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Daniel Levitin: How to stay calm when you know you'll be stressed
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You're not at your best when you're stressed. In fact, your brain has evolved over millennia to release cortisol in stressful situations, inhibiting rational, logical thinking but potentially helping you survive, say, being attacked by a lion. Neuroscientist Daniel Levitin thinks there's a way to avoid making critical mistakes in stressful situations, when your thinking becomes clouded -- the pre-mortem. "We all are going to fail now and then," he says. "The idea is to think ahead to what those failures might be."
Daniel Levitin - Neuroscientist
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Double-click the English transcript below to play the video.
00:13
A few years ago,
I broke into my own house.
I broke into my own house.
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I had just driven home,
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it was around midnight
in the dead of Montreal winter,
in the dead of Montreal winter,
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I had been visiting my friend,
Jeff, across town,
Jeff, across town,
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and the thermometer on the front porch
read minus 40 degrees --
read minus 40 degrees --
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and don't bother asking
if that's Celsius or Fahrenheit,
if that's Celsius or Fahrenheit,
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minus 40 is where the two scales meet --
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it was very cold.
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And as I stood on the front porch
fumbling in my pockets,
fumbling in my pockets,
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I found I didn't have my keys.
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In fact, I could see them
through the window,
through the window,
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lying on the dining room table
where I had left them.
where I had left them.
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So I quickly ran around
and tried all the other doors and windows,
and tried all the other doors and windows,
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and they were locked tight.
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I thought about calling a locksmith --
at least I had my cellphone,
at least I had my cellphone,
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but at midnight, it could take a while
for a locksmith to show up,
for a locksmith to show up,
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and it was cold.
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01:00
I couldn't go back to my friend
Jeff's house for the night
Jeff's house for the night
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because I had an early flight
to Europe the next morning,
to Europe the next morning,
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and I needed to get
my passport and my suitcase.
my passport and my suitcase.
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So, desperate and freezing cold,
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I found a large rock and I broke
through the basement window,
through the basement window,
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cleared out the shards of glass,
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I crawled through,
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I found a piece of cardboard
and taped it up over the opening,
and taped it up over the opening,
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figuring that in the morning,
on the way to the airport,
on the way to the airport,
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I could call my contractor
and ask him to fix it.
and ask him to fix it.
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This was going to be expensive,
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but probably no more expensive
than a middle-of-the-night locksmith,
than a middle-of-the-night locksmith,
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so I figured, under the circumstances,
I was coming out even.
I was coming out even.
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Now, I'm a neuroscientist by training
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and I know a little bit
about how the brain performs under stress.
about how the brain performs under stress.
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It releases cortisol
that raises your heart rate,
that raises your heart rate,
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it modulates adrenaline levels
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and it clouds your thinking.
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So the next morning,
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when I woke up on too little sleep,
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worrying about the hole in the window,
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and a mental note
that I had to call my contractor,
that I had to call my contractor,
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and the freezing temperatures,
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02:02
and the meetings I had upcoming in Europe,
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02:05
and, you know, with all
the cortisol in my brain,
the cortisol in my brain,
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my thinking was cloudy,
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but I didn't know it was cloudy
because my thinking was cloudy.
because my thinking was cloudy.
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02:13
(Laughter)
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And it wasn't until I got
to the airport check-in counter,
to the airport check-in counter,
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that I realized I didn't have my passport.
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(Laughter)
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So I raced home in the snow
and ice, 40 minutes,
and ice, 40 minutes,
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got my passport,
raced back to the airport,
raced back to the airport,
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I made it just in time,
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but they had given away
my seat to someone else,
my seat to someone else,
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so I got stuck in the back of the plane,
next to the bathrooms,
next to the bathrooms,
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in a seat that wouldn't recline,
on an eight-hour flight.
on an eight-hour flight.
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Well, I had a lot of time to think
during those eight hours and no sleep.
during those eight hours and no sleep.
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(Laughter)
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And I started wondering,
are there things that I can do,
are there things that I can do,
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systems that I can put into place,
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that will prevent bad things
from happening?
from happening?
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Or at least if bad things happen,
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will minimize the likelihood
of it being a total catastrophe.
of it being a total catastrophe.
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So I started thinking about that,
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but my thoughts didn't crystallize
until about a month later.
until about a month later.
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I was having dinner with my colleague,
Danny Kahneman, the Nobel Prize winner,
Danny Kahneman, the Nobel Prize winner,
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and I somewhat embarrassedly told him
about having broken my window,
about having broken my window,
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and, you know, forgotten my passport,
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03:13
and Danny shared with me
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that he'd been practicing
something called prospective hindsight.
something called prospective hindsight.
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(Laughter)
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It's something that he had gotten
from the psychologist Gary Klein,
from the psychologist Gary Klein,
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who had written about it
a few years before,
a few years before,
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also called the pre-mortem.
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Now, you all know what the postmortem is.
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Whenever there's a disaster,
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a team of experts come in and they try
to figure out what went wrong, right?
to figure out what went wrong, right?
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Well, in the pre-mortem, Danny explained,
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you look ahead and you try to figure out
all the things that could go wrong,
all the things that could go wrong,
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and then you try to figure out
what you can do
what you can do
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to prevent those things from happening,
or to minimize the damage.
or to minimize the damage.
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03:48
So what I want to talk to you about today
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are some of the things we can do
in the form of a pre-mortem.
in the form of a pre-mortem.
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Some of them are obvious,
some of them are not so obvious.
some of them are not so obvious.
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I'll start with the obvious ones.
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Around the home, designate a place
for things that are easily lost.
for things that are easily lost.
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Now, this sounds
like common sense, and it is,
like common sense, and it is,
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but there's a lot of science
to back this up,
to back this up,
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based on the way our spatial memory works.
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There's a structure in the brain
called the hippocampus,
called the hippocampus,
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that evolved over tens
of thousands of years,
of thousands of years,
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to keep track of the locations
of important things --
of important things --
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where the well is,
where fish can be found,
where fish can be found,
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that stand of fruit trees,
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where the friendly and enemy tribes live.
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The hippocampus is the part of the brain
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that in London taxicab drivers
becomes enlarged.
becomes enlarged.
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It's the part of the brain
that allows squirrels to find their nuts.
that allows squirrels to find their nuts.
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And if you're wondering,
somebody actually did the experiment
somebody actually did the experiment
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where they cut off
the olfactory sense of the squirrels,
the olfactory sense of the squirrels,
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and they could still find their nuts.
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They weren't using smell,
they were using the hippocampus,
they were using the hippocampus,
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this exquisitely evolved mechanism
in the brain for finding things.
in the brain for finding things.
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But it's really good for things
that don't move around much,
that don't move around much,
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not so good for things that move around.
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So this is why we lose car keys
and reading glasses and passports.
and reading glasses and passports.
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So in the home,
designate a spot for your keys --
designate a spot for your keys --
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a hook by the door,
maybe a decorative bowl.
maybe a decorative bowl.
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For your passport, a particular drawer.
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For your reading glasses,
a particular table.
a particular table.
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If you designate a spot
and you're scrupulous about it,
and you're scrupulous about it,
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your things will always be there
when you look for them.
when you look for them.
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What about travel?
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Take a cell phone picture
of your credit cards,
of your credit cards,
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your driver's license, your passport,
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mail it to yourself so it's in the cloud.
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If these things are lost or stolen,
you can facilitate replacement.
you can facilitate replacement.
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Now these are some rather obvious things.
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Remember, when you're under stress,
the brain releases cortisol.
the brain releases cortisol.
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Cortisol is toxic,
and it causes cloudy thinking.
and it causes cloudy thinking.
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So part of the practice of the pre-mortem
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is to recognize that under stress
you're not going to be at your best,
you're not going to be at your best,
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and you should put systems in place.
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05:55
And there's perhaps
no more stressful a situation
no more stressful a situation
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than when you're confronted
with a medical decision to make.
with a medical decision to make.
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And at some point, all of us
are going to be in that position,
are going to be in that position,
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where we have to make
a very important decision
a very important decision
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about the future of our medical care
or that of a loved one,
or that of a loved one,
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to help them with a decision.
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And so I want to talk about that.
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And I'm going to talk about
a very particular medical condition.
a very particular medical condition.
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But this stands as a proxy for all kinds
of medical decision-making,
of medical decision-making,
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and indeed for financial decision-making,
and social decision-making --
and social decision-making --
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any kind of decision you have to make
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that would benefit from a rational
assessment of the facts.
assessment of the facts.
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So suppose you go to your doctor
and the doctor says,
and the doctor says,
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"I just got your lab work back,
your cholesterol's a little high."
your cholesterol's a little high."
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Now, you all know that high cholesterol
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is associated with an increased risk
of cardiovascular disease,
of cardiovascular disease,
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heart attack, stroke.
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And so you're thinking
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having high cholesterol
isn't the best thing,
isn't the best thing,
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and so the doctor says,
"You know, I'd like to give you a drug
"You know, I'd like to give you a drug
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that will help you
lower your cholesterol, a statin."
lower your cholesterol, a statin."
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And you've probably heard of statins,
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you know that they're among
the most widely prescribed drugs
the most widely prescribed drugs
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in the world today,
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you probably even know
people who take them.
people who take them.
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And so you're thinking,
"Yeah! Give me the statin."
"Yeah! Give me the statin."
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But there's a question
you should ask at this point,
you should ask at this point,
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a statistic you should ask for
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that most doctors
don't like talking about,
don't like talking about,
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and pharmaceutical companies
like talking about even less.
like talking about even less.
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It's for the number needed to treat.
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Now, what is this, the NNT?
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It's the number of people
that need to take a drug
that need to take a drug
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or undergo a surgery
or any medical procedure
or any medical procedure
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before one person is helped.
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And you're thinking,
what kind of crazy statistic is that?
what kind of crazy statistic is that?
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The number should be one.
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My doctor wouldn't prescribe
something to me
something to me
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if it's not going to help.
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But actually, medical practice
doesn't work that way.
doesn't work that way.
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And it's not the doctor's fault,
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if it's anybody's fault,
it's the fault of scientists like me.
it's the fault of scientists like me.
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We haven't figured out
the underlying mechanisms well enough.
the underlying mechanisms well enough.
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But GlaxoSmithKline estimates
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that 90 percent of the drugs work
in only 30 to 50 percent of the people.
in only 30 to 50 percent of the people.
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So the number needed to treat
for the most widely prescribed statin,
for the most widely prescribed statin,
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what do you suppose it is?
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How many people have to take it
before one person is helped?
before one person is helped?
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300.
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This is according to research
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by research practitioners
Jerome Groopman and Pamela Hartzband,
Jerome Groopman and Pamela Hartzband,
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independently confirmed by Bloomberg.com.
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I ran through the numbers myself.
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300 people have to
take the drug for a year
take the drug for a year
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before one heart attack, stroke
or other adverse event is prevented.
or other adverse event is prevented.
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Now you're probably thinking,
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"Well, OK, one in 300 chance
of lowering my cholesterol.
of lowering my cholesterol.
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Why not, doc? Give me
the prescription anyway."
the prescription anyway."
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But you should ask at this point
for another statistic,
for another statistic,
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and that is, "Tell me
about the side effects." Right?
about the side effects." Right?
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So for this particular drug,
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the side effects occur
in five percent of the patients.
in five percent of the patients.
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And they include terrible things --
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debilitating muscle and joint pain,
gastrointestinal distress --
gastrointestinal distress --
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but now you're thinking, "Five percent,
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not very likely
it's going to happen to me,
it's going to happen to me,
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I'll still take the drug."
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But wait a minute.
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Remember under stress
you're not thinking clearly.
you're not thinking clearly.
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So think about how you're going
to work through this ahead of time,
to work through this ahead of time,
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so you don't have to manufacture
the chain of reasoning on the spot.
the chain of reasoning on the spot.
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300 people take the drug, right?
One person's helped,
One person's helped,
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five percent of those 300
have side effects,
have side effects,
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that's 15 people.
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You're 15 times more likely
to be harmed by the drug
to be harmed by the drug
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than you are to be helped by the drug.
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Now, I'm not saying whether you
should take the statin or not.
should take the statin or not.
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I'm just saying you should have
this conversation with your doctor.
this conversation with your doctor.
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Medical ethics requires it,
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it's part of the principle
of informed consent.
of informed consent.
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You have the right to have access
to this kind of information
to this kind of information
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to begin the conversation about whether
you want to take the risks or not.
you want to take the risks or not.
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Now you might be thinking
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I've pulled this number
out of the air for shock value,
out of the air for shock value,
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but in fact it's rather typical,
this number needed to treat.
this number needed to treat.
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For the most widely performed surgery
on men over the age of 50,
on men over the age of 50,
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removal of the prostate for cancer,
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the number needed to treat is 49.
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That's right, 49 surgeries are done
for every one person who's helped.
for every one person who's helped.
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And the side effects in that case
occur in 50 percent of the patients.
occur in 50 percent of the patients.
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They include impotence,
erectile dysfunction,
erectile dysfunction,
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urinary incontinence, rectal tearing,
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fecal incontinence.
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And if you're lucky, and you're one
of the 50 percent who has these,
of the 50 percent who has these,
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they'll only last for a year or two.
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So the idea of the pre-mortem
is to think ahead of time
is to think ahead of time
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to the questions
that you might be able to ask
that you might be able to ask
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that will push the conversation forward.
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You don't want to have to manufacture
all of this on the spot.
all of this on the spot.
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And you also want to think
about things like quality of life.
about things like quality of life.
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Because you have a choice oftentimes,
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do you I want a shorter life
that's pain-free,
that's pain-free,
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or a longer life that might have
a great deal of pain towards the end?
a great deal of pain towards the end?
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These are things to talk about
and think about now,
and think about now,
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with your family and your loved ones.
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You might change your mind
in the heat of the moment,
in the heat of the moment,
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but at least you're practiced
with this kind of thinking.
with this kind of thinking.
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Remember, our brain under stress
releases cortisol,
releases cortisol,
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and one of the things
that happens at that moment
that happens at that moment
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is a whole bunch on systems shut down.
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There's an evolutionary reason for this.
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Face-to-face with a predator,
you don't need your digestive system,
you don't need your digestive system,
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or your libido, or your immune system,
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because if you're body is expending
metabolism on those things
metabolism on those things
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and you don't react quickly,
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you might become the lion's lunch,
and then none of those things matter.
and then none of those things matter.
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Unfortunately,
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one of the things that goes out the window
during those times of stress
during those times of stress
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is rational, logical thinking,
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as Danny Kahneman
and his colleagues have shown.
and his colleagues have shown.
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So we need to train ourselves
to think ahead
to think ahead
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to these kinds of situations.
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I think the important point here
is recognizing that all of us are flawed.
is recognizing that all of us are flawed.
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We all are going to fail now and then.
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The idea is to think ahead
to what those failures might be,
to what those failures might be,
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to put systems in place
that will help minimize the damage,
that will help minimize the damage,
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or to prevent the bad things
from happening in the first place.
from happening in the first place.
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Getting back to that
snowy night in Montreal,
snowy night in Montreal,
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when I got back from my trip,
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I had my contractor install
a combination lock next to the door,
a combination lock next to the door,
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with a key to the front door in it,
an easy to remember combination.
an easy to remember combination.
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And I have to admit,
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I still have piles of mail
that haven't been sorted,
that haven't been sorted,
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and piles of emails
that I haven't gone through.
that I haven't gone through.
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So I'm not completely organized,
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but I see organization
as a gradual process,
as a gradual process,
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and I'm getting there.
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Thank you very much.
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(Applause)
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ABOUT THE SPEAKER
Daniel Levitin - NeuroscientistDaniel Levitin incorporates findings from neuroscience into everyday life.
Why you should listen
Dr. Daniel Levitin is a neuroscientist at McGill University in Montreal, dean at Minerva Schools in San Francisco and a musician. His research focuses on pattern processing in the brain.
His three books This Is Your Brain on Music, The World in Six Songs, and the recent The Organized Mind are all bestsellers. A polymath at heart, he has performed with top musicians and holds a few gold and platinum records.
Levitin earned his B.A. in Cognitive Psychology and Cognitive Science at Stanford University, and went on to earn his Ph.D. in Psychology from the University of Oregon, researching complex auditory patterns and pattern processing in expert and non-expert populations. He completed post-doctoral training at Stanford University Medical School (in Neuroimaging) and at UC Berkeley (in Cognitive Psychology). He has consulted on audio sound source separation for the U.S. Navy, and on audio quality for several rock bands and record labels (including the Grateful Dead and Steely Dan), and served as one of the “Golden Ears” expert listeners in the original Dolby AC3 compression tests. He worked for two years at the Silicon Valley think tank Interval Research Corporation.
He taught at Stanford University in the Department of Computer Science, the Program in Human-Computer Interaction, and the Departments of Psychology, Anthropology, Computer Music, and History of Science.
Daniel Levitin | Speaker | TED.com