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Focus on Your Focus - Part 1

A while back we talked about the risks incurred by not listening to the warnings of “That Little Voice.” We also talked about how easy it is to miss environmental clues of impending danger that our “little voice” shouts out to us in the article on “The Dog that Didn’t Bark.” 

There’s no doubt these skills are critical for safety in the cockpit, but there’s another issue that we haven’t spent much time on.  That’s how we can train our brains to not only hear those voices of warning, but also truly focus on that crucial information and block out distractions that lead to mistakes and accidents.  Margaret Garrett and Tara McManus’ Boston based rock group very appropriately named “Mr. Airplane Man” has the perfect theme song for our topic this month called “Focus” which starts out, “I'm losing my focus, hold on we're not hopeless.” But in the air, if you lose your focus things can become hopeless and very quickly. 

A great example for pilots on this topic is in the world of professional athletes.  Sports psychologists get really deep into analyzing an athlete’s ability to focus since it’s a key requirement to rise to the top of their game.  A while back I quoted tennis great John McEnroe who said that when he was in his groove, the tennis ball looked like he was swinging at a beach ball as it came over the net.  What he didn’t say is how he got there.  Venus Williams, another great American tennis star gives us more insight. “For the players it is complete and pure focus.  You don’t see anything or hear anything except the ball and what’s going on in your head.”  There’s no doubt that this is a central skill for aviation safety too so let’s look at how these pro athletes who rise to the heights of success accomplish this amazing feat of concentration.

Keeping our focus is tough, especially these days with all the noise that we’re continuously inundated with.  These distractions in the cockpit can be even worse.  Noise is sound that contains no information and all the noise around us and inside our heads makes our task of staying alert and focused really difficult.  It’s distracting because our minds can only concentrate on a fraction of this bombardment of incoming information.  Focusing on what, at least at the moment, seems most important is regulated in a place called the “reticular activating system” (RAS).  It’s located deep in the back of the brain and we’ve talked about it before.  Our hard-wired capacity to focus on what’s important and block out the noise is limited since our brains are capable of keeping only 4-6 items in the RAS active attention center at any one time.  Another challenge is that we can hold those items in the RAS for only 20-30 seconds before they are erased or replaced by the next hot button item demanding our attention.  That means that we have to continuously make decisions about what to pay attention to, what to prioritize, and what’s noise and needs to be ignored.  According to John Ratey’s great book, “A User’s Guide to the Brain,” the attention process is more than just noticing incoming stimuli.  It also requires thinking about and processing that information with several different aspects of perception including filtering out conflicting perceptions, balancing multiple perceptions and attaching appropriate significance to these perceptions.  That’s actually a lot of mental work and we only have two ways to get it done - with our two basic forms of attention, passive and active. 

Passive attention is an involuntary process driven by external events that jump out at us from our environment like a bright flash of light or a sudden loud sound (or sudden silence when the engine quits!).  Active attention is harder; it takes work driven by our alertness, concentration, and immediate demands of our surroundings.  Putting all this together, attention and focus is the capacity to consistently maintain the mental effort required to perform a task and the ability to inhibit distracting actions, stimuli, or thoughts that lead you astray.  It’s a complex process that includes being alert and selecting what we should be attending to, ignoring what we don’t need to attend to, and maintaining all that focus for the right amount of time. That’s why sports psychologists are really interested in this, it’s the state of mind of a major league baseball player hitting a 100 mph fastball coming at him from 66 feet away over the fence for a home run or a star tennis player returning a 125 mph serve down the line for a winner.

Focus and attention are a kind of mental spotlight that illuminate targets either in our external environment or in the internal world of our subjective experiences. Staying alert is the first step in the attention and focus process and that comes from the same part of the brain, the Reticular Activating System.  An important part of the alertness process, especially in the cockpit, is the actual duration of attention, something that neuroscientists call “focal maintenance.” It’s needed to stay focused, stay in the moment, and maintain the needed mental energy over the time span required to accomplish the mission at hand. In order to do this we have to fight off that noise and all those distractions.  It’s kind of like trying to listen to one conversation in a crowded, noisy room.  This has been referred to as the “cocktail party effect” and requires you to tune into (focus on) only one speaker and block everything else out.  This ability to selectively attend to only a single voice, or task, among lots of things going on requires voluntary, energy dependent active attention. Researchers on the attention processes in athletes who see “beach balls” instead of tennis balls are even able to measure attention.  One reliable metric is called, “pupillometry,” the study of changes in pupil diameter as a function of focus and cognitive processing that shows that the more attention we focus on a task the more dilated our pupils get.

Distraction is the enemy of this whole process.  It’s the opposite; it’s when our attention is captured involuntarily like when you’re in that crowded room deep in conversation with one person and out of nowhere there’s a loud bang or flash of light. Distraction can also be driven by anxiety which has been shown to divert a skilled performer's attention to tasks that are irrelevant. Anxiety has a very real negative impact on performance, especially in emergency situations that we’ve talked about it before in several previous articles since it’s so crucial for pilots to understand and conquer. Information overload is another form of distraction as it makes it harder to filter out all the “noise” that deteriorates performance.  Information overload and anxiety are also linked to something that happens to pro athletes and to all of us at times, commonly called “choking.”  It’s when we experience a sudden and significant deterioration in a task that we’ve practiced and mastered but just can’t pull off at the crucial moment. Choking is due to internal distractions like letting our brain focus on the pressure of the moment and robs our brains of the mental bandwidth to accomplish the task at hand.  The sports world is full of examples like 4 putting on the last hole of the US Open or striking out with bases loaded in the bottom of the ninth inning in the last game of the World Series.  In our world, it’s like a pilot botching an approach and landing that’s been done a hundred times perfectly before, but the consequences are hugely more dangerous for us.  There are methods to maintain and even enhance your focus that come from the world of professional athletics and psychology.  Next month we’ll discuss ways you can enhance your own game and nail that World Series homer in the bottom of the ninth inning or hit winners down the backhand line at Wimbledon.  Well...if it’s not there, at least we’ll cover the tools you can use to ramp up your own game and nail those approaches in low IFR. 

Kenneth Stahl, MD, FACS

Kenneth Stahl, MD, FACS is an expert in adapting principles of aviation safety to the healthcare industry for patient safety. He also writes and teaches pilot safety principles and error avoidance. He is triple board-certified in cardiac surgery, trauma surgery, surgical critical care and general surgery and holds an active ATP certification and a 20-year member of the AOPA. Dr. Stahl practices surgery full-time and is Healthcare Division President for Convergent Performance, an industry leader in teamwork, checklist and accountability training and consulting. He can be reached at [email protected]

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