How to stay calm when you know you’ll be stressed | Daniel Levitin

A few years ago,
I broke into my own house. I had just driven home, it was around midnight
in the dead of Montreal winter, I had 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’s 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 had 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 cellphone, 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 and 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 opening, figuring that in the morning,
on the way to the airport, I could call my contractor
and ask him to fix it. This was going to be expensive, but probably no more expensive
than a 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 on too little sleep, worrying about the hole in the window, and a 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. (Laughter) And it wasn’t until I got
to the airport check-in counter, that I realized I didn’t have my passport. (Laughter) 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 and no sleep. (Laughter) And I started wondering,
are there things that I can do, systems that I can put into place, that will 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, forgotten my passport, and Danny shared with me that he’d been practicing
something called prospective hindsight. (Laughter) 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 postmortem is. Whenever there’s a disaster, a 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 — 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 taxicab 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 where they cut off
the olfactory sense 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 pre-mortem 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 a 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’s a little high.” Now, you all know that 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 will 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. 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. And you’re thinking,
what kind of crazy statistic is that? 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 it’s anybody’s fault,
it’s the fault of scientists like me. We haven’t figured out
the underlying mechanisms well enough. But GlaxoSmithKline estimates that 90 percent of the drugs work
in only 30 to 50 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 is helped? 300. This is according to research by research practitioners
Jerome Groopman and Pamela Hartzband, independently confirmed by 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, OK, 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, “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
you’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 you I want a shorter life
that’s pain-free, 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 under stress
releases cortisol, and one of the things
that happens at that moment is a whole bunch on 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 you’re 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. Unfortunately, one of the things that goes out the window
during those times of 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. (Applause)

About the author


  1. Sorry but this speech is poor. The title is unrelated and misleading. The advice basic, obvious and examples weak. Stress / anxiety causes mental tunnel vision, we get energised but lose the awareness to think broadly, that's why it's easy to forget things because we get distracted by what's immediately on our minds. It helps to slow down, think broadly and make a list on paper (eg the night before). Then when short on time refer to the list and focus on the essentials. Got more time? Do the extras after completing the essentials

  2. We don't know what we don't know and so it would be difficult to think ahead as to what may or may not happen.

  3. i'd been watching TED and became a huge fan since the program launched few years ago.. i agree that over the years there has been issues and flaws with their programs but still very helpful to alot of people…love TED

  4. The primary thing to do under a stress situation is to be calm observe and introspect…..Do not show it to the world…….But critical analysis in head is required. Some prognostic and predictive rational thinking also helps a great deal……Assume the future must go wildly wrong! One can then see the picture and act accordingly; good talk from someone with a neuro background.

  5. As Daniel Levitin stated; When you're stressed, you can't operate at your best.

    That's why the title seems misleading, because he believes the truth is you can't. He gave us something we can do, though; how to think ahead of time and be ready for stressful situations. There might be ways to immediately calm yourself and de-stress, but as far as Daniel's concern as a neuroscientist; you can't.

    The title is meant as an attention grabber, it's titled in a way to grab our attention with what they know we believe in so they can deliver the truth to us. Whether that truth is correct or not is debatable, but this is what they believe in; I think it's wrong to assume the worst about the title when it's intention wasn't malicious.

  6. "Look ahead and think of all the things that could go wrong". Hello anxiety disorder. Not the best advice I've ever heard.

  7. I'm at 9:43 and am beginning to doubt this guy is actually capable of making a point. It's digression at its purist. Like snow on a grass covered mountain. Btw, popsicles are delicious too, although the label's fat content is misleading, just like the video's title 😉

  8. What this guy just said is one of the most insanely idiotic things I have ever heard.

    At no point in his rambling, incoherent story was he even close to anything that could be considered a rational thought. Everyone in that room is now dumber for having listened to it.

  9. * OMG, I get so angry at myself every single time I forget about this THING come back to it again and again 😂 due to this crazy title to lure stupid me in!

  10. How to stay calm when you know you'll be stressed — designate a place for your keys or just another way of saying "If i would know , i would tell you, but in the meantime let's talk about something else "

  11. Besides the stress topic – the fact that he is willing to tell the truth about pharmaceutical companies (priceless)

  12. What Mr Levitin means by "pre-mortem" may be called commonly Risk Management: identify potential risks, their likeliness, the extent of their impact, how to mitigate or avoid them. By the way, Montreal is a cold place during winter, but not as much as Mr Levitin's words may imply. PL Montreal

  13. This was one of the worst Ted talks I've ever listened to. No coherent point to this. Just an anecdote and a few random tips.

  14. As a person who works in a financial institute, please don't take a photo of your debit or credit card. This is dangerous on so many levels. What if you lose your phone? What if your account gets hacked? People can still do things with just the number and expiration date. If you lose your card call your financial institute and put a temporary block on it or use their tools, such as an app, to do it yourself until you can find it.

  15. The squirrel thing freaked me out. Like, they really cut off the animal’s sense of smell in the hope that they’ll still be able to forage for nuts? 😨😨

  16. I pretty much cringed everytime he said "Brain releases cortisol" I knew he meant it releases CRH, but still for a ted talk, I would have expected less dumbed down talk.

  17. The title of this was misleading and if anything I now feel more stressed compared to when I started watching this video. Am I going to worry and stress over my health now too? 😤

  18. So, in short, it is risk management.
    Foreseeing possible consequences and risks,
    and then think of good plans before bad things happens

  19. When I drive to the airport, I always take a photo with my phone of the sign nearest my car so I can find it when I return. That is because I once totally forgot where I parked, and I wandered around for some time looking for it. Haha. Im sure others are smart enough to know to do this, but I had to learn the hard way.

  20. Train yourself to think ahead and put systems in place to minimize the damage or prevent problems. He calls it a 'pre-mortem' .

  21. If you really try a pre-mortem with your doctor he'll despise you, doesn't want to AND couldn't, even if he wanted to. To treat patients like cattle and medicine as a lucrative business is the norm and anybody going into poltics is quickly bought by drug companies. Though bought with money they are convinced by false but nice looking pseudo-reasoning. The first step to a solution would be to prevent companies that are too big and have bigger resources than the government. In good working capitalism the government must be the strongest partner and without business interests.

  22. i watched this video very carefully and after watching till the end, i came in the comment section.Found that from 300 people just only one could understand what the doctor said.Others got the side effects only.

  23. This is the worst advice ever. Stress and anxiety is caused by thinking about potentially negative future events. Why is this guy is telling us that exploring all possible negative future events mitigates stress?

  24. Is it me or the title had nothing to do with the content !! I still don’t know how to stay calm in a stressful situation… but I do now know which question shall I ask my doctor when prescribing new drugs 😂

Leave a Reply

Your email address will not be published. Required fields are marked *