• The Strategic Perspective

How to Keep Calm in High-Pressure Situations

Updated: Oct 11, 2019

Whether you are a coffee shop Barista, an Account Manager, CEO or Emergency Medicine Practitioner, you will all face high pressure situations. In 99% of careers, you will experience high pressure situations; at least periodically. The stakes may be greater or lesser but in that moment, your physiological response will be the same. This comes down to perspective, based on your level of training and experience.

I have resuscitated patients in cardiac arrest, drilling intraosseous lines while reading their cardiac rhythms, pushing medication and intubating them within minutes, on the ground, in tight spaces and bad lighting. I can also remember working one of my first summer jobs in high school, at Jamba Juice and feeling the same kind of pressure when the line was out of the door, on a hot summer day.

Naturally, the more experience you acquire, the more of those situations you are in, the less pressure you will feel from them. However, there will always be curve-balls that you may never fully get used to. The mind's perception of the situation is usually what kicks off the body’s stress response. Once you understand that, you have a better chance of keeping calm.

In a nutshell, when the body’s stress response kicks in, the hypothalamus sends signals to the pituitary gland and the adrenal medulla. This causes your heart rate to increase, blood pressure to rise, an increase in breathing, an increase in cortisol, a flood of glucose and a decrease in digestive activity. You can see how unhealthy this is for your body and how chronic levels of high stress lead to weight gain and diabetes.

High levels of cortisol will also impair the brain's ability to function at it’s normal capacity, leading to stupid mistakes that may have dire consequences. There is a simple fix however, that I will teach you.

You will need to change your perception and you will need to be mindful of your breathing to effectively handle high stress situations. Depending upon the situation and your personality, the order in which you do this may be different. Meditation is a great tool to learn how to do this. I’m going to get a little philosophical but my highest pressure situations in emergency medicine were critically ill, pediatric patients.

In order to maintain composure and professionalism, I would temporarily change my perception of the concept of children. For those moments, in my eyes, they were not children with whole lives and experiences ahead of them. They did not have families that would be devastated if they were lost. I had to believe they were just small anatomical components having reactions that I studied and practiced to manage, understanding that sometimes, these reactions were not manageable. I then made sure to keep my breathing under control.

When you can control your breathing, you can then control your heart rate and your blood pressure. This allows you to focus, act methodically and not make stupid mistakes.

Meditation allows you to practice mindful breathing and becoming present in the moment, with one solitary focus. Many times, high pressure situations tend to jumble your thinking. That is part of what makes them so high pressure. There are a lot of “what ifs” that could lead to terrible consequences. If you can’t keep your mind on track to where it needs to go, it will go where you don’t want it to.

The same concept applies to skiing through a bunch of trees. You always look where you want to go, like the trees aren’t even there. Why? Because if you focus on the trees, you’re bound to hit one, sooner or later.

In summary:

  • Practice meditation. To make it easier to start, light a candle, sit quietly for 5 minutes, focusing on your breathing and the flicker of the candle. When your mind starts to wander, bring it back to the flicker of the candle. Be present in the moment and allow yourself to be captivated by its movement. That is mindful thought. If you notice your breathing pattern speeding up, slow it down. That is mindful breathing. This exercise is a very good place to start, however, there are many different techniques you can try, until you find the one that works best for you.

  • Change your perception or your perspective, even if you have to trick your conscious reality.

  • Focus on slowing down and regulating your breathing while in the moment.

  • Focus on the outcome you want, not the one you don’t.

  • If all else fails, channel your inner Yoda and remember, "The greatest teacher, failure is."