During the 2015 Netball World Cup final, Australian Diamonds player Caitlin Bassett faced an incredibly high-pressure moment. With the match against New Zealand’s Silver Ferns tied in the final seconds, Bassett took a game-winning shot that secured the victory and the championship for Australia. This moment required focus and composure under intense pressure.

Similarly, in the medical field, surgeons encounter unexpected complications during operations, requiring immediate focus and calm under pressure to ensure patient safety and outcomes. Performing well under pressure requires us to tap into and manage our psychological, emotional, and physical responses. This includes:

• Regulating our arousal levels
• Focusing our attention
• Reframing our mental dialogue

When used effectively, these skills help us stay focused, manage stress, and excel even in challenging circumstances.

The following techniques are two evidence-based options designed to help performers master their focus during high-stress situations, such as during a surgical complication or when taking the game-winning shot.

The Quiet Eye Technique: Anchoring Attention 

Quiet Eye is an evidence-based technique that involves narrowing or anchoring your attention before engaging in a skilled task or activity. Originally developed for high-performance sports, the Quiet Eye technique has proven useful in medical contexts, particularly during surgery.

Research shows that Quiet Eye can improve performance in various motor activities performed under pressure, such as improving free throws in basketball and knot tying during surgical procedures (Causer, 2014; Gil et al., 2022; Labeau et al., 2016). Additionally, the Quiet Eye technique has been found to decrease the time needed to acquire new skills, aiding learning in high-stress environments (Gil et al., 2022).

Instruction for Quiet Eye technique:

1. Pause and focus gaze on a task-relevant focus point (FP).
2. Lift gaze (hold at least 100 ms)
3. Return to FP (hold at least 100 ms)
4. Continue with the performance task

The Physiological Sigh: Calming Body and Mind

The physiological sigh technique is a simple breathing exercise designed to quickly reduce stress and calm the nervous system in high-pressure situations. It can be done anywhere, without any equipment, and takes just moments to implement. This technique leverages the body’s natural mechanisms to reset and regulate physiological states.

The physiological sigh works in two main ways:

• It increases oxygen exchange by expanding the alveoli in the lungs.
• It counters the ‘fight-or-flight’ response of stress-induced sympathetic nervous system activation by engaging the parasympathetic nervous system during extended exhalation.

In the context of surgery, this technique provides immediate stress reduction and enhances mental focus, allowing users to stay concentrated on their tasks in real time.

Instructions for Physiological Sigh technique:

1. First Inhale: Take a deep breath in through your nose, filling your lungs.
2. Second Inhale: Without exhaling, take another, smaller breath in to fully inflate your lungs.
3. Slow Exhale: Slowly and completely exhale through your mouth, emptying your lungs entirely.
4. Repeat this cycle up to three times before continuing with your task.

Practice is key to improving performance in any context – sport, medicine, performing arts. Developing effective techniques to manage unexpected stressors requires exploring what works best for you. There’s no one-size-fits-all solution—so experiment with different evidence based techniques and explore what helps you perform best under pressure.