For the patient who is psychologically healthy, there are numerous motivations to recover. Patients are generally frustrated with their physical symptoms and difficulties with functioning. The desire to be healthy motivates them to strive to overcome whatever hurdles are in their path. Most patients are able to persevere through the course of treatment and recovery. However in some cases whether due to the severity of the medical condition, incorrect diagnosis, inadequate treatment, preexisting psychological vulnerabilities, complicating psychological reactions or factors in the social environment some patients fill to recover and instead enter a downward spiral. A number of factors can contribute to this downward spiral (Gatchel, 1994).