Emergency Mind:

Wiring Your Brain for Performance Under Pressure

By Dan Dworkis, MD PhD FACEPEmergencyMind
ISBN-13: 9798746482327
$9.99 eBook; $19.99 paperback
Independently published by Sangfroid Press

Reviewed by Gila Hayes

For over a year, my virtual bookshelf has held Daniel Dworkis’ 2021 book, The Emergency Mind. After last month’s lead interview discussed evolving threats, the mental agility required to react and survive and warned about denial, motivated by that discussion, I dug into The Emergency Mind.

It is a very thought-provoking book that encourages personal evaluation and improvement. I think armed citizenry is, for the most part, blessed with ready access to good instructors who can teach firearms safety and operation, accurate marksmanship, and elementary tactics but rarer is detailed instruction and coaching in functioning effectively under extreme stress.

Authored by an emergency room doctor, The Emergency Mind teaches effective decisions and action under tremendous pressure. While Dworkis’ illustrations are from the ER, it is easy for the student of self defense to substitute defensive scenarios for the medical emergencies used as illustrations, and family or associates who are present during a self-defense emergency for the ER team to whom the book frequently refers. 

“While you cannot control what emergencies come your way, you do control how you prepare; you control what you do now to build your emergency mind and wire your brain to perform under pressure,” Dworkis introduces, adding later that “performing under pressure is a set of skills that can be broken down, trained, and put back together again.” Role play and visualization are useful for practicing emergency responses. Habituating good responses to daily stress builds habits that kick in under dire circumstances, he writes.

Most if not all emergencies include the factors of uncertainty, high-impact outcomes, and significant pressure. Combined or separate, the three are enough to create paralyzing indecision. Pressure is both internal and external, Dworkis observes. Internally, emotions like doubt and fear can cloud judgment and decrease effectiveness. Dehydration, sleep deprivation or poor nutrition can hurt performance, too. Lighting, temperature, and noise are environmental factors that also “play a role in diverting your attention and increasing your cognitive load,” he says.

Preparation reduces pressure, he continues. Pre-learned mental models speed up decision making when limited information is available. Dworkis explains that the mental models taught in his book require exploration and practice to work for the reader. “Mental models are the conceptual frameworks we all use to explain how parts of reality work. Anytime you extrapolate information from sets of experiences to guide future actions, generate rules for how things are supposed to work, or balance sets of competing principles to fine tune a decision, you are using mental models to explore, map, and predict the world around and within you.” He offers five categories of models, all adaptable to self defense, and discusses the path to better performance under great pressure.

How to mitigate stress and apply the correct solution is the focus of a section entitled Applying Knowledge Under Pressure. Dworkis contrasts a desperate rush and attempt to overpower obstacles against the finesses of an experienced, calm response in which “the best leaders actively seek out and build moments of calm into even the most chaotic and critical cases. These ‘spare moments’ allow you the time and space to improve decision making, process new information, and pivot to new directions.” He details methods and training to stay composed and put your skills to work in chaotic environments.

The section entitled Handling Uncertainty and Imperfection covers making decisions despite information gaps, a source of stress present in daily life as well as life-and-death emergencies. Acknowledge that the situation is “suboptimal” (not horrible or hopeless), he advises, then get to work solving the problem. If there’s time, pause momentarily to breath and flush out the physiologic effects of fight or flight. If no time is available, take action using pre-made steps to address the emergency, for example, CPR instruction teaches the ABCs airway, breathing, circulation and while Dworkis’ ER examples are considerably more complex, a linear, pre-learned response speeds reacting productively under extreme stress.

Training should include stress. Increasing pressure incrementally can uncover “previously unseen weakness in your understanding or execution of the technique and the opportunity to address it.” A good start is visualization practice, he advises. Alternate training between low-stress, calm instruction and drills that include stress like physical or mental exhaustion, noise, or other distractions which can identify needed corrections or unanticipated stumbling blocks. Quantify the results and ask outside observers to give feedback. Afterwards, identify the techniques that you were able to perform even under trying circumstances, then overtrain those skills in simulations of the worst possible environment in which you could be called upon to use the skill, he writes. This section is packed with good instruction, far more than there’s room to mention here.

No one likes to fail, so the book’s Part II Handling Uncertainty and Imperfection challenges readers to accept fallibility. Dworkis cites the Japanese philosophy that in the natural world much is imperfect, impermanent and incomplete. In an emergency, holding out for the perfect solution, a permanent correction, or a complete understanding of the situation may be fatal. “Focus on improving your performance and doing the best you can with what you have. You accept uncertainty and change, since they are omnipresent, and you devote yourself to growing with every crisis you encounter,” he writes.

Dworkis explores cognitive biases that we employ to quickly – but sometimes erroneously – make decisions under pressure. Recency bias gives more weight to recent events or information that’s easiest to recall, or discounting information about which we have no personal experience. Most humans hate uncertainty so it is easy to fall prey to these thinking errors. Anchoring gives undue value to the first fact determined about a situation, making it hard to abandon an initial conclusion even when later details show it incorrect. Confirmation bias causes us to ignore facts that challenge our currently held belief. When the emergency is so physically, mentally, and emotionally challenging, people sometimes take refuge in denial. Fight the habit in day-to-day life by acknowledging and acting to resolve problems as quickly as they arise, he teaches. 

Dworkis reminds readers that eliminating uncertainty is unrealistic. Become comfortable with it. Study how you currently react to uncertainty, he writes. Part of the stress is due to our own physical reactions like shallow breathing and tight muscles. “Once you have a solid grasp on how you currently experience and respond to uncertainty, you can start to expand your comfort in its presence. Experiment with different techniques in low stakes situations, like using deep breathing to counter the physical feelings uncertainty may bring when you’re opening an email containing a medical test result. Finally, in situations where you know you will face uncertainty...train and overtrain your basic skills to improve your response times.”

At the heart of responding effectively in an emergency is the ability to make high- and low-impact decisions under pressure. If time allows, others who are present may have seen something you did not, so Dworkis teaches the humility required to inquire, “What am I missing?” Ask the right kinds of questions. “During an active event, this typically means that your questions should be exclusively present- and future-focused.” Ask questions that are focused on the immediate crisis and actions you can take to resolve it.

Related to asking what you missed and changing course is abandoning an initial response that’s failing in favor of Plan B. Don’t get fixated on what you think is the right course of action, the book advises. Implement backup plans early in Plan A’s failure, not after it has failed profoundly. Plan B should be a “skillful transition,” an “alternative path to success.” Know what Plan B is before beginning Plan A. Those who “proactively build and train Plan B methods directly into their approach, with systems that are designed to be robust to failure and resistant to error” are more effective during emergencies. He describes “stumble-and-recovery” practice drills that are reminiscent of training using inert ammunition to simulate recovery from equipment failure.

To be better prepared, anticipate failure, he advises. Brainstorming with associates and mental rehearsal can pull lessons from recent problems. Start from the end, the imagined failure, and work “backward to figure out how and why things went wrong,” he teaches. “Each way that you can visualize failure becomes a chance to design and implement a solution — one that minimizes the probability of the imagined failure becoming reality.” Debriefs after a critical incident can show where a poor decision led to a suboptimal outcome.

Dworkis identifies factors leading to poor decisions, including failure to focus on what’s important and tunnel vision on one element of a problem to exclusion of other pertinent factors. In a crisis, he writes, limit the decisions you make to only those immediately relevant. “To perform well under pressure, you must be able to identify those decisions that require your immediate attention. But it is equally important to identify your least critical decisions and have the discipline to put those aside.”

Dworkis commits many pages to how to apply abstract knowledge to making a decision and taking action. We hear the term “best practice” a lot, but can the human brain faced with life or death choose and perform to that standard? “No matter how ‘perfect’ a solution to a problem may appear on paper, if it’s impossible to implement when and where an emergency is happening, it is not the correct response,” he writes. “Unstable situations in which conditions are rapidly changing might be better served by less ideal solutions that can be implemented more quickly and with lower resource cost.”

Emergencies also require adapting to rapidly changing needs, so Dworkis recognizes trade-offs between “precision and practicality” allowed by only “a deep knowledge not only of how your craft is supposed to function, but also of the details of your environment and the resources at your disposal at this exact time.” That doesn’t mean being satisfied with poor results; after resolving the emergency, honest review and detailed study is required to make it work better next time.

Dworkis closes The Emergency Mind by urging readers to experiment with the exercises he outlines, the mental models he describes, and the ways to handle emergencies his book presented. His book included many, many important points not mentioned in this review. I found it one of the most useful books I’ve read this year. 

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