular procedure for men over 50. Yes, 49 operations are performed for every person who receives assistance.

And in that situation, 50% of the patients experience the adverse effects. They include faecal incontinence, rectal tearing, urine incontinence, and erectile dysfunction. They'll only last for a year or two, if you're lucky and one of the lucky 50% who has them. Therefore, the purpose of the pre-mortem is to prepare questions that you might be able to ask to advance the dialogue. You shouldn't need to make everything on the moment.

Additionally, you should consider factors like life quality.Because you frequently have a choice, do you want a shorter life that is pain-free or a longer life that could end in significant pain?

These are issues that you should discuss and consider right away with your family and other close friends.In the heat of the moment, you might change your opinion, but at least you're used to this type of thinking.Remember that when we are stressed, our brain releases cortisol, which 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 might 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, one of the things that falters under pressure is logical, reasonable thought.We must therefore practise planning ahead for these kinds of circumstances. Realising 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 potential failures and put in place measures that will either lessen the harm or stop it from happening in the first place. Recalling that frigid night in Montreal, I had my contractor install a combination lock next to the entrance when I returned from my trip. The lock contained a key for the front door and had an easy-to-remember combination. And I must admit, I still have mountains of unsorted mail and a backlog of unread emails. I'm not entirely organised, but I consider organisation to be a process, and I'm making progress.

I sincerely appreciate it.