tell yourself about your medical and how it impacts you physically is the variable going to focus on here begin with an My client Sierra endured uncomfortable bouts of gastroesophageal reflux disease The symptoms were so painful that she was frequently distracted from work and family responsibilities slept upright at night and so slept poorly and despite medication had a perpetual burning sensation in her chest By the time Sierra entered therapy she had seen a number ofgastroenterologists without gaining relief When I talked to her about the relationship between stress anxiety and medical conditions she was exasperated and felt that I was minimizing her genuine physical illness After some conversation Sierra softened her view although she was unable to believe that her GERD symptoms could be helped by anything other than a medical fix We persevered She started practicing mindfulness changed her diet and studied the relationship between stress and physical health Eventually she became aware that her GERD although very real and painful often flared after she experienced a stressful event Armed with this knowledge she developed strategies to use each time her anxiety was triggered She still experienced GERD but reported that the intensity of her symptoms