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12:20
How to stay calm when you know you'll be stressed | Daniel Levitin | TED
TED
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May 10, 2026
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Transcript
0:13
A few years ago,
I broke into my own house.
0:16
I had just driven home,
0:18
it was around midnight
in the dead of Montreal winter,
0:20
I had been visiting my friend,
Jeff, across town,
0:23
and the thermometer on the front porch
read minus 40 degrees --
0:27
and don't bother asking
if that's Celsius or Fahrenheit,
0:30
minus 40 is where the two scales meet --
0:33
it was very cold.
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0:34
And as I stood on the front porch
fumbling in my pockets,
0:37
I found I didn't have my keys.
0:40
In fact, I could see them
through the window,
0:42
lying on the dining room table
where I had left them.
0:45
So I quickly ran around
and tried all the other doors and windows,
0:48
and they were locked tight.
0:50
I thought about calling a locksmith --
at least I had my cellphone,
0:53
but at midnight, it could take a while
for a locksmith to show up,
0:56
and it was cold.
1:00
I couldn't go back to my friend
Jeff's house for the night
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1:03
because I had an early flight
to Europe the next morning,
1:05
and I needed to get
my passport and my suitcase.
1:08
So, desperate and freezing cold,
1:10
I found a large rock and I broke
through the basement window,
1:14
cleared out the shards of glass,
1:16
I crawled through,
1:17
I found a piece of cardboard
and taped it up over the opening,
1:21
figuring that in the morning,
on the way to the airport,
1:24
I could call my contractor
and ask him to fix it.
1:26
This was going to be expensive,
1:28
but probably no more expensive
than a middle-of-the-night locksmith,
1:31
so I figured, under the circumstances,
I was coming out even.
1:36
Now, I'm a neuroscientist by training
1:39
and I know a little bit
about how the brain performs under stress.
1:43
It releases cortisol
that raises your heart rate,
1:46
it modulates adrenaline levels
1:49
and it clouds your thinking.
1:51
So the next morning,
1:53
when I woke up on too little sleep,
1:55
worrying about the hole in the window,
1:58
and a mental note
that I had to call my contractor,
2:01
and the freezing temperatures,
2:02
and the meetings I had upcoming in Europe,
2:05
and, you know, with all
the cortisol in my brain,
2:08
my thinking was cloudy,
2:10
but I didn't know it was cloudy
because my thinking was cloudy.
2:13
(Laughter)
2:15
And it wasn't until I got
to the airport check-in counter,
2:18
that I realized I didn't have my passport.
2:20
(Laughter)
2:22
So I raced home in the snow
and ice, 40 minutes,
2:26
got my passport,
raced back to the airport,
2:28
I made it just in time,
2:30
but they had given away
my seat to someone else,
2:32
so I got stuck in the back of the plane,
next to the bathrooms,
2:35
in a seat that wouldn't recline,
on an eight-hour flight.
2:39
Well, I had a lot of time to think
during those eight hours and no sleep.
2:43
(Laughter)
2:44
And I started wondering,
are there things that I can do,
2:47
systems that I can put into place,
2:49
that will prevent bad things
from happening?
2:51
Or at least if bad things happen,
2:53
will minimize the likelihood
of it being a total catastrophe.
2:59
So I started thinking about that,
3:00
but my thoughts didn't crystallize
until about a month later.
3:03
I was having dinner with my colleague,
Danny Kahneman, the Nobel Prize winner,
3:07
and I somewhat embarrassedly told him
about having broken my window,
3:10
and, you know, forgotten my passport,
3:13
and Danny shared with me
3:14
that he'd been practicing
something called prospective hindsight.
3:19
(Laughter)
3:20
It's something that he had gotten
from the psychologist Gary Klein,
3:24
who had written about it
a few years before,
3:26
also called the pre-mortem.
3:28
Now, you all know what the postmortem is.
3:30
Whenever there's a disaster,
3:31
a team of experts come in and they try
to figure out what went wrong, right?
3:36
Well, in the pre-mortem, Danny explained,
3:38
you look ahead and you try to figure out
all the things that could go wrong,
3:42
and then you try to figure out
what you can do
3:45
to prevent those things from happening,
or to minimize the damage.
3:48
So what I want to talk to you about today
3:51
are some of the things we can do
in the form of a pre-mortem.
3:55
Some of them are obvious,
some of them are not so obvious.
3:58
I'll start with the obvious ones.
3:59
Around the home, designate a place
for things that are easily lost.
4:05
Now, this sounds
like common sense, and it is,
4:09
but there's a lot of science
to back this up,
4:12
based on the way our spatial memory works.
4:15
There's a structure in the brain
called the hippocampus,
4:18
that evolved over tens
of thousands of years,
4:21
to keep track of the locations
of important things --
4:25
where the well is,
where fish can be found,
4:27
that stand of fruit trees,
4:30
where the friendly and enemy tribes live.
4:32
The hippocampus is the part of the brain
4:34
that in London taxicab drivers
becomes enlarged.
4:38
It's the part of the brain
that allows squirrels to find their nuts.
4:41
And if you're wondering,
somebody actually did the experiment
4:44
where they cut off
the olfactory sense of the squirrels,
4:47
and they could still find their nuts.
4:49
They weren't using smell,
they were using the hippocampus,
4:52
this exquisitely evolved mechanism
in the brain for finding things.
4:57
But it's really good for things
that don't move around much,
5:01
not so good for things that move around.
5:03
So this is why we lose car keys
and reading glasses and passports.
5:07
So in the home,
designate a spot for your keys --
5:10
a hook by the door,
maybe a decorative bowl.
5:13
For your passport, a particular drawer.
5:15
For your reading glasses,
a particular table.
5:18
If you designate a spot
and you're scrupulous about it,
5:21
your things will always be there
when you look for them.
5:24
What about travel?
5:25
Take a cell phone picture
of your credit cards,
5:28
your driver's license, your passport,
5:30
mail it to yourself so it's in the cloud.
5:32
If these things are lost or stolen,
you can facilitate replacement.
5:37
Now these are some rather obvious things.
5:39
Remember, when you're under stress,
the brain releases cortisol.
5:43
Cortisol is toxic,
and it causes cloudy thinking.
5:46
So part of the practice of the pre-mortem
5:49
is to recognize that under stress
you're not going to be at your best,
5:53
and you should put systems in place.
5:55
And there's perhaps
no more stressful a situation
5:58
than when you're confronted
with a medical decision to make.
6:02
And at some point, all of us
are going to be in that position,
6:05
where we have to make
a very important decision
6:07
about the future of our medical care
or that of a loved one,
6:11
to help them with a decision.
6:12
And so I want to talk about that.
6:14
And I'm going to talk about
a very particular medical condition.
6:17
But this stands as a proxy for all kinds
of medical decision-making,
6:21
and indeed for financial decision-making,
and social decision-making --
6:25
any kind of decision you have to make
6:27
that would benefit from a rational
assessment of the facts.
6:31
So suppose you go to your doctor
and the doctor says,
6:34
"I just got your lab work back,
your cholesterol's a little high."
6:39
Now, you all know that high cholesterol
6:42
is associated with an increased risk
of cardiovascular disease,
6:46
heart attack, stroke.
6:47
And so you're thinking
6:49
having high cholesterol
isn't the best thing,
6:51
and so the doctor says,
"You know, I'd like to give you a drug
6:54
that will help you
lower your cholesterol, a statin."
6:57
And you've probably heard of statins,
6:59
you know that they're among
the most widely prescribed drugs
7:01
in the world today,
7:03
you probably even know
people who take them.
7:05
And so you're thinking,
"Yeah! Give me the statin."
7:07
But there's a question
you should ask at this point,
7:10
a statistic you should ask for
7:11
that most doctors
don't like talking about,
7:14
and pharmaceutical companies
like talking about even less.
7:18
It's for the number needed to treat.
7:21
Now, what is this, the NNT?
7:23
It's the number of people
that need to take a drug
7:26
or undergo a surgery
or any medical procedure
7:29
before one person is helped.
7:31
And you're thinking,
what kind of crazy statistic is that?
7:34
The number should be one.
7:35
My doctor wouldn't prescribe
something to me
7:37
if it's not going to help.
7:39
But actually, medical practice
doesn't work that way.
7:41
And it's not the doctor's fault,
7:43
if it's anybody's fault,
it's the fault of scientists like me.
7:46
We haven't figured out
the underlying mechanisms well enough.
7:48
But GlaxoSmithKline estimates
7:51
that 90 percent of the drugs work
in only 30 to 50 percent of the people.
7:56
So the number needed to treat
for the most widely prescribed statin,
8:00
what do you suppose it is?
8:02
How many people have to take it
before one person is helped?
8:05
300.
8:07
This is according to research
8:08
by research practitioners
Jerome Groopman and Pamela Hartzband,
8:12
independently confirmed by Bloomberg.com.
8:14
I ran through the numbers myself.
8:17
300 people have to
take the drug for a year
8:20
before one heart attack, stroke
or other adverse event is prevented.
8:24
Now you're probably thinking,
8:25
"Well, OK, one in 300 chance
of lowering my cholesterol.
8:28
Why not, doc? Give me
the prescription anyway."
8:30
But you should ask at this point
for another statistic,
8:33
and that is, "Tell me
about the side effects." Right?
8:36
So for this particular drug,
8:37
the side effects occur
in five percent of the patients.
8:41
And they include terrible things --
8:43
debilitating muscle and joint pain,
gastrointestinal distress --
8:47
but now you're thinking, "Five percent,
8:49
not very likely
it's going to happen to me,
8:51
I'll still take the drug."
8:52
But wait a minute.
8:54
Remember under stress
you're not thinking clearly.
8:56
So think about how you're going
to work through this ahead of time,
8:59
so you don't have to manufacture
the chain of reasoning on the spot.
9:02
300 people take the drug, right?
One person's helped,
9:05
five percent of those 300
have side effects,
9:07
that's 15 people.
9:09
You're 15 times more likely
to be harmed by the drug
9:13
than you are to be helped by the drug.
9:16
Now, I'm not saying whether you
should take the statin or not.
9:19
I'm just saying you should have
this conversation with your doctor.
9:22
Medical ethics requires it,
9:24
it's part of the principle
of informed consent.
9:26
You have the right to have access
to this kind of information
9:29
to begin the conversation about whether
you want to take the risks or not.
9:33
Now you might be thinking
9:34
I've pulled this number
out of the air for shock value,
9:37
but in fact it's rather typical,
this number needed to treat.
9:40
For the most widely performed surgery
on men over the age of 50,
9:45
removal of the prostate for cancer,
9:47
the number needed to treat is 49.
9:50
That's right, 49 surgeries are done
for every one person who's helped.
9:54
And the side effects in that case
occur in 50 percent of the patients.
9:59
They include impotence,
erectile dysfunction,
10:01
urinary incontinence, rectal tearing,
10:04
fecal incontinence.
10:06
And if you're lucky, and you're one
of the 50 percent who has these,
10:09
they'll only last for a year or two.
10:12
So the idea of the pre-mortem
is to think ahead of time
10:16
to the questions
that you might be able to ask
10:19
that will push the conversation forward.
10:21
You don't want to have to manufacture
all of this on the spot.
10:24
And you also want to think
about things like quality of life.
10:27
Because you have a choice oftentimes,
10:29
do you I want a shorter life
that's pain-free,
10:31
or a longer life that might have
a great deal of pain towards the end?
10:35
These are things to talk about
and think about now,
10:37
with your family and your loved ones.
10:39
You might change your mind
in the heat of the moment,
10:42
but at least you're practiced
with this kind of thinking.
10:45
Remember, our brain under stress
releases cortisol,
10:49
and one of the things
that happens at that moment
10:52
is a whole bunch on systems shut down.
10:54
There's an evolutionary reason for this.
10:56
Face-to-face with a predator,
you don't need your digestive system,
10:59
or your libido, or your immune system,
11:02
because if you're body is expending
metabolism on those things
11:05
and you don't react quickly,
11:07
you might become the lion's lunch,
and then none of those things matter.
11:11
Unfortunately,
11:12
one of the things that goes out the window
during those times of stress
11:16
is rational, logical thinking,
11:18
as Danny Kahneman
and his colleagues have shown.
11:22
So we need to train ourselves
to think ahead
11:25
to these kinds of situations.
11:27
I think the important point here
is recognizing that all of us are flawed.
11:33
We all are going to fail now and then.
11:36
The idea is to think ahead
to what those failures might be,
11:40
to put systems in place
that will help minimize the damage,
11:44
or to prevent the bad things
from happening in the first place.
11:48
Getting back to that
snowy night in Montreal,
11:50
when I got back from my trip,
11:52
I had my contractor install
a combination lock next to the door,
11:56
with a key to the front door in it,
an easy to remember combination.
12:00
And I have to admit,
12:01
I still have piles of mail
that haven't been sorted,
12:04
and piles of emails
that I haven't gone through.
12:07
So I'm not completely organized,
12:09
but I see organization
as a gradual process,
12:12
and I'm getting there.
12:13
Thank you very much.
12:14
(Applause)
— end of transcript —
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