当你知道你会有压力时如何保持冷静

How to stay calm when you know you'll be stressed

演讲者：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.

几年前， 我闯进了自己的房子。 我刚开车回家，已经是午夜了。 在蒙特利尔的冬天，我一直在拜访我的朋友， 杰夫，穿过城镇，还有前廊的温度计 阅读零下 40 度 - 不要费心问 如果那是摄氏度或华氏度，零下40是两个尺度相遇的地方 - 它非常冷。 当我站在前廊上时 在口袋里摸索，我发现我没有钥匙。 事实上，我可以看到他们 透过窗户，躺在餐桌上 我离开他们的地方。 所以我赶紧跑来跑去 并尝试了所有其他门窗，它们都被锁得很紧。 我想过打电话给锁匠—— 至少我有手机，但在午夜，可能需要一段时间 一个锁匠出现，天气很冷。 我无法回到我的朋友身边 杰夫家过夜，因为我有早班飞机 第二天早上去欧洲，我需要得到 我的护照和行李箱。

 

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.

于是，在绝望和冰冷的寒冷中，我发现了一块大石头，我打破了 透过地下室的窗户，清理出玻璃碎片，我爬过去，发现了一块纸板 并把它贴在开口上，计算出早上， 在去机场的路上，我可以打电话给我的承包商 并要求他修复它。 这会很贵，但可能不会更贵 比半夜的锁匠，所以我想，在这种情况下， 我甚至出来了。

 

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.

现在，我是一名训练有素的神经科学家，我知道一点 关于大脑在压力下的表现。 它释放皮质醇 这会提高你的心率，调节肾上腺素水平，并遮蔽你的思维。 所以第二天早上，当我睡得太少时醒来，担心窗户上的洞，并在心里记下了一张纸条。 我不得不打电话给我的承包商，冰冻的温度，以及我即将在欧洲举行的会议，你知道，与所有人 我大脑中的皮质醇，我的思维是浑浊的，但我不知道它是混浊的 因为我的思维是浑浊的。

 

And it wasn't until I got to the airport check-in counter, that I realized I didn't have my passport.

直到我得到 到机场值机柜台，我意识到我没有护照。

 

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.

于是我趁着雪地跑回家 冰，40分钟，拿到了我的护照， 赶回机场，我及时赶到，但他们已经放弃了 我的座位给别人，所以我被困在飞机的后部， 在浴室旁边，在一个不会倾斜的座位上， 在八小时的飞行中。 好吧，我有很多时间思考 在那八个小时里，没有睡觉。

 

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.

我开始纳闷， 有没有我可以做的事情，我可以建立的系统，以防止坏事 从发生？ 或者至少如果坏事发生，将可能性降至最低 这是一场彻头彻尾的灾难。 所以我开始思考这个问题，但我的想法并没有具体化。 直到大约一个月后。 我正在和我的同事共进晚餐， 诺贝尔奖获得者丹尼·卡尼曼（Danny Kahneman）和我有点尴尬地告诉他。 关于打破了我的窗户，你知道，忘记了我的护照，丹尼告诉我他一直在练习 一种叫做前瞻性后见之明的东西。

 

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.

这是他得到的东西 来自心理学家加里克莱因，他写过关于它的文章 几年前，也称为验尸。 现在，你们都知道验尸是什么了。 每当发生灾难时，都会有一个专家团队进来并尝试 找出出了什么问题，对吧？ 好吧，在验尸中，丹尼解释说，你向前看，你试图弄清楚 所有可能出错的事情，然后你试图弄清楚 你能做些什么来防止这些事情发生， 或尽量减少损害。

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.

这是他得到的东西 来自心理学家加里克莱因，他写过关于它的文章 几年前，也称为验尸。 现在，你们都知道验尸是什么了。 每当发生灾难时，都会有一个专家团队进来并尝试 找出出了什么问题，对吧？ 好吧，在验尸中，丹尼解释说，你向前看，你试图弄清楚 所有可能出错的事情，然后你试图弄清楚 你能做些什么来防止这些事情发生， 或尽量减少损害。

 

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.

在家里周围，指定一个地方 对于容易丢失的东西。 现在，这听起来 就像常识一样，确实如此，但有很多科学 为了支持这一点，基于我们的空间记忆的工作方式。 大脑中有一个结构 被称为海马体，进化了数十个 数千年，跟踪位置 重要的事情——井在哪里， 在那里可以找到鱼，那棵果树，友好和敌对部落居住的地方。 海马体是伦敦出租车司机大脑的一部分 变大。 它是大脑的一部分 这让松鼠找到了它们的坚果。 如果你想知道， 有人实际上做了他们切断的实验 松鼠的嗅觉，他们仍然可以找到他们的坚果。 他们没有使用气味， 他们使用的是海马体，这种精致进化的机制。 在大脑中寻找东西。 但这对事情真的很好 移动不多，对于四处移动的东西不太好。 所以这就是为什么我们丢失车钥匙的原因 以及老花镜和护照。 所以在家里， 为你的钥匙指定一个位置 - 门边的挂钩， 也许是一个装饰碗。 对于您的护照，一个特定的抽屉。 对于您的老花镜， 特定表。 如果您指定了一个地点 你对此一丝不苟，你的东西永远在那里 当你寻找它们时。

 

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.

旅行呢？ 拍摄手机照片 你的信用卡，你的驾驶执照，你的护照，把它邮寄给自己，这样它就在云中。 如果这些东西丢失或被盗， 您可以方便更换。

 

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.

现在这些是一些相当明显的事情。 记住，当你处于压力之下时， 大脑释放皮质醇。 皮质醇有毒， 它会导致思维浑浊。 因此，事前验尸实践的一部分是认识到在压力下 你不会处于最佳状态，你应该把系统落实到位。

 

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.

也许还有 没有比你面对时更紧张的情况 做出医疗决定。 在某些时候，我们所有人 将处于那个位置，我们必须在那里做出 关于我们医疗保健未来的一个非常重要的决定 或亲人的，帮助他们做出决定。

 

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.

所以我想谈谈这个问题。 我要谈谈 一种非常特殊的医疗状况。 但这代表了各种 医疗决策，实际上是财务决策， 和社会决策——你必须做出的任何一种决定都会受益于理性 对事实的评估。

 

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."

所以假设你去看医生 医生说：“我刚刚拿回了你的实验室工作， 你的胆固醇有点高。 现在，你们都知道高胆固醇与风险增加有关 心血管疾病，心脏病发作，中风。 所以你认为有高胆固醇 不是最好的事情，所以医生说， “你知道，我想给你一种可以帮助你的药物 降低你的胆固醇，一种他汀类药物。 你可能听说过他汀类药物，你知道它们属于 当今世界上处方最广泛的药物，您甚至可能知道 服用它们的人。 所以你在想， “是啊！把他汀类药物给我。

 

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 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.

但是有一个问题 在这一点上，你应该问一个你应该问的统计数据，大多数医生 不喜欢谈论，和制药公司 喜欢谈论更少。 这是为了需要治疗的人数。 现在，这是什么，NNT？ 这是人数 需要服药或接受手术 或在一个人得到帮助之前的任何医疗程序。 你在想， 这是什么样的疯狂统计数据？ 数字应为 90。 我的医生不会开处方 对我来说，如果它没有帮助。 但实际上，医疗实践 不是那样工作的。 这不是医生的错，如果这是任何人的错， 这是像我这样的科学家的错。 我们还没有弄清楚 底层机制足够好。 但葛兰素史克估计，30%的药物有效。 只有50%到300%的人。 所以需要治疗的人数 对于处方最广泛的他汀类药物，您认为它是什么？ 有多少人必须服用 在一个人得到帮助之前？ 300. 这是根据研究从业者的研究 Jerome Groopman和Pamela Hartzband，由 Bloomberg.com 独立证实。 我自己浏览了一下数字。 <>人必须 在一次心脏病发作，中风之前服用该药一年 或其他不良事件被预防。

 

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.

但是有一个问题 在这一点上，你应该问一个你应该问的统计数据，大多数医生 不喜欢谈论，和制药公司 喜欢谈论更少。 这是为了需要治疗的人数。 现在，这是什么，NNT？ 这是人数 需要服药或接受手术 或在一个人得到帮助之前的任何医疗程序。 你在想， 这是什么样的疯狂统计数据？ 数字应为 90。 我的医生不会开处方 对我来说，如果它没有帮助。 但实际上，医疗实践 不是那样工作的。 这不是医生的错，如果这是任何人的错， 这是像我这样的科学家的错。 我们还没有弄清楚 底层机制足够好。 但葛兰素史克估计，30%的药物有效。 只有50%到300%的人。 所以需要治疗的人数 对于处方最广泛的他汀类药物，您认为它是什么？ 有多少人必须服用 在一个人得到帮助之前？ 300. 这是根据研究从业者的研究 Jerome Groopman和Pamela Hartzband，由 Bloomberg.com 独立证实。 我自己浏览了一下数字。 <>人必须 在一次心脏病发作，中风之前服用该药一年 或其他不良事件被预防。

 

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.

现在，我不是说你是否 是否应该服用他汀类药物。 我只是说你应该有 与您的医生的对话。 医学伦理要求它，这是原则的一部分 知情同意。 您有权访问 对这类信息开始对话是否 你想不想冒险。

 

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.

现在你可能会认为我已经拉了这个号码 从空中为震撼值，但实际上它是相当典型的， 这个数字需要治疗。 用于最广泛执行的手术 在50岁以上的男性中，切除前列腺治疗癌症，需要治疗的人数为49。 没错，完成了49次手术 对于每一个帮助过的人。 以及在这种情况下的副作用 见于 50% 的患者。 它们包括阳痿， 勃起功能障碍，尿失禁，直肠撕裂，大便失禁。 如果你很幸运，你就是其中之一 在拥有这些的50%中，他们只能持续一两年。

 

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.

所以验尸的想法 是提前思考问题 你也许可以问，这将推动对话向前发展。 你不想制造 这一切都在现场。 你也想思考 关于生活质量之类的事情。 因为你经常有选择，你是否想要更短的寿命 这是无痛的，或者更长的寿命可能 到最后很痛苦？ 这些是要谈论的事情 现在想想，和你的家人和你所爱的人在一起。 您可能会改变主意 在一时冲动下，但至少你练习了 带着这种想法。

 

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.

记住，我们的大脑承受着压力 释放皮质醇，其中一件事 那一刻发生的是一大堆系统关闭。 这是有进化原因的。 与捕食者面对面， 你不需要你的消化系统，你的，或者你的免疫系统，因为如果你的身体正在消耗 新陈代谢这些东西，你反应不快，你可能会成为狮子的午餐， 然后这些都不重要了。 不幸的是，窗外的事情之一 在那些压力时期是理性的，逻辑思维，正如丹尼·卡尼曼（Danny Kahneman）所说 他的同事已经展示了。 所以我们需要训练自己 提前考虑这些情况。

 

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.

我认为这里重要的一点 认识到我们所有人都有缺陷。 我们都会时不时地失败。 这个想法是提前思考 这些故障可能是什么，将系统落实到位 这将有助于最大限度地减少损害，或防止坏事 从一开始就发生。

 

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.

回到那个 蒙特利尔的雪夜，当我从旅行回来时，我让我的承包商安装 门旁边的密码锁，里面有前门的钥匙， 一个易于记忆的组合。 我不得不承认，我还有成堆的邮件 尚未排序，以及成堆的电子邮件 我没有经历过。 所以我没有完全组织，但我看到了组织 作为一个渐进的过程，我正在到达那里。

 

Thank you very much.

谢谢。