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

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A locked door in minus-40-degree Montreal taught Daniel Levitin more about decision-making than a lifetime in the lab.

Daniel Levitin studies how stress hijacks the brain for a living, and at TEDGlobal>London in September 2015 he opened his talk with a confession: he once smashed his own basement window to get into his house rather than walk fifty feet to a spare key he’d forgotten he had. The cognitive neuroscientist uses that moment to explain why cortisol, the hormone your body dumps into your bloodstream under acute stress, is brilliant for outrunning a lion and terrible for making a good decision. His fix borrows from psychologist Gary Klein’s idea of the “pre-mortem” — doing the hard thinking about failure before the crisis hits, not during it.

• Levitin locked himself out of his Montreal home at minus 40 degrees, panicked, and smashed a basement window to get his keys — only to later realize a spare had been sitting nearby the whole time.
• He cites the most widely prescribed statin as requiring 300 patients to take it for a year to prevent one heart attack or stroke, while roughly 15 of those 300 suffer debilitating side effects — meaning a patient is 15 times more likely to be harmed than helped.
• Prostate removal surgery for cancer carries a number needed to treat of 49, alongside a 50% rate of severe side effects like incontinence and erectile dysfunction.

Cortisol Impairs Cognitive Performance Under Pressure

Levitin’s argument starts with basic neurochemistry. When something goes wrong fast — a locked door, a diagnosis, a car skidding on ice — the brain floods with cortisol, a hormone built for one job: get you out of immediate physical danger. It’s great for sprinting from a predator. It’s terrible for weighing tradeoffs, doing arithmetic, or reading fine print, because it actively suppresses the kind of slow, rational thinking those tasks require.

“We all are going to fail now and then,” Levitin says in the talk. “The idea is to think ahead to what those failures might be.” That’s the pre-mortem: instead of doing an autopsy after a decision goes wrong, you run the failure scenario in advance, while your prefrontal cortex is still fully online and cortisol isn’t calling the shots.

The Spare Key Problem

Levitin’s own locked-door story is the cleanest illustration of the trap. Rushed, cold, and stressed, he broke a window instead of pausing to remember where he’d stashed a spare — a decision his calm self would never have made. His prescribed fix is almost embarrassingly simple: designate one specific spot at home for the things you lose constantly, so spatial memory does the work your stressed brain can’t. Before traveling, he also recommends emailing yourself photos of your passport, driver’s license, and credit cards, so a stolen wallet abroad doesn’t turn into a full-blown crisis.

None of this is about willpower or trying to “stay calm” through sheer effort — it’s about removing decisions from the moment they’d otherwise be made under duress. If you’re someone who spends real energy fighting spiraling thoughts in the moment, the same pre-mortem logic shows up in pieces like Reasons To Stop Worrying (Break The Habit of Excessive Thinking) — plan the response before the trigger hits, not after.

Applying the Pre-Mortem to Medical Decisions

Levitin’s sharpest application of the concept is in the doctor’s office, where stress and unfamiliar terminology routinely wreck informed consent. His advice: before agreeing to a medication or procedure, ask for the number needed to treat — the count of patients who’d have to take a drug or undergo a surgery for just one of them to see a benefit.

He runs the numbers on two common cases. The most widely prescribed statin has an NNT of 300 for preventing one heart attack or stroke over a year, while about 5% of users — 15 out of that same 300 — experience debilitating side effects. Do the math, Levitin says, and a patient is 15 times more likely to be harmed by the drug than helped by it. Prostate removal surgery for cancer fares similarly: an NNT of 49, paired with a 50% rate of severe side effects such as incontinence and erectile dysfunction.

A patient taking the statin is 15 times more likely to experience a debilitating side effect than to be spared a heart attack or stroke.

Levitin’s point isn’t that statins or prostate surgery are wrong choices — it’s that patients rarely hear these numbers stated plainly, and stress in the exam room makes it even harder to ask for them on the spot. Preparing the question in advance, during a pre-mortem rather than mid-appointment, is what lets a patient actually weigh a treatment against their own values around quality of life. Readers wrestling with how much weight to give their own instincts under pressure might also find something in How To Eliminate Self Doubt Forever & The Power of Your Unconscious Mind, which covers a related piece of the same problem — trusting a decision you made when you were thinking clearly.

Levitin never says the window-smashing story again in the talk, but he doesn’t need to — it’s the whole argument in one image: a smart man, thinking clearly about everything except the one thing cortisol wouldn’t let him remember.