All language subtitles for How_to_stay_calm_when_you_know_you_ll_be_stressed_Daniel_Levitin

a few years ago i broke into my own

house uh i had just driven home it was

around midnight in the dead of montreal

winter i'd been visiting my friend jeff

across town

and

the thermometer on the front porch read

minus 40 degrees

and don't bother asking if that celsius

or fahrenheit minus 40 is where the two

scales meet

it was very cold and as i stood on the

front porch fumbling in my pockets

i found i didn't have my keys

in fact i could see them through the

window lying on the dining room table

where i'd left them

so i quickly ran around and tried all

the other doors and windows and they

were locked tight

i thought about calling a locksmith at

least i had my cell phone but at

midnight it could take a while for a

locksmith to show up and it was cold

i couldn't go back to my friend jeff's

house for the night because i had an

early flight to europe the next morning

and i needed to get my passport in my

suitcase

so desperate and freezing cold i found a

large rock and i broke through the

basement window cleared out the shards

of glass i crawled through i found a

piece of cardboard and taped it up over

the whole opening figuring that in the

morning on the way to the airport i

could call my contractor and ask him to

to fix it this was going to be expensive

but probably no more expensive than the

middle of the night locksmith so i

figured under the circumstances i was

coming out even

now i'm a neuroscientist by training and

i know a little bit about how the brain

performs under stress

it releases cortisol that raises your

heart rate

it modulates adrenaline levels and it

clouds your thinking

so the next morning

when i woke up i'm too little sleep

worrying about the hole in the window

and the mental note that i had to call

my contractor and the freezing

temperatures and the meetings i had

upcoming in europe and

you know with all the cortisol in my

brain my thinking was cloudy but i

didn't know it was cloudy because my

thinking was cloudy and

it wasn't until i got to the airport

check encounter

that i realized i didn't have my

passport

so i raced home in the snow and ice 40

minutes got my passport raced back to

the airport i made it just in time but

they had given away my seat to someone

else so i got stuck in the back of the

plane next to the bathrooms in a seat

that wouldn't recline on an eight-hour

flight

well i had a lot of time to think during

those eight hours of no sleep

and i started wondering are there things

that i can do systems that i can put

into place

that'll prevent bad things from

happening

or at least if bad things happen will

minimize the likelihood of it being a

total catastrophe

so i started thinking about that but my

thoughts didn't crystallize until about

a month later i was having dinner with

my colleague danny kahneman the nobel

prize winner and i somewhat

embarrassedly told him about having

broken my window and

you know forgot my passport and danny

shared with me that he'd been practicing

something called

prospective hindsight

it's something that he had gotten from

the psychologist gary klein who had

written about it a few years before also

called the pre-mortem now you all know

what the post-mortem is whenever there's

a disaster you know team of experts come

in and they try to figure out what went

wrong right well in the pre-mortem danny

explained you look ahead and you try to

figure out all the things that could go

wrong

and then you

try to figure out what you can do to

prevent those things from happening or

to minimize the damage so what i want to

talk to you about today are some of the

things we can do in the form of a

pre-mortem some of them are obvious

some of them are not so obvious i'll

start with the obvious ones around the

home

designate a place for things that are

easily lost

now this sounds like common sense and it

is but there's a lot of science to back

this up based on the way our spatial

memory works there's a structure in the

brain called the hippocampus that

evolved over tens of thousands of years

to keep track of the locations of

important things

uh where the well is where fish can be

found that stand of fruit trees

where the friendly and enemy tribes live

the hippocampus is the part of the brain

that in london taxi cab drivers becomes

enlarged it's the part of the brain that

allows squirrels to find their nuts and

if you're wondering somebody actually

did the experiment while they cut off

the olfactory scents of the squirrels

and they could still find their nuts

they weren't using smell they were using

the hippocampus this exquisitely evolved

mechanism in the brain for finding

things

but it's really good for things that

don't move around much not so good for

things that move around so this is why

we lose car keys and reading glasses and

passports so in the home designate a

spot for your keys a hook by the door

maybe a decorative bowl for your

passport a particular drawer for your

reading glasses a particular table if

you designate a spot and you're

scrupulous about it your things will

always be there when you look for them

what about travel take a cell phone

picture of your credit cards your

driver's license your passport

mail it to yourself so it's in the cloud

if these things are lost or stolen you

can facilitate replacement

now these are some rather obvious things

remember when you're under stress the

brain releases cortisol cortisol is

toxic and it causes cloudy thinking so

part of the practice of the premortem is

to recognize that under stress you're

not going to be at your best and you

should put systems in place

and there's perhaps no more stressful a

situation than when you're confronted

with a medical decision to make and at

some point all of us are going to be in

that position where we have to make a

very important decision about the future

of our medical care or that of a loved

one to help them with the decision and

so i want to talk about that and i'm

going to talk about a very particular

medical condition

but this stands as a proxy for all kinds

of medical decision making and indeed

for financial decision making and social

decision making any kind of decision you

have to make that would benefit from a

rational assessment of the facts

so suppose you go to your doctor and the

doctor says i just got your lab work

back

your cholesterol is a little high

now you all know that cholesterol is

high cholesterol is associated with an

increased risk of cardiovascular disease

heart attack stroke and so you're

thinking having high cholesterol isn't

the best thing and so the doctor says

you know i'd like to give you a drug

that'll help you lower your cholesterol

a statin

and you've probably heard of statins you

know that they're among the most widely

prescribed drugs in the world today you

probably even know people who take them

and so you're thinking yeah give me the

statin

but there's a question you should ask at

this point a statistic you should ask

for that most doctors don't like talking

about and pharmaceutical companies like

talking about even less

uh it's for the number needed to treat

now what is this the nnt

it's the number of people that need to

take a drug or undergo a surgery or any

medical procedure before one person is

helped

you're thinking what kind of crazy

statistic is that right the number

should be one my doctor wouldn't

prescribe something to me if it's not

going to help

but actually medical practice doesn't

work that way and it's not the doctor's

fault if if anybody's fault it's the

fault of scientists like me we haven't

figured out the underlying mechanisms

well enough but galaxo smith klein

estimates that ninety percent of the

drugs work in only thirty to fifty

percent of the people

so the number needed to treat for the

most widely prescribed statin

what do you suppose it is

how many people have to take it before

one person's helped 300.

this is according to research by

research practitioners jerome groupen

and pamela hartsband independently

confirmed by bloomberg.com i ran through

the numbers myself

300 people have to take the drug for a

year before one heart attack stroke or

other adverse event is prevented now

you're probably thinking well okay uh

one in 300 chance of lowering my

cholesterol why not doc give me the

prescription anyway but you should ask

at this point for another statistic and

that is tell me about the side effects

right so for this particular drug the

side effects occur in five percent of

the patients and they include terrible

things debilitating muscle and joint

pain

gastrointestinal distress but now you're

thinking well five percent not very

likely it's going to happen to me i'll

still take the drug but wait a minute

remember under stress we're not thinking

clearly so think about how you're going

to work through this ahead of time so

you don't have to manufacture the chain

of reasoning on the spot 300 people take

the drug right one person's helped five

percent of those 300 have side effects

that's 15 people

you're 15 times more likely to be harmed

by the drug

than you are to be helped by the drug

now i'm not saying whether you should

take the statin or not i'm just saying

you should have this conversation with

your doctor medical ethics requires it

it's part of the principle of informed

consent you have the right to have

access to this kind of information to

begin the conversation about whether you

want to take the risks or not now you

might be thinking i've pulled this

number out of the air for shock value

but in fact it's rather typical this

number needed to treat for the most

widely performed surgery on men over the

age of 50 removal of the prostate for

cancer the number needed to treat is 49

that's right 49 surgeries are done for

every one person who's helped and the

side effects in that case

occur in 50 percent of the patients they

include impotence erectile dysfunction

urinary incontinence rectal tearing

fecal incontinence and if you're lucky

and you're one of the 50 percent who has

these they'll only last for a year or

two

so

the idea of the pre-mortem is to think

ahead of time to the questions that you

might be able to ask that will push the

conversation forward you don't want to

have to manufacture all of this on the

spot and you also want to think about

things like quality of life because you

have a choice oftentimes do i want a

shorter life that's

or a longer life that might have a great

deal of pain towards the end these are

things to talk about and think about now

with your family and your loved ones you

might change your mind in the heat of

the moment but at least you're practiced

with this kind of thinking

remember our brain uh under stress

releases cortisol and one of the things

that happens at that moment is a whole

bunch of systems shut down there's an

evolutionary reason for this face to

face with a predator you don't need your

digestive system or your libido or your

immune system because if your body is

expending metabolism on those things and

you don't react quickly you might become

the lion's lunch and then none of those

things matter

what uh unfortunately one of the things

that goes out the window during those

time to stress is rational logical

thinking as danny kahneman and his

colleagues have shown

so we need to train ourselves to think

ahead to these kinds of situations

i think the important point here

is recognizing that all of us are flawed

we all are going to fail now and then

the idea is to think ahead to what those

failures might be to put systems in

place that will help minimize the damage

or to prevent the bad things from

happening in the first place

getting back to that snowy night in

montreal when i got back from my trip i

had my contractor install a combination

lock next to the door

with a key to the front door in it an

easy to remember combination and i have

to admit i still have piles of mail that

haven't

been sorted and piles of emails that i

haven't gone through so i'm not

completely organized but i see

organization as a gradual process and

i'm getting there thank you very much

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