
The Pre-Surgical Psychological Evaluation: What It Is, Why It Matters, and What to Expect
December 9, 2025
So many of us suffer from constant worrying even when we know, logically, that everything is fine. Or we keep avoiding situations that matter to us, even though we genuinely want to show up.
This is common because our brains are running programs that worked for a completely different society. The same mechanisms that kept our ancestors alive (e.g., fighting off lions and bears) are now creating anxiety, rumination, and avoidance that get in the way of the life we want to live.
Here’s what’s changed. Modern society bombards us with micro-threats that we were never meant to bear all at once. We know about wars, famines, and anxiety-provoking situations hundreds or thousands of miles away, sometimes before we’ve even gotten out of bed to start the day. Our brains are in constant hyperdrive, trying to process threats that our ancestors would never have encountered simultaneously.
When your brain responds to this constant bombardment with anxiety and avoidance, it’s not a character flaw. It’s neurobiology.
My name is Dr. Rebecca Steele, and I am a licensed clinical psychologist with advanced training in neuropsychology. I want to help you understand why your brain does what it does, and how you can finally work with it instead of constantly fighting against it.
Key Takeaways
- Your brain’s anxiety, rumination, and avoidance behaviors aren’t character flaws—they’re survival mechanisms in hyperdrive due to constant modern micro-stressors
- Understanding the neurological “why” behind these patterns is the first step to change
- Neuropsychology-informed therapy addresses the brain-based causes of your struggles, not just the symptoms
- Working with a doctoral-level psychologist trained in both neuropsychology and clinical psychology means getting targeted, evidence-based care
The Survival Brain vs. The Modern Brain
What is fascinating about our brain is that it was designed to adapt to various situations where threats were physical and immediate (think predators, hostile tribes, dangerous weather). We came pre-packaged with some incredibly effective survival tools.
These include:
- Constant threat scanning helped us spot danger before it spotted us
- Pattern recognition let us predict what might happen next based on past experiences
- Quick avoidance responses got us out of harm’s way before we had time to think about it
These mechanisms worked brilliantly for the problems our ancestors faced. The issue? Most people’s brains haven’t received the memo that society has changed.
That constant threat scanning now shows up as anxiety. You’re not watching for predators anymore, but your brain is still scanning for threats in every email, every social interaction, every upcoming deadline. Add to this the constant stream of global crises at your fingertips through news and social media, and you have a brain that’s processing an overwhelming volume of information it was never designed to handle all at once.
This pattern can also show up as a trauma response. When you’ve experienced trauma, your brain’s threat detection system becomes even more sensitive, scanning for danger constantly to keep you safe. Whether it’s from trauma or the relentless micro-stressors of modern life (or both), the result is the same: a threat detection system that won’t turn off.
Your pattern recognition has turned into rumination, replaying situations over and over looking for what went wrong and what might go wrong next time.
Your quick avoidance responses now keep you from having difficult conversations, trying new things, or putting yourself in situations where you might feel uncomfortable.
According to the Anxiety and Depression Association of America, anxiety disorders affect 40 million adults in the United States. That’s nearly one in five people walking around with a threat detection system that won’t turn off. The constant state of hypervigilance is absolutely exhausting!
When Survival Patterns Become Daily Problems
There’s a difference between a brain that’s helping you stay safe and a brain that’s keeping you stuck.
Some worry is useful, of course. It helps you prepare, plan, and pay attention to things that matter. But when worry starts interfering with your daily life, something has shifted:
- Your ability to work effectively
- Your capacity to maintain relationships
- Your ability to get through your day without constant mental exhaustion
The same goes for avoidance, it makes perfect sense to avoid actual danger. It doesn’t make sense when you’re avoiding phone calls, social events, or opportunities because your brain has labeled them as threats when they’re really just uncomfortable.
Here’s what it looks like when your brain’s protective patterns are working against you:
- Thought loops you can’t escape, even when you know they’re unproductive
- You feel anxious about situations that you intellectually recognize aren’t dangerous
- Avoiding what matters because your brain’s alarm system won’t stop firing
- Constantly bracing for the next problem, criticism, or setback
The exhausting part is that you can’t just “think your way out” of these patterns. You can’t logic your way past anxiety or willpower your way through avoidance. That approach is like trying to reason with a smoke alarm that’s going off. The alarm doesn’t care about your logical arguments, it’s just doing its job.
The Neuropsychology Advantage: Understanding Why Your Brain Does What It Does
Understanding how your brain functions is where everything changes.
My Journey to Neuropsychology
I came to neuropsychology through my own experience with doubt and struggling against patterns that felt impossible to overcome. For years, I was drawn to this field but afraid to pursue it. My own experiences with self-doubt made me question whether I was capable of doing this work.
But I kept being pulled back because I saw something important. People who don’t understand their brain functioning often feel helpless when they’re dealing with problems they can’t see or explain.
Neuropsychological work gives people the opportunity to understand exactly how their underlying brain processes are affecting them. That understanding is what makes change possible.
How I Approach Your Care
When someone comes to see me, I’m not just looking at what’s wrong. I’m looking at why it’s happening.
The questions I’m asking include:
- Is this anxiety, or is it something that looks like anxiety but has a different cause?
- Are these attention problems actually ADHD, or are they the result of chronic stress or a trauma response overwhelming your working memory?
- Is this memory concern normal aging, or something that warrants closer attention?
My training in neuropsychology means I can do the detective work to figure out where the breakdowns are happening. My background in clinical psychology means I know what to do about it once we understand the problem.
This is what sets my work apart as a doctoral-level psychologist. I’m not just treating symptoms. I’m helping you understand the mechanisms behind those symptoms so we can address them at the source.
Whether you’re dealing with anxiety, trauma responses, cognitive concerns, or patterns that just aren’t working for you anymore, the first step is understanding what’s actually going on. That’s the work I do with patients at my Garden City office on Long Island and virtually throughout New York State, because specialized neuropsychological care should be accessible no matter where you are.
What It Looks Like to Work With Your Brain Instead of Against It
Working with your brain instead of against it means understanding what it’s trying to do and then using that knowledge strategically.
The process is collaborative. We start by understanding what patterns are showing up and what’s triggering your brain’s protective systems. Then we get specific about what’s actually happening and what we can do about it.
Neuropsychology-Informed Psychotherapy
Psychotherapy that’s informed by neuropsychology looks different from standard talk therapy. We’re not just talking about your feelings. We’re looking at the brain-based patterns behind those feelings and working with your neurobiology to create change. This is especially important for anxiety, trauma, and patterns that keep showing up even when you don’t want them to.
Cognitive Screening
Sometimes you need a clearer picture of what’s happening cognitively. Cognitive screening isn’t a scary diagnostic test. It’s a way to understand where you are right now so we have a baseline.
It gives us concrete information about how your brain is processing information and where the challenges are occurring. That information becomes the roadmap for what to do next.
Cognitive Training and Rehabilitation
For some people, the work involves building new skills and strengthening existing ones. Cognitive training and rehabilitation helps create new neural pathways. Your brain is more adaptable than you might think, and targeted training can strengthen the cognitive functions that matter most for what you’re dealing with.
What This Looks Like in Practice
In practical terms, this work means learning to recognize when your threat detection system is in overdrive so you can intervene before anxiety spirals. It’s understanding which avoidance behaviors are actually protective and which ones are just keeping you stuck. It’s building skills to interrupt rumination loops before they take over your whole afternoon.
This isn’t about fighting your brain or trying to force yourself to “just relax.” It’s about understanding how your brain functions and using that understanding to make different choices.
Understanding How Your Brain Functions
When you understand where your thought and behavior patterns come from and what purpose they’re trying to serve, those patterns that once felt impossible to change suddenly start to make sense.
Here’s what you need to know:
- Your anxiety isn’t proof that you’re weak
- Your avoidance isn’t a character flaw
- Your rumination doesn’t mean your brain is broken
These are your brain’s attempts to protect you using the tools it has available.
The relief that comes from this understanding can be profound! It’s not that there is something specifically wrong with you. Your brain is doing what it was designed to do. But that doesn’t mean you’re stuck with patterns that aren’t helping you.
I’ve spent years pursuing this work because I’ve seen firsthand how understanding the source of the problem changes everything. The rewarding process of revealing the source of impairment and then helping people move forward is what drives my practice.
You deserve to understand what’s happening in your own brain. You deserve care from someone who sees both the neuroscience and the human experience.
Whether you’re in Garden City, Long Island or elsewhere in New York, I’m here to help you understand what’s happening and find a path forward. You don’t have to keep fighting your brain. You can start working with it instead.
Request a consultation to get started.
About Dr. Rebecca A. Steele
Dr. Steele is a licensed clinical psychologist with advanced training in neuropsychology. She provides compassionate, evidence-based psychotherapy in-person at her Garden City office on Long Island and virtually throughout New York State. As a National Register Health Service Psychologist, she brings both clinical expertise and neuropsychological insight to help you understand your mind and support your mental and emotional well-being.

