Category: News

Driving Anxiety after a Motor Vehicle Accident: The Importance of Treatment

It is common for car accident survivors to develop various psychological symptoms, including driving or passenger anxiety. While many people recover, some continue experiencing high anxiety related to driving or even being a passenger in a car. The anxiety may also escalate to an overwhelming fear of driving resulting in avoidance of driving. This can seriously disrupt a person’s life, which is why psychological treatment is critical.

Risk Factors:

·       severity of the accident

·       severity of injury

·       coming close to dying

·       flashbacks

·       history of traumatic events

·       pre-existing psychological factors

·       continued litigation related to the car accident


·       uneasy/anxious about driving

·       difficulty driving/riding in a car

·       excessive worry

·       irritability/anger

·       fear of getting into another accident, harming self/others

·       avoidance of driving or driving only when necessary

·       physical symptoms (feeling tense, sweating, trembling, difficulty breathing, heart pounding)

·       panic attacks


Lack of treatment post motor vehicle accident can prolong psychological symptoms and make them worse. At NRS|LS, we provide cognitive-behavioral therapy, including biofeedback that can help overcome driving anxiety and restore confidence in driving.  Early treatment post accident is critical.

If you or someone you know experiences driving anxiety, please contact our office for a consultation.


Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Chief Post-Doctoral Fellow
Permit# TP #213-03


Caregiver Grief in Loved Ones with Dementia

Grief is a sense of deep sorrow experienced after a significant loss. The death of a spouse or a
close family member is among the five most significant stressful life changes causing grief. With
dementia, spouses and other caregivers often start experiencing grief years even while their loved
one are still with them.

Caregiver grief in dementia is caused by the so-called “ambiguous” loss. The loss is ambiguous
because a loved one with dementia is still physically present but continuously struggles both
cognitively and psychologically. The stress level produced by ambiguous loss is equal to or even
greater than the grief following the person’s loss. Various factors contribute to the experience of
ambiguous loss. Some of the factors include the severity of the dementia symptoms, the burdens
and losses associated with caregiving, uncertainty about the future, the caregivers’ psychological
and physical health, and the ability of the family unit to cope with the changes associated with

The problem with ambiguous loss is that the caregivers often do not even know that they are
going through a grieving process. Moreover, the grieving process due to ambiguous loss is often
not recognized or supported in society, preventing caregivers from sharing their grief with others.
As a result, they have difficulty adjusting to their loss.

At NRS|LS, we offer Medical Adjustment Counseling ® (MAC) for patients with dementia and their
caregivers to help with the biopsychosocial changes of the person with dementia and his/her family members.

If you have any questions, or are in need of MAC, please call our office for more information.

Eleonora Gallagher, Psy.D.
Neuropsychology Post-Doctoral Fellow
NJ Permit: TP# 213-079


This is the last topic of three in our series on Psychoneuroimmunology and Neuropsychology. This current topic will be on the effects of the human gut microbiome (gastrointestinal system) upon thinking abilities, and behavioral functioning.

This series will be expanded into an article that will be submitted to the Journal of Psychoneuroimmunology by the authors.

In recent years there has been rapid growth in the discipline of Psychoneuroimmunology. A more recent area of research is investigating how the gastrointestinal and immune systems interact with the brain and affect brain function in cognition (thinking) and/or emotional behavior. The close connection between the microbiome (gut), nervous, endocrine, and immune systems has become a major challenge for interdisciplinary research. Newly developed methods in neuropsychology, immunology, and imaging have allowed deeper insights and understanding into the mechanisms of neuroimmune interactions.

Additionally, the role of neuroinflammation on cognition and neuropsychology, basics of psychoneuroimmunology, and neuropsychology, including neuropsychological examinations of cognition are providing a greater understanding of the complex relationship between the gut and our thinking. Besides the relationship between the gut, brain, and cognitive problems, emotional disturbance, behavioral abnormalities, and psychiatric systems are starting to become better understood with adults and in children.

Your gut includes the stomach, small intestine, and large intestine which includes the colon, liver, and gallbladder. The gut is responsible for ensuring that you absorb the nutrients of the food you eat, properly expel waste and toxins, and maintain a strong immune system.

Emerging research suggests that the human gut microbiome provides an avenue to improve cognition/thinking. Two design methods understanding the relationship between the gut and the brain (cognition) are correlational and have documented pre/post interventions. These methods have demonstrated that microbiome environment affects cognitive flexibility of thinking and executive functioning, in the form of planning, organization, and efficient daily functioning. The gut/microbiome environment is now clearly establishing a strong relationship between gut health and improved cognition, and behavioral/emotional brain functions. Results have shown improved cognition observed in visuospatial memory, verbal learning, memory, and attention.

The adherence of a proper diet and supplements is also gaining greater importance. Probiotics have recently become extremely popular. What the term really translates to is eating certain fruits and vegetables that feed the productive bacteria in the gut. The truth is every fruit and vegetable that you eat raw feeds good bacteria.

There are also significant supplemental regimens that aid in the gut that affect our thinking and cognition. There are a number of biotics in the form of probiotics, prebiotics, paraprobiotics, and symbiotics. Without diving into the complexity of the variations of probiotics, suffice it to say, that significant relationships between microbiome diversity and its enhancing cognitive flexibility, executive functioning, and memory have now become clearly established. The findings linking the gut microbiome and its relationship to our immune and neurological systems are becoming fact based. The most positive effects are linked to interventions containing probiotic, prebiotic, and a combination of the two (symbiotic).

Finally, new research is investigating the connection between autism and gut health. Comprehensive studies are identifying patterns in gut bacteria profiles to autism, pointing to new advancements. Researchers have identified microbial signatures for autism spectrum disorder, a critical finding that offers information about how the gut microbiome influences our neurological syndrome. Hence, there is hope to focus on improving diet and incorporating supplements that will favorably impact and improve cognition and behavior.

Should you have any questions regarding this new and exciting field in terms of how neuropsychology is affecting our health, please give us a call for a consultation.

Julianna R. Greco
Academy of Allied Health and Science

Robert B. Sica, Ph.D., ABN, FACPN
Board-Certified in Neuropsychology Director, Neuropsychological Rehabilitation Services|LifeSpan


Thank You To Our Summer Interns

Thank you to the 2023 NRS|LS summer interns! This was an impressive group of students, and we look forward to seeing you accomplish your future endeavors.

Francesca M. (Florida Gulf Coast University)
Jasmin S. (University of Pittsburg)
Amisha R. (Biotechnology High School)
Julianna G. (Academy of Allied Health and Science)
Olivia P. (University of Nebraska)
Grace G. (Ohio State University)
Ella R. (Lehigh University)
Rohit S. (Johns Hopkins), not pictured
Yana Z. (Academy of Allied Health and Science), not pictured

nrs lifespan summer interns

When Medicine Can’t Help Chronic Pain

Conventional wisdom suggests that chronic pain is a medical problem and that medical doctors
are the best at treating pain? This may be true. However, decades of research have shown that an
“interdisciplinary” approach to treating a chronic pain condition is superior to any single
intervention (to be clear, chronic pain is not the same as acute pain. Acute pain = being in pain
for under 6 months; Chronic pain = 6+ months of pain). The best long-term outcomes occur
when patients work with many doctors across specialties and, in the best case scenario, these
doctors actually talk to each other regularly and coordinate treatment plans, recommendations,
information, etc. Specialties that may be involved in the treatment of chronic pain include:
orthopedics, sports medicine, pain medicine and rehabilitation, physical therapy, acupuncture,
massage therapy, and psychology.

Many people are confused about the role that a psychologist would play in the treatment of
someone with chronic pain. There are several reasons for this. One reason is that many people
with chronic pain don’t know the extent of the neuroanatomy behind chronic pain, regardless of
where it is felt in the body. For instance, we know that lower back pain doesn’t begin and end in
the lower back or the spinal cord. Pain registers in multiple parts of the brain, including the
thalamus, limbic system, cerebral cortex, and somatosensory cortex. The limbic system and
cerebral cortex do many things, including shaping our emotions and thought process. Activity
that happens in these areas of the brain directly influences pain signals. Simply put, emotions
and thoughts shape the experience of pain. And since psychologists are experts in the domains
of emotions and thoughts, they play a pivotal role in improving the outcomes of those with
chronic pain, especially when it appears that medical interventions aren’t helping.

Psychological approaches to chronic pain aren’t mysterious or random. And the positive
outcomes aren’t simply due to a placebo effect. Neuroscience studies show that psychological
approaches actually reverse the neural changes associated with chronic pain. Effective treatment
combines a variety of techniques (cognitive-behavioral, psychoeducational, mindfulness-based
stress reduction, biofeedback/relaxation, and pacing) to help patients self-manage their pain and
require less medical intervention(s) and medication.

If you are interested in learning more about psychological treatment for chronic pain at NRS|Lifespan,
please call 732-988-3441 to schedule a consultation appointment.


Lauren Gashlin, PsyD
Clinical Psychology

Neuroautoimmune Diseases and Cognitive Dysfunction Part 2 of the 4-Part Series

Cognitive dysfunction refers to a broad range of changes and abnormalities in our  thinking that affects a person’s memory, perception, language, problem-solving, and other mental abilities. Cognitive dysfunction is not a specific medical condition, rather a term used to describe a group of symptoms that can arise from underlying brain conditions. Part 2 of the Neuroimmunity Series will describe cognitive dysfunction that results from three common neuroautoimmune diseases: multiple sclerosis, autoimmune encephalitis, and neurosarcoidosis.

Multiple Sclerosis (MS)    

Multiple sclerosis is a neuroautoimmune disease that affects the central nervous system, leading to inflammation and damage to the protective myelin sheath surrounding nerve fibers. It is believed to be caused by the dysregulation of certain immune cells, which are crucial in defending the brain from viruses and certain bacteria. When these cells become dysregulated, they target the body’s own cells and tissues, leading to autoimmune disorders. Cognitive deficits of MS include poor attention, decreased memory, motor changes, and reduced speed of information processing which occur in approximately 40% of patients.

Autoimmune Encephalitis (AE) 

Autoimmune encephalitis (AE) is a type of inflammatory neuroautoimmune disorder characterized by the immune system mistakenly attacking healthy brain tissue. In patients with AE, the body’s immune system produces antibodies that target specific proteins found on neurons, leading to inflammation and damage in the brain. Since there are many specific proteins affected in patients with autoimmune encephalitis, there can be a wide range of thinking changes. Symptoms of AE include memory problems, mood swings, personality changes, tremors, seizures, loss of coordination, hallucinations, delusions, paranoia, and difficulty understanding language.


Neurosarcoidosis is a rare form of sarcoidosis (a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata) that specifically involves the nervous system. It is characterized by the development of granulomas that can build up on the brain, spinal cord, cranial nerves, or the protective membranes of these areas. This leads to thinking changes in processing speed, attention concentration, memory, to name a few. In addition, physical problems can occur with vision, difficulty swallowing, fatigue, headaches, weakness in sensory nerves, and in some cases seizures.

Neuropsychologist’s Role

The role of the neuropsychologist with neuroautoimmune disorders is to evaluate a person’s thinking and behavioral abilities that typically becomes disrupted as a result of the above conditions. Upon obtaining objective neurocognitive data, the neuropsychologist works with your medical team to address the severity, treatments needed, and outcomes of these patients. Reintegration into work, life, school, etc., is a vital part of treatment. Here at NRS|LS, our board-certified neuropsychologists are prepared to treat you or your family member that may be affected by impaired neuroimmunity causing a variety of psychological and neuropsychological changes.

Stay tuned for Part 3 of the Neuroimmunity Series.

Please call our office for further information.

Julianna R. Greco
Academy of Allied Health and Science

Robert B. Sica, Ph.D.
Board-Certified in Neuropsychology
Director, Neuropsychological Rehabilitation Services|LifeSpan



Migraine Headaches: How Biofeedback Can Help

It is estimated that 39 million of people in America suffer from migraine headaches. Symptoms usually vary from person to person and often involve various parts of the body (e.g., pain/pressure around eyes, temples, jaw, neck, sinuses, sensitivity to light, noise, nausea, vomiting, appetite loss, dizziness, blurred vision). A migraine attack can seriously affect person’s day-to-day life. It may lead to changes in mood (e.g., irritability), muscle tension/pain, low energy levels, and trouble concentrating. Not surprisingly, the World Health Organization (WHO) recognizes severe migraine attack as a seriously disabling condition. Fortunately, biofeedback can help a person learn skills to reduce the headache frequency and severity by up to 45-60% (American Migraine Foundation).

Common Migraine Triggers

  • Emotional/physical stress
  • Poor sleep
  • Certain foods (alcohol, especially red wine, dairy products, chocolate), sweeteners and preservatives
  • Dehydration
  • Hormonal Changes
  • Certain Medications
  • Barometric pressure changes


Lifestyle changes can help reduce the above triggers for migraines. Biofeedback can also be beneficial, especially as it can help mange stress that often triggers migraine attacks. Our bodies change when we are in pain or stressed.  The heart rate increases, breathing is faster/more shallow, and muscles get more tense. Biofeedback can provide skills to slow your breathing, reduce heart rate, including physical tension so that you can regain control over your body. Here at NRS, we offer biofeedback which can help you manage your migraine more effectively. If you or someone you know suffers from migraine headaches, please contact our office for a consultation.


Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Post-Doctoral Fellow
Permit# TP #213-03


Does Your Brain Have an Immune System?

Part 1 of a 4-Part Series

For many years it was widely believed that the brain’s immune system was separate from the rest of the body, but extensive research has suggested that the two systems are tightly related. While the immune system plays the beneficial role in the normal development and recovery of the brain, it is also a factor in several neurodegenerative diseases and mental conditions that can cause serious and long-lasting harm.

The central nervous system is protected by an elastic covering called the meninges and the immune cells within this membrane. The specialized blood vessels are sealed off from the rest of the body by the blood-brain barrier. However, in the outermost layer of the meninges, the dura mater, blood vessels are not sealed off. Pathways carry slow moving blood which can create a place where harmful cells can easily accumulate and enter the brain. To account for this vulnerability, the immune cells are highly present in the dura mater.

Recent studies have shown that some of the immune cells in the dura mater are trained to fight these infections by spending time in the gut first. These are called IgA cells and are usually found in other barriers such as the mucous membranes, the lungs, besides the gut. Rather than waiting for infection to occur, IgA cells are constantly pumping out antibodies against microbes that they first encountered in the gut.

Neuroimmunology is a field that is often overlooked when it comes down to the quality of an individual’s thinking. While there are the beneficial elements noted above, unfortunately negative consequences can arise that warrant attention as a result of this connection:

  • Autoimmune diseases cause the immune system to attack its own cells. A prominent example of an immune attack on the brain is multiple sclerosis (MS), where the cells that normally protect us mistakenly attack myelin (the protective covering around a brain cell) in the central nervous system and cause neuropsychological problems.
  • While MS varies from patient to patient, the attacks to the CNS can cause symptoms such as vision problems, muscle weakness (partial or complete paralysis is not uncommon in later stages), tingling, numbness, balance issues, bladder control problems, fatigue, mood changes, and cognitive changes in memory, processing, and organization.

Here at NRS|LS, our board-certified neuropsychologists are prepared to treat you or your family member that maybe affected by impaired neuro-immunity causing a variety of psychological and neuropsychological changes besides the physical symptoms

Part 2 of the Neuroimmunity Series coming soon.

Please call our office for further information.


Julianna R. Greco
Academy of Allied Health and Science

Robert B. Sica, Ph.D.
Board-Certified in Neuropsychology
Founder/Owner, Neuropsychological Rehabilitation Services|LifeSpan




Modifying the Home Environment for Family Members with Dementia

Research indicates the ability to complete everyday tasks declines in people with dementia, causing increased stress in their home environment. Home is the place where people with dementia spend most of their time. Modifying their home environment can help support their sense of independence and reduce anxiety and depression. Below are examples of the changes you can make to your home if you have a family member with dementia:

  • People with dementia reportedly do better in rooms with clear functions (e.g., kitchen, dining room). The rooms using open-concept floor plans produce confusion.
  • Label drawers, simplify the room, and remove clutter to make it easier for them to find things.
  • Automated lighting increases safety.
  • Play preferred music during mealtimes to increase food intake in people who have low appetite and forget to eat.
  • Make “help yourself” meals instead of giving a person a pre-prepared plate to increase the use of utensils and social interaction.
  • Display pictures showing how to brush teeth and use magnifying mirrors in the bathroom to help improve oral hygiene.
  • Choose clothing items considering their individual style and cultural preferences and arrange them in order to make dressing easier.
  • Place photos and objects bringing happy memories around their room to create a pleasant environment.
  • Add easy-to-read digital clocks and keep window curtains open during the day to help them stay oriented to time.

If you have any questions about neuropsychological testing that will define the needs and treatment options for dementia patients, please call our office.

Eleonora Gallagher, Psy.D.
Neuropsychology Post-Doctoral Fellow
NJ Permit: TP# 213-079



The Effects of Music on the Brain

“Music can lift us out of depression or move us to tears- it’s a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more–it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.” -Oliver Sacks, neurology professor, best-selling author, and physician

Music is shown to help with mood, cognition, and motor function. In fact, multiple areas of the brain are engaged when we listen to and/or create music, including auditory cortex, prefrontal cortex, motor cortex, amygdala, and hippocampus.

Specifically, for individuals with Alzheimer’s disease or other forms of dementia, familiar tunes can help them recall past experiences as well as enhance cognitive function. According to research, this is due to the connection between music and the hippocampus. Neuroscience News reports, “Music has a unique link to our memories. An old song can transport us back to a specific place and time, evoking vivid emotions.”

Music is often used as a therapeutic tool as it releases dopamine, a neurotransmitter associated with pleasure and reward. To put it simply, it makes us feel good. Research has revealed music therapy has shown promise in treating a variety of conditions, including Parkinson’s disease, depression, stroke, and brain injuries.

In addition, the relaxing properties also help individuals with chronic pain, insomnia, stress, and anxiety. In fact, some music is designed for deep relaxation using specific frequencies and binaural beats.

Lastly, does musical genre matter? Below is a list of different types of music and their benefits:

  • Classical: can enhance dopamine secretion and synaptic function, learning, and memory
  • Rap: can stimulate emotion, language, motivation, motor function, and processing
  • Jazz: can soothe the body
  • Heavy Metal: can elicit a sense of identity and a knack for community development
  • Pop/Rock: can improve endurance and enhances physical performance

It is a fact: Music shows promise for helping to heal the brain.


Michelle Blose, PsyD
Neuropsychology, Post-Doctoral Fellow
NJ Permit: TP# 203-032