DRB Health Psychology recognizes the stress of living with a medical condition often requires patients to balance lifestyle changes with conflicting personal expectations. These conflicts create stress and often contribute to feelings of anger, demoralization, guilt, and worry. The stress of trying to achieve balance while living with the symptoms and limitations of chronic medical conditions can cause the symptoms of one’s condition to worsen, undermining medical treatments and progress

For many chronic medical conditions, stress creates a vicious cycle: problematic symptoms lead to difficulties and stress. Difficulties and stress leads to greater challenges balancing lifestyle changes and management of symptoms. This stress then leads to even more stress contributing to symptoms becoming more frequent, more intense, and the management of symptoms becomes even more difficult.

Using the evidenced-based methods of Cognitive Behavioral Therapy, Motivational Interviewing, and Patient-Centered philosophy Dr. Brecher reinforces patients’ determination and resilience. Dr. Brecher aims to help patients break the vicious cycle between stress and chronic medical condition progression, support medical treatment and management, and improve quality of life.

The therapy offered at DRB Health Psychology is rooted in decades of psychological research and experience. Treatment aims to develop clarity to life style changes needed to effectively manage medical conditions and develop confidence in one’s ability to enact and maintain the healthy lifestyle change.

The American Heart Association summarized the research on psychological well-being’s impact on cardiovascular health and found psychological wellbeing can noticeably contribute to the course and progression of cardiovascular diseases.

Stress and emotional distress, such as anger, anxiety, depression, and pessimistic outlook negatively impacts cardiovascular functioning through several biological pathways, including contributing to arterial stiffness, inflammation, higher levels of bad cholesterol, and platelet aggregation. Each impact increases the risk and progression of cardiovascular diseases. 

Conversely, psychological wellbeing is associated with elevated good cholesterol levels,  and decreased risk of hospitalization for cardiovascular events such as heart attacks, strokes, and death.

The Department of Health and Human Services recognizes stress and emotional distress contribute to the activation of biological mechanisms in the central nervous system, inflammatory responses, muscle tension, and pain sensitivity that influence symptom severity and contribute to disability.

The increased symptom activation associated with stress responses can create a cyclical pattern: increased symptom severity and reduced function increases stress, which again increases symptom severity. This cyclical relationship is true regardless of the source of pain and other symptoms, be it musculoskeletal, neurological, or autoimmune/ rheumatological. Therefore, The Department of Health and Human Services advocates for the inclusion of psychological interventions that address the impact of dysfunction from symptoms and chronic pain as a key component of effective treatment and management.

The American Diabetes Association recommends psychological treatment should be a part of integrated treatment for all patients with diabetes. This statement is true for all patients with conditions of the endocrine system. In some instances, chronic stress and emotional distress are recognized to influence body’s ability to engage in hormonal regulation and in other instances, endocrine conditions may cause the body to be unable to regulate the body’s response to stress and emotional distress.

The endocrine’s relationship with stress and emotional distress contributes to a cycle with endocrine conditions where greater stress leads more symptoms and dysregulation (such as greater A1C or irregular cortisol levels), leading to greater symptoms and more stress.

Psychological treatments can help patients cope with the demands of lifestyle changes required to help regulate the body’s difficulty to regulate itself and break this cycle.

The American Gastroenterological Association recognizes chronic digestive conditions, such as irritable bowel syndrome, gastro-esophageal reflux disease, and inflammatory bowel diseases, are intertwined with the psychological wellbeing of the patient.

Stress and emotional distress have been observed to contribute to gut dysfunction through neural, immunological, and microbiome interactions. A cycle of burden between managing GI symptoms contributing to stress, and vice versa, can cause increased gut dysfunction, leading an further increase of symptoms.

Psychological interventions therefore are recommended as a means of helping patients reduce the burden of these symptoms. By helping reducing stress and emotional distress, the interactions between stress and gut dysfunction can be reduced.

The American Academy of Neurology recognizes that stress can increase the severity of symptoms across several neurological conditions, including Epilepsy and seizure frequency, headaches and migraines, and Multiple Sclerosis. Other research has also associated stress with symptom severity of Neuropathic pain and Parkinson's Disease. Managing stress with these conditions may be difficult because the condition itself brings on a significant amount of stress and emotional response.

The mechanisms by which stress influences symptom severity is different to each condition, varying between hormonal and/or neurological pathways. Improvements in coping has demonstrated common improvements of symptom frequency and severity, and for some conditions, slowing disease progression. Psychological treatment can help develop and promote these beneficial methods of coping with emotional distress and stress.

The American Cancer Society encourages patients with cancer to connect to sources of emotional support. While there is some evidence that suggests reducing stress can help the course of cancer, this evidence is not well established nor agreed upon by experts. However, what is well recognized is patients with cancer often experience a range of emotions that can fluctuate often and quickly following diagnosis and during the course of treatment. Due to external influences, patients may feel a burden to be optimistic and strong regardless of circumstances. Emotional distress, anger, anxiety, depression, fear, and guilt are all normal emotions to experience. Patients also often experience burdens and challenges while living with cancer that frequently include living with pain, uncertainty towards treatment options, and changes in functioning.

Psychological interventions can help provide the emotional support the American Cancer Society recommends to help people with cancer manage the emotional burden of their diagnosis. Burdens and challenges often experienced while living with cancer, frequently include living with pain, fear, and changes in functioning because of the cancer and medical treatments. Psychological interventions can help address these burdens towards improving patient quality and satisfaction with life.

The American Thoracic Society includes psychological support as a standard of care for patients with chronic lung disease. Research of respiratory diseases has observed the overlap of symptoms between respiratory diseases with symptoms of anxiety and depression, such as shortness of breath/difficulty breathing and low energy. There is an intertwined cyclical relationship that can significantly impact an individual's quality and satisfaction of life, and can influence the course of treatment.  

Difficulty breathing can be confused with anxiety, anxiety can be confused with respiratory distress, and each can result in the other because both cause heavier or strained breathing. Strained breathing and poor oxygen intake can deplete an individual's energy, limiting motivation and ability to participate in typical daily activities. Low energy and low motivation can each on its own, or together, result in feelings of depression which can negatively impact the management of symptoms, and the progression of respiratory diseases.

Psychological interventions can be tailored to help people with respiratory diseases return to their daily life activities as well as recognize and respond to common symptoms of respiratory distress, anxiety, and depression.

Research has observed a correlation between urinary track symptom severity and frequency with stress, and emotional distress. While the mechanisms of association have not yet been determined, psychological interventions have been recommended by the American Urological Association to aid patients in addressing this connection. Psychological treatments focus on stress management and adaptive lifestyle changes to reduce the impact of symptom interference on day-to-day functioning and improve quality of life.