當(dāng)你知道你會有壓力時如何保持冷靜

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

演講者：Daniel Levitin

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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.

幾年前， 我闖進(jìn)了自己的房子。?我剛開車回家，已經(jīng)是午夜了。 在蒙特利爾的冬天，我一直在拜訪我的朋友， 杰夫，穿過城鎮(zhèn)，還有前廊的溫度計 閱讀零下 40 度 -?不要費心問 如果那是攝氏度或華氏度，零下40是兩個尺度相遇的地方 -?它非常冷。?當(dāng)我站在前廊上時 在口袋里摸索，我發(fā)現(xiàn)我沒有鑰匙。?事實上，我可以看到他們 透過窗戶，躺在餐桌上 我離開他們的地方。?所以我趕緊跑來跑去 并嘗試了所有其他門窗，它們都被鎖得很緊。?我想過打電話給鎖匠—— 至少我有手機，但在午夜，可能需要一段時間 一個鎖匠出現(xiàn)，天氣很冷。?我無法回到我的朋友身邊 杰夫家過夜，因為我有早班飛機 第二天早上去歐洲，我需要得到 我的護(hù)照和行李箱。

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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，在絕望和冰冷的寒冷中，我發(fā)現(xiàn)了一塊大石頭，我打破了 透過地下室的窗戶，清理出玻璃碎片，我爬過去，發(fā)現(xiàn)了一塊紙板 并把它貼在開口上，計算出早上， 在去機場的路上，我可以打電話給我的承包商 并要求他修復(fù)它。?這會很貴，但可能不會更貴 比半夜的鎖匠，所以我想，在這種情況下， 我甚至出來了。

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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.

現(xiàn)在，我是一名訓(xùn)練有素的神經(jīng)科學(xué)家，我知道一點 關(guān)于大腦在壓力下的表現(xiàn)。?它釋放皮質(zhì)醇 這會提高你的心率，調(diào)節(jié)腎上腺素水平，并遮蔽你的思維。?所以第二天早上，當(dāng)我睡得太少時醒來，擔(dān)心窗戶上的洞，并在心里記下了一張紙條。 我不得不打電話給我的承包商，冰凍的溫度，以及我即將在歐洲舉行的會議，你知道，與所有人 我大腦中的皮質(zhì)醇，我的思維是渾濁的，但我不知道它是混濁的 因為我的思維是渾濁的。

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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 到機場值機柜臺，我意識到我沒有護(hù)照。

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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.

于是我趁著雪地跑回家 冰，40分鐘，拿到了我的護(hù)照， 趕回機場，我及時趕到，但他們已經(jīng)放棄了 我的座位給別人，所以我被困在飛機的后部， 在浴室旁邊，在一個不會傾斜的座位上， 在八小時的飛行中。?好吧，我有很多時間思考 在那八個小時里，沒有睡覺。

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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.

我開始納悶， 有沒有我可以做的事情，我可以建立的系統(tǒng)，以防止壞事 從發(fā)生？?或者至少如果壞事發(fā)生，將可能性降至最低 這是一場徹頭徹尾的災(zāi)難。?所以我開始思考這個問題，但我的想法并沒有具體化。 直到大約一個月后。?我正在和我的同事共進(jìn)晚餐， 諾貝爾獎獲得者丹尼·卡尼曼（Danny Kahneman）和我有點尷尬地告訴他。 關(guān)于打破了我的窗戶，你知道，忘記了我的護(hù)照，丹尼告訴我他一直在練習(xí) 一種叫做前瞻性后見之明的東西。

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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.

這是他得到的東西 來自心理學(xué)家加里克萊因，他寫過關(guān)于它的文章 幾年前，也稱為驗尸。?現(xiàn)在，你們都知道驗尸是什么了。?每當(dāng)發(fā)生災(zāi)難時，都會有一個專家團隊進(jìn)來并嘗試 找出出了什么問題，對吧？?好吧，在驗尸中，丹尼解釋說，你向前看，你試圖弄清楚 所有可能出錯的事情，然后你試圖弄清楚 你能做些什么來防止這些事情發(fā)生， 或盡量減少損害。

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.

這是他得到的東西 來自心理學(xué)家加里克萊因，他寫過關(guān)于它的文章 幾年前，也稱為驗尸。?現(xiàn)在，你們都知道驗尸是什么了。?每當(dāng)發(fā)生災(zāi)難時，都會有一個專家團隊進(jìn)來并嘗試 找出出了什么問題，對吧？?好吧，在驗尸中，丹尼解釋說，你向前看，你試圖弄清楚 所有可能出錯的事情，然后你試圖弄清楚 你能做些什么來防止這些事情發(fā)生， 或盡量減少損害。

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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.

在家里周圍，指定一個地方 對于容易丟失的東西。?現(xiàn)在，這聽起來 就像常識一樣，確實如此，但有很多科學(xué) 為了支持這一點，基于我們的空間記憶的工作方式。?大腦中有一個結(jié)構(gòu) 被稱為海馬體，進(jìn)化了數(shù)十個 數(shù)千年，跟蹤位置 重要的事情——井在哪里， 在那里可以找到魚，那棵果樹，友好和敵對部落居住的地方。?海馬體是倫敦出租車司機大腦的一部分 變大。?它是大腦的一部分 這讓松鼠找到了它們的堅果。?如果你想知道， 有人實際上做了他們切斷的實驗 松鼠的嗅覺，他們?nèi)匀豢梢哉业剿麄兊膱怨?他們沒有使用氣味， 他們使用的是海馬體，這種精致進(jìn)化的機制。 在大腦中尋找東西。?但這對事情真的很好 移動不多，對于四處移動的東西不太好。?所以這就是為什么我們丟失車鑰匙的原因 以及老花鏡和護(hù)照。?所以在家里， 為你的鑰匙指定一個位置 -?門邊的掛鉤， 也許是一個裝飾碗。?對于您的護(hù)照，一個特定的抽屜。?對于您的老花鏡， 特定表。?如果您指定了一個地點 你對此一絲不茍，你的東西永遠(yuǎn)在那里 當(dāng)你尋找它們時。

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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？?拍攝手機照片 你的信用卡，你的駕駛執(zhí)照，你的護(hù)照，把它郵寄給自己，這樣它就在云中。?如果這些東西丟失或被盜， 您可以方便更換。

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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.

現(xiàn)在這些是一些相當(dāng)明顯的事情。?記住，當(dāng)你處于壓力之下時， 大腦釋放皮質(zhì)醇。?皮質(zhì)醇有毒， 它會導(dǎo)致思維渾濁。?因此，事前驗尸實踐的一部分是認(rèn)識到在壓力下 你不會處于最佳狀態(tài)，你應(yīng)該把系統(tǒng)落實到位。

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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.

也許還有 沒有比你面對時更緊張的情況 做出醫(yī)療決定。?在某些時候，我們所有人 將處于那個位置，我們必須在那里做出 關(guān)于我們醫(yī)療保健未來的一個非常重要的決定 或親人的，幫助他們做出決定。

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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.

所以我想談?wù)勥@個問題。?我要談?wù)?一種非常特殊的醫(yī)療狀況。?但這代表了各種 醫(yī)療決策，實際上是財務(wù)決策， 和社會決策——你必須做出的任何一種決定都會受益于理性 對事實的評估。

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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."

所以假設(shè)你去看醫(yī)生 醫(yī)生說：“我剛剛拿回了你的實驗室工作， 你的膽固醇有點高。?現(xiàn)在，你們都知道高膽固醇與風(fēng)險增加有關(guān) 心血管疾病，心臟病發(fā)作，中風(fēng)。?所以你認(rèn)為有高膽固醇 不是最好的事情，所以醫(yī)生說， “你知道，我想給你一種可以幫助你的藥物?降低你的膽固醇，一種他汀類藥物。?你可能聽說過他汀類藥物，你知道它們屬于 當(dāng)今世界上處方最廣泛的藥物，您甚至可能知道 服用它們的人。?所以你在想， “是??！把他汀類藥物給我。

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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.

但是有一個問題 在這一點上，你應(yīng)該問一個你應(yīng)該問的統(tǒng)計數(shù)據(jù)，大多數(shù)醫(yī)生 不喜歡談?wù)?，和制藥公?喜歡談?wù)摳佟?這是為了需要治療的人數(shù)。?現(xiàn)在，這是什么，NNT？?這是人數(shù) 需要服藥或接受手術(shù) 或在一個人得到幫助之前的任何醫(yī)療程序。?你在想， 這是什么樣的瘋狂統(tǒng)計數(shù)據(jù)？?數(shù)字應(yīng)為 90。?我的醫(yī)生不會開處方 對我來說，如果它沒有幫助。?但實際上，醫(yī)療實踐 不是那樣工作的。?這不是醫(yī)生的錯，如果這是任何人的錯， 這是像我這樣的科學(xué)家的錯。?我們還沒有弄清楚 底層機制足夠好。?但葛蘭素史克估計，30%的藥物有效。 只有50%到300%的人。?所以需要治療的人數(shù) 對于處方最廣泛的他汀類藥物，您認(rèn)為它是什么？?有多少人必須服用 在一個人得到幫助之前？?300.?這是根據(jù)研究從業(yè)者的研究 Jerome Groopman和Pamela Hartzband，由 Bloomberg.com 獨立證實。?我自己瀏覽了一下數(shù)字。?<>人必須 在一次心臟病發(fā)作，中風(fēng)之前服用該藥一年 或其他不良事件被預(yù)防。

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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.

但是有一個問題 在這一點上，你應(yīng)該問一個你應(yīng)該問的統(tǒng)計數(shù)據(jù)，大多數(shù)醫(yī)生 不喜歡談?wù)?，和制藥公?喜歡談?wù)摳佟?這是為了需要治療的人數(shù)。?現(xiàn)在，這是什么，NNT？?這是人數(shù) 需要服藥或接受手術(shù) 或在一個人得到幫助之前的任何醫(yī)療程序。?你在想， 這是什么樣的瘋狂統(tǒng)計數(shù)據(jù)？?數(shù)字應(yīng)為 90。?我的醫(yī)生不會開處方 對我來說，如果它沒有幫助。?但實際上，醫(yī)療實踐 不是那樣工作的。?這不是醫(yī)生的錯，如果這是任何人的錯， 這是像我這樣的科學(xué)家的錯。?我們還沒有弄清楚 底層機制足夠好。?但葛蘭素史克估計，30%的藥物有效。 只有50%到300%的人。?所以需要治療的人數(shù) 對于處方最廣泛的他汀類藥物，您認(rèn)為它是什么？?有多少人必須服用 在一個人得到幫助之前？?300.?這是根據(jù)研究從業(yè)者的研究 Jerome Groopman和Pamela Hartzband，由 Bloomberg.com 獨立證實。?我自己瀏覽了一下數(shù)字。?<>人必須 在一次心臟病發(fā)作，中風(fēng)之前服用該藥一年 或其他不良事件被預(yù)防。

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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.

現(xiàn)在，我不是說你是否 是否應(yīng)該服用他汀類藥物。?我只是說你應(yīng)該有 與您的醫(yī)生的對話。?醫(yī)學(xué)倫理要求它，這是原則的一部分 知情同意。?您有權(quán)訪問 對這類信息開始對話是否 你想不想冒險。

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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.

現(xiàn)在你可能會認(rèn)為我已經(jīng)拉了這個號碼 從空中為震撼值，但實際上它是相當(dāng)?shù)湫偷模?這個數(shù)字需要治療。?用于最廣泛執(zhí)行的手術(shù) 在50歲以上的男性中，切除前列腺治療癌癥，需要治療的人數(shù)為49。?沒錯，完成了49次手術(shù) 對于每一個幫助過的人。?以及在這種情況下的副作用 見于 50% 的患者。?它們包括陽痿， 勃起功能障礙，尿失禁，直腸撕裂，大便失禁。?如果你很幸運，你就是其中之一 在擁有這些的50%中，他們只能持續(xù)一兩年。

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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.

所以驗尸的想法 是提前思考問題 你也許可以問，這將推動對話向前發(fā)展。?你不想制造 這一切都在現(xiàn)場。?你也想思考 關(guān)于生活質(zhì)量之類的事情。?因為你經(jīng)常有選擇，你是否想要更短的壽命 這是無痛的，或者更長的壽命可能 到最后很痛苦？?這些是要談?wù)摰氖虑?現(xiàn)在想想，和你的家人和你所愛的人在一起。?您可能會改變主意 在一時沖動下，但至少你練習(xí)了 帶著這種想法。

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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.

記住，我們的大腦承受著壓力 釋放皮質(zhì)醇，其中一件事 那一刻發(fā)生的是一大堆系統(tǒng)關(guān)閉。?這是有進(jìn)化原因的。?與捕食者面對面， 你不需要你的消化系統(tǒng)，你的，或者你的免疫系統(tǒng)，因為如果你的身體正在消耗 新陳代謝這些東西，你反應(yīng)不快，你可能會成為獅子的午餐， 然后這些都不重要了。?不幸的是，窗外的事情之一 在那些壓力時期是理性的，邏輯思維，正如丹尼·卡尼曼（Danny Kahneman）所說 他的同事已經(jīng)展示了。?所以我們需要訓(xùn)練自己 提前考慮這些情況。

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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.

我認(rèn)為這里重要的一點 認(rèn)識到我們所有人都有缺陷。?我們都會時不時地失敗。?這個想法是提前思考 這些故障可能是什么，將系統(tǒng)落實到位 這將有助于最大限度地減少損害，或防止壞事 從一開始就發(fā)生。

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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.

回到那個 蒙特利爾的雪夜，當(dāng)我從旅行回來時，我讓我的承包商安裝 門旁邊的密碼鎖，里面有前門的鑰匙， 一個易于記憶的組合。?我不得不承認(rèn)，我還有成堆的郵件 尚未排序，以及成堆的電子郵件 我沒有經(jīng)歷過。?所以我沒有完全組織，但我看到了組織 作為一個漸進(jìn)的過程，我正在到達(dá)那里。

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Thank you very much.

謝謝。

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