It’s almost my favorite time of year. March Madness, followed by the NBA playoffs. For basketball fans like me, this is ball-pounding bliss. Just stand near a television long enough and you’ll likely hear exaltations of awe and admiration. How do they do it? Especially with millions of people watching?
“Stephen Curry from waaaaay downtown… a clutch three!”
“Cold-blooded shot! She’s got ice water in her veins.”
“Thompson stepping up to the line to calmly sink two huuuge free throws.”
Of course, it is not just basketball players who must compose themselves when buried in the metaphorical pressure cooker; we all must do it in our professional and personal lives sometimes. How does one prepare?
I’m sure that you’ve heard of the benefits of visualization. Picture yourself giving a great presentation, nailing the interview, or catching that wave and you’re probably more likely to actually do it. Besides, if you’re like me, you like to plan things and feel under control. Planning helps us feel safe.
But accidents and the unplanned happen, and any day any one of us can find ourselves in an emergency situation. Can we use visualization and planning to deal with the unknown and unexpected?
I think so, and with this in mind (thanks to the assistance of my neighborhood YMCA Zennie, Myoun, who can perch one-legged on a Bosu ball for hours), I’ve got some Buddhist wisdom that can help unforeseen and unpleasant situations. It could be a ten-car pileup, a building evacuation, or (and this is particularly in my wheelhouse) a trip to the emergency department (ED). Whatever arises, use the framework below to help manage your injuries and your psyche.
We are constantly judging our experiences as either good or bad—and if we deem something to be “bad,” we want to get rid of it immediately. But in an emergency, we need to accept what has happened and recognize that judging it as “good” or “bad” does not matter. Research out of Carnegie Mellon University suggests that the act of mindfulness and especially the acknowledgment of pain, suffering, and stress can decrease stress hormone levels for up to four months and perhaps even change neural wiring. 
Now, let's take the example of a trip to the ED. This may not be the ideal time to launch into your first mindfulness exercise, but if you already have some training or experience in the practice, it would be a perfect time to deploy it.
Take some deep breaths, really deep, and calm down. You are having a unique experience: your own safari. A safari is not just a chance to photograph large mammals, it is, literally, an adventure with an unknown outcome.
Going to the ED may not have been the journey you planned for, but like many other emergency situations, it presents unique opportunities for bringing together family and friends, channeling empathy for others who may be in a similar situation, and perhaps committing to healthy lifestyle choices for the future (like, for example, quitting smoking for good!) Perhaps there is even an opportunity to find a nugget of joy in the situation—like the fact that the ED offers oven-warmed blankets. Acknowledging this can help down-regulate the stress response going on in your brain.
When it comes to breathing, there are a number of cadence pattern options that can slow anxious breathing and, through vagal nerve feedback loops, provoke and maintain calm. Box breathing is simple and easy to demonstrate; we often use it in the ED. Draw a square on a whiteboard and assign four seconds to each side—four-second inhale, four-second hold, four-second exhale, four-second hold, repeat. Or, if you prefer, Dr. Andrew Weil endorses a 4-7-8 rhythm (four-second inhale, seven-second hold, eight-second exhale) while others, such as Wim Hof, suggest cyclic hyperventilation (longer inhales and shorter exhales). Some people like cyclic sighing (longer exhalations).
A recent study from Balban et al published in Cell Reports Medicine compared the effects of a number of breathing strategies, deployed in five-minute increments, on mood, anxiety, and physiology (heart rate and breathing).  The investigators randomized 111 participants to one of four regimens that were learned and repeated once daily for a month before the assessment of psychological and physiological outcomes.
Interestingly, all three of the breathing techniques tested were superior to just mindful meditation in improving mood and reducing respiratory rate. The cyclic sighing, however (1.25 seconds breath in, 2 seconds out), had the greatest benefits. To emphasize here, these benefits were accrued with just five minutes a day of deliberate practice—most ED patients will have five minutes at least, and probably many more, of waiting time. So, if something similar happens to you, consider giving a sigh or two and going with the flow.
Back at home, find a breathing meditation that works for you and practice it for a few minutes a day—you’ll improve your daily relaxation and be ready to calm yourself down when challenges arise.
If you did end up in the ED, chances are that you would have to make some choices—to receive pain medication or not; to undergo further testing or not, or even to go home from the ED or not. The days of paternal medicine are long gone, and we now recognize that patient choice is vitally important. Importantly though, choices should be dynamic—affected by additional information and changes in medical status.
The Buddhists would caution patients from making decisions about their care before having all the relevant information (“I came here for an x-ray, and gosh darn it I am going to get an x-ray!”) By processing and accepting each choice as it comes, you will be in the best place to make the right decision.
Some basketball greats believe in visualization as a tool for success. Others, like Myoun, believe that you can improve shooting by mental imagery just as easily as by physical practice. I am skeptical of this particular claim, but I do believe that how we prepare and train our minds can help us immensely when stress and anxiety intersect with the unexpected.
I hope not to encounter you in this sort of situation, but if the unlikely occurs, I think preparation will do us both some good.
1. Creswell, J. David, et al. "Alterations in resting-state functional connectivity link mindfulness meditation with reduced interleukin-6: A randomized controlled trial." Biological psychiatry 80.1 (2016): 53-61.
2. Balban, Melis Yilmaz, et al. "Brief structured respiration practices enhance mood and reduce physiological arousal." Cell Reports Medicine (2023): 100895.