An excerpt from our newest title, Life and Death Design by Katie Swindler

We’ve just published our newest title, Life and Death Design: What Life-Saving Technology Can Teach Everyday UX Designers, by Katie Swindler. Below are the blurb and an excerpt of chapter 1, “A Designer’s Guide to the Human Stress Response,” so you can sample it for yourself. You can also check out the book site, which includes a table of contents, testimonials, and all the other good stuff you’d expect.

If you’d like to pick up a copy, you can purchase it directly from Rosenfeld Media and you’ll get a free copy of the ebook when you purchase the paperback.

OK, the blurb, followed by the excerpt; enjoy!

Emergencies — landing a malfunctioning plane, resuscitating a heart attack victim, or avoiding a head-on car crash — all require split-second decisions that can mean life or death. Fortunately, designers of life-saving products have leveraged research and brain science to help users reduce panic and harness their best instincts. Life and Death Design brings these techniques to everyday designers who want to help their users think clearly and act safely.

Because technology has become so integrated into every aspect of people’s lives, it is a near certainty that, over the course of your career as a digital designer, you will design products that will be used by someone during or directly following a moment of crisis, even if that is not the product’s primary intent. By studying and understanding the human stress response, you can better anticipate people’s needs and behaviors in those moments, allowing your product to support them in the moments that really matter.

In this chapter, we’re going to start with an overview of the acute stress response, which includes five major stages:

1. Startle reflex
2. Intuitive assessment
3. Fight, flight, or freeze
4. Reasoned reaction
5. Recovery

In order to illustrate all the steps of the response, we’ll follow the tale of a woman named Amy (named for the neurological star of the stress response — the amygdala) as she experiences a frightening event. Amy and the following story are fictional, but the science underlying Amy’s adventure is as real as it gets.

Amy’s Accident

Amy is about to have a very bad morning. She’s driving to work — it’s a route she’s followed a hundred times before. She’s driving on the kind of mental autopilot only daily commuters can achieve. Engrossed in her podcast episode, Amy begins to execute a standard maneuver, switching from the center lane to the left lane of a three- lane highway, when an unexpected movement is caught by the very edge of her peripheral vision. This is when the trouble begins.

The unexpected movement triggers the first phase of the acute stress response, the startle reflex. Her system is flooded with adrenaline, a stress hormone that supercharges the body for survival reactions like fighting or fleeing danger. This unconscious reflex causes her to simultaneously turn her attention toward the threat while moving her body away from it. Her arms jerk the wheel sharply to the right in order to move herself and her car out of the path of the incoming object.

Now that Amy has turned to face the approaching object, she enters the second phase of the response, intuitive assessment. She effortlessly and instantly identifies the mystery object as a motorcycle recklessly speeding in the left lane. Intuitively, she assesses the trajectory of the motorcycle compared to the trajectory of her own vehicle and, without the need for any actual math, she correctly calculates that she is no longer in danger of colliding with the driver. However, she is so focused on avoiding the cyclist that she doesn’t realize her reflexive motion, fueled by adrenaline, was an overcorrection, sending her car veering into the right lane. BAM!

Amy’s front bumper clips the side of a minivan. Her vehicle bounces back, thrown into the center lane. This is the moment when Amy officially enters a full fight-or-flight response, the third stage of the acute stress response. This stage is fueled by even more adrenaline along with a healthy dose of cortisol, another important stress hormone that increases focus, drives immediate action, and prioritizes fast, intuitive decision-making over logic and reason. She wrestles with the wheel to keep from rebounding into the motorcycle on her left. Supercharged by adrenaline, her foot slams down hard on the brake. She hears the squeal of tires from multiple vehicles and sees cars swerving all around as they try to avoid rear-ending her. In her panic, Amy is frozen in her seat. Only her eyes move, darting between her mirrors and windows, as the traffic slows to a crawl around her. Miraculously, no additional crashes occur.

A robotic voice fills the car, “Vehicle crash detected. Connecting to OnStar Emergency.” Amy remembers that OnStar crash support service came included with her car purchase and is equal parts embarrassed and relieved when a few seconds later a “real human” comes on the line. “This is Randall with OnStar. Is anyone injured?” This rational question kicks Amy’s brain out of the panic mode of fight or flight and into the fourth stage, reasoned reaction. She reports that she is uninjured, but she is unsure about the people in the other vehicle. Centered by Randall’s clear, step-by-step directions, Amy follows his instructions to pull her badly damaged car to the side of the road and confer with the other driver. Luckily, no one in the van is injured either. Still, Randall offers to send a police officer to the scene to create an accident report for the insurance company and Amy agrees.

By the time Amy parks her car on the shoulder, her heart rate and breathing have almost returned to normal. Amy has now entered the recovery period, the fifth and final stage. Since her response to the accident involved very little physical exertion, Amy still has plenty of leftover adrenaline in her system, causing shaking hands and jitteriness. While she waits for the police to arrive, she channels her restless energy into using her phone to do all kinds of things: taking down the other driver’s contact information, texting her boss to tell her she’ll be late for work, and taking pictures of the damage to her own car and the minivan. She even uses her insurance app to file a claim and order a tow truck for her car, and then orders an Uber for herself to the nearest car rental agency. Although it will be another hour or two before the effects of the adrenaline and cortisol fully wear off, Amy, her car, and all the other people and vehicles involved in the incident will make a full recovery from this stressful morning.

Amy’s acute stress response both helped and hurt her during this encounter. First, it helped her reflexively avoid a collision with the motorcycle, but this caused her to overcorrect and hit the minivan. Next, it helped her wrestle the car back under control, though in bringing it to a sudden stop, she nearly caused a pileup. And finally, it took her back to rational thinking in the end, allowing her to execute a flurry of activity in the aftermath of the event.

At each step of the response, her ancient instincts had to work with multiple types of modern interfaces: digital, physical, and voice controlled. Some of those interactions were more successful than others. Different parts of the stress response require different approaches from designs. Understanding those various needs is critical to creating designs that can properly protect and empower a user in a moment of crisis.

Startle Reflex Considerations

When you are designing for a startle response, it’s helpful to remember that a startle response is a powerful force of nature, allowing humans to respond to danger with lightning-fast reactions. You can attempt to harness it through your designs, but this requires your interface to be in just the right place at just the right time. In Amy’s story, her hands were on the steering wheel at the moment she was startled, so she was able to use the wheel to jerk out of the path of the motorcycle. This reaction is exactly why drivers are instructed to keep their hands on the wheel at all times while controlling a vehicle. Physical interfaces like steering wheels, buttons, and knobs tend to be better at capturing these speedy reactions than touchscreens, but there are design lessons that can be borrowed from these analog controls to maximize the responsiveness of all kinds of digital interfaces including touchscreens, which we’ll explore more in Chapter 2, “The Startle Reflex.”

It’s also important for designers to keep in mind that, more often than not, startle reflexes are just a nuisance. Either they are false alarms, or they cause someone to overreact, like Amy careening into the right lane after jerking away from the motorcycle. Designers should always take steps to minimize false startle moves, or, if prevention is impossible, put systems in place to protect users from themselves in these uncontrolled, reactionary moments. We’ll dig into specific techniques for accomplishing these goals in Chapter 2.

Intuitive Assessment Considerations

When Amy turned to assess the threat level of the speeding motorcycle, this assessment, like all intuitive knowledge, happened instantaneously in her subconscious through a process of pattern matching. Even though she had never seen that particular vehicle before, she was able to match it to the category of objects she had learned was listed as “motorcycles.” Similarly, she was able to predict the motorcycle’s trajectory intuitively, based on how she had seen similar vehicles move in the past.

It’s important to note that nearly all of the driving maneuvers Amy executed throughout this story were powered by her intuition. She never once stopped to calculate how many degrees to turn her wheel to avoid a collision. All of her interactions came from an intuitive understanding of the car’s interface, which she had developed through years of repeated use.

NOTE: A Dangerous Learning Curve

It takes time and practice to develop reliable intuition for tasks as complex as driving. This is why the first 18 months of driving are so dangerous for new drivers, with car accidents topping the list of causes of death among American teenagers.

Designing for intuition can be a mixed bag. On the one hand, a truly intuitive interface can make technology feel almost like an extension of the user, allowing the person to focus all of their conscious efforts on the problem they are trying to solve. However, there are times when creating interfaces that rely too heavily on intuitive decision- making, unrestrained by fact checking or logic, can lead users to make hasty decisions that are overly influenced by harmful biases and stereotypes. When you are designing for intuition, it is critical to understand the types of environments where this subconscious ability to match patterns and automate decision-making is helpful, and the kinds of situations where users need to have their bias checked by the systems they use. We’ll explore different techniques for maximizing the benefits of intuition and minimizing the drawbacks in Chapter 3, “Intuitive Assessment.”

Fight, Flight, or Freeze Considerations

When a fight-or-flight response is triggered, the user’s rational mind is no longer in charge. No matter what their original objective was, now survival is the only goal. Often, users forget about technical solutions altogether in this state, falling back on more primal methods of dealing with danger. But, occasionally, users are forced through circumstances to interface with technology while in the grips of panic.

During Amy’s accident, her use of technology (AKA the car interface) during her fight-or-flight response was highly inconsistent. On the one hand, the fight-or-flight response enhanced her physical strength in a way that helped her get the car steering back under control after hitting the minivan. But the instinct to slam hard on her brakes, a form of the freeze response, actually increased her risk of a second collision with the cars behind her. This kind of unpredictable performance is very common when someone is panicking.

The best thing that technology can do when someone is in fight-or- flight mode is to protect them from harm and get them back to a rational state of mind as quickly as possible. For someone triggered to flee a situation, always allow them to exit or quit if they wish. Additionally, consider ways to provide clear, unobstructed paths to help, preferably human help. For someone in fight mode, look for ways to deescalate the situation. For those who are frozen in fright, give clear, specific direction to help them snap out of their indecision. (For example, the type of direction the OnStar operator Randall provided for Amy.) All of these techniques and more will be explored in Chapter 4, “Fight, Flight, or Freeze.”

Reasoned Reaction Considerations

More often than not, to survive and thrive in the modern world requires more logic than instincts. Well-designed systems and services can help users act rationally in a stressful situation by taking complex, multifaceted procedures and breaking them down into step-by-step processes. As illustrated in Amy’s story, companies like OnStar will design talk paths for their operators that allow them to triage the information-gathering process quickly and efficiently in an emergency. The goal is to ask about injuries first, and then address safety concerns like getting out of traffic, before moving on to more mundane issues like accident reports and insurance claims. Having these conversation flows written out and streamlined by the design team ahead of time allows the operator to stay calm and focus on the needs of the person in the crash, while executing each step correctly and in the right order of priority.

Experiences that are well crafted for reasoned response help users focus on the most relevant information for the task at hand and make well-informed choices at every step in the process. Techniques for designs that support rational decision-making under stress are explored thoroughly in Chapter 5, “Reasoned Reaction.”

Recovery Period Considerations

Users often turn to technology for help in the aftermath of a stressful event. In Amy’s story, as soon as she resolved the immediate threat, she was on her phone engaged in a flurry of activity.

While the physical aftereffects of adrenaline, like shaking hands, may be of some concern to interface designers, of much more relevance are the lingering mental effects of cortisol during this period. Cortisol drives action. In low-to-moderate levels, it is extremely helpful in terms of focus and motivation. During an acute stress response, however, cortisol floods the brain, intensifying focus to the point of tunnel vision and compelling a person to address the immediate threat to the exclusion of all other goals. High levels of cortisol can cause poor decision-making, reduce creative problem solving, and increase aggression in users. And while the effects of an adrenaline rush rarely last for more than an hour, cortisol can take several hours to be filtered out of the bloodstream.

These negative mental effects have major implications for all kinds
of designs used in the aftermath of a stressful event. Luckily, designers can help shorten this recovery period by designing aesthetics that calm the person and lead to empowering actions. In Chapter 6, “Recovery,” we’ll examine all the techniques that designers can leverage to help users weather the recovery period.