Learning to Let Go
Mindfulness Practice in Rehabilitation Psychology
With Annie Repaci
Annie Repaci became part of the RIM Sangha in 2014 after Amy Gardner invited members of her yoga class to join the Saturday morning drop-in sessions at Rooted in Mindfulness. Annie fondly recalls her first sit at RIM, laughing as she described how her mind and emotions were all over the place—but she still felt deeply supported. She returned the next week and has been part of the community ever since.
Over the years, Annie attended drop-in sessions, completed several Foundations of Mindfulness classes, and eventually took the Mindfulness Mentor Support Program (MMSP). The MMSP course deepened her practice and introduced a profound perspective: we are all both teachers and students on this journey.
“Applying all that to my daily life was the thing that was helping me like nothing else had ever helped. When I introduce the Dharma to patients in therapy sessions, they say it helped them more than anything else.”
Voices sat down to talk with Annie about how she uses her Dharma practice in her profession as a rehabilitation psychologist, working with patients recovering from brain injuries due to accidents, strokes, and other traumas.
Annie works with patients who often have experienced an emergency room visit, an extended hospital stay, and time in acute rehab or in-patient care. Once stable, they are discharged to continue their recovery at home, and Annie steps in as part of the rehabilitation team.
Returning home to rehabilitate brings its own set of challenges. Annie describes them as an ambiguous and uncertain adjustment, filled with questions that don’t have immediate answers: Will I get better? How much will I recover? Will I be able to go back to work? What happens if I can’t return? I’m the main provider for my family—what now? This uncertainty can make the transition both physically and emotionally overwhelming.
Annie explains that Traumatic Brain Injuries (TBIs) often result from split-second events, such as a fall, a motor vehicle accident, an overdose, or a stroke. The degree of impairment varies widely, ranging from mild concussions that may resolve within days or weeks to severe TBIs that can permanently impact a person’s ability to live independently.
These sudden, life-altering changes leave little to no time for preparation, making the experience deeply traumatic for the individual and their families. They must navigate an entirely new reality.
Families often face the profound loss of the person they once knew as their relationship with that person changes. For example, after a brain injury occurs, a spouse may now also take on the role of caregiver. In some cases, their partner might seem childlike or unable to fulfill the role they once held in the relationship.
Annie observes that initially, caregiving can feel all-consuming because there are so many immediate needs. Over time, small steps toward independence may be made—perhaps the individual can assist with transfers or need less help in the bathroom—but they still can’t manage tasks independently. The weight of responsibility remains squarely on the caregiver’s shoulders.
Caregivers, Annie asserts, often find themselves exhausted, neglecting their own needs and grappling with overwhelming expectations and worries about how they can continue to manage everything.
She works with patients and their families—sometimes separately, sometimes together—depending on their needs. While Annie doesn’t do formal couples counseling, she does help couples navigate life together after a brain injury, exploring how to adapt to this new reality as partners. Both the patient and their family often face profound, unanswerable questions.
Every brain injury is unique, and so is every recovery. Annie explains that someone with a minor head injury might struggle more than someone with a more severe injury—it’s unpredictable. No two journeys are the same, with the extraordinary challenges of facing so many unknowns and the anxiety that uncertainty can create.
Voices asked Annie to identify some Dharma concepts driving her patient interactions. Annie responded:
- Present moment—focusing on what is here right now so they can let go of their past identity and fears about their future identity.
- Self-compassion—offering themselves self-compassion in all those difficult moments.
- Calm—working with their breath so that they can calm themselves. Breath is a somatic experience that allows them to reset the nervous system.
- Awareness of clinging—knowing when they're holding on to something not in their control. They can’t let go of the fight unless they're aware of it.
"All of this is the Dharma, but I don’t use that vocabulary. Clients have different religious affiliations. The Dharma is full of psychology—Buddhist psychology. As Jesse says, the Dharma is the nature of things. And it's in the nature of human behavior to cling to our sense of self-identity.
PRESENT MOMENT
Annie emphasizes the importance of Present Moment Awareness in her counseling, helping her patients recognize how often the mind drifts away from the present. “We catch ourselves floating to the future,” she explains, “caught up in what-ifs and worst-case scenarios, or we get pulled back to the past, revisiting trauma, questioning what could have been done differently. This takes us out of the present moment. We can't be grounded when we’re lost in the unknown future or trying to rewrite the past. Instead, we get stuck in cycles of worry, anxiety, and depression.”
Annie works with patients dealing with physical, speech, and motor impairments and the emotional weight that often accompanies these challenges. During their initial sessions, she asks a grounding question: “What’s the biggest challenge you’re facing right now?” Their answers frequently revolve around the fear of the “unknowns.”
This is when Annie introduces an essential teaching of the Dharma: impermanence. She notes that patients often view their conditions as permanent or static, expressing fears that things won’t improve. Annie offers them a new perspective: “Can you focus on just getting through this moment—right now—without worrying about the future? You don’t have to figure out your entire life in this moment. All you need to do is face this one moment.”
This simple yet profound reframing often brings an immediate sense of relief. Patients feel a weight lifted, realizing they don’t need to carry the burden of predicting or controlling the future. While they remain curious about how their rehabilitation journey will unfold, Annie helps them see that jumping ahead mentally isn’t helpful. Instead, they begin to appreciate the value of staying present, one moment at a time.
SELF COMPASSION
When patients feel anxious or depressed about their recovery and believe it’s not okay to be where they are, Annie gently asks them, “Can it be okay today? You don’t have to figure out the rest of your life right now, but can it be okay to be where you are in this moment?” This simple question opens the door to practicing self-compassion, a concept that Annie and her patients explore together.
Annie describes how self-compassion often feels foreign to people raised to prioritize others, put others' needs first, and take responsibility for other people’s emotions. Annie creates an environment where patients can shift this mindset. Her patients are invited to participate in small-group sessions several times a week, engaging in physical therapy, occupational therapy, speech therapy, recreational therapy, and psychology. Through these sessions, they share their experiences, fostering both self-compassion and empathy for one another.
Annie also introduces her patients to the science behind their struggles. “The nervous system,” she explains, “gets agitated when we think about giving ourselves compassion. It feels awkward, even unsettling.” She normalizes this reaction and offers practical strategies to ease into self-kindness. One such strategy is reframing: “Imagine this recovery was happening to your best friend. What would you say to them? Can you say those same words to yourself?”
For many, this exercise is deeply emotional. Some feel awkward, and others are moved to tears, but Annie observes the shift. “They see the change,” she notes. “And I see it too. Self-compassion begins to feel possible.” Through this work, patients gradually learn to offer themselves the grace and understanding they would so readily give to someone else.
CALMING
Annie integrates psychoeducation into her trauma work with patients recovering from brain injuries, addressing the profound disruption these injuries cause to their lives. She speaks openly about grief, helping patients recognize and process the loss of their previous way of life. A crucial part of her work involves teaching patients to cultivate stillness and calm, which allows for a deeper understanding of their experiences. To support this, Annie introduces somatic breathing exercises and other modalities to help patients find moments of calm, observe fears without being consumed by them, and regain a sense of stability in both heart and mind.
The challenges Annie’s patients face extend far beyond their physical recovery. Many grapple with complex psychosocial issues such as homelessness, strained relationships, financial insecurity due to an inability to work, or the need to rely on temporary housing during recovery. Addiction can further complicate their situations, and even when patients are motivated to adopt healthier lifestyles, they often find themselves surrounded by others who are unsupportive of change. Annie works to address these layered difficulties with empathy and practical guidance.
When it comes to calming techniques, Annie starts gently, tailoring her approach to each patient’s comfort and capacity. “I’ll begin with a couple of minutes of focusing on the breath,” she explains. “We practice noticing the breath, acknowledging that thoughts will come and persist, and then gently returning attention to the breath.” She observes that responses vary: some patients experience agitation, opening their eyes, or beginning to talk, while others can stay with the practice for longer periods. For those with significant physical impairments, such as numbness or paralysis from a stroke, she avoids starting with body-based awareness exercises, as these sensations may be difficult or distressing. However, breath meditation is an accessible starting point and a consistent anchor that patients can return to.
Chronic pain is a common challenge for many of Annie’s patients, particularly those suffering from migraines. For these individuals, Annie often recommends frequent practice of calming techniques and resources like the meditation app Headspace. She notes that patients frequently report these practices are more effective than any medication they’ve tried.
One of Annie’s go-to strategies is adapted from a Jon Kabat-Zinn’s Coming to Your Senses exercise, commonly called the 5-4-3-2-1 technique. Patients are guided to ground themselves by identifying five things they can see, four things they can touch, three they can hear, two they can smell, and one they can taste. Annie explains that this practice anchors patients in the present moment, pulling them out of the anxiety of an uncertain future. “All of these things are real and happening right now,” she maintains. “It connects them to a sense of calm and the here and now.”
Through these practices, Annie offers her patients tools for managing the physical and emotional toll of their recovery and finding moments of peace amidst their challenges.
AWARENESS
When addressing everything outside a patient’s control—such as the unchangeable past—Annie takes time to help them focus on what they can control. She calls this Discernment, understanding the difference between what lies within one’s power and what does not.
In therapy, Annie redirects their focus when patients express frustration over what they can no longer do. She explores what they can do in the present, even if it means approaching tasks differently. She often asks, “Can different be okay, just for today? Not for the rest of your life—just for today.” Together, they discuss and practice the modifications introduced in therapy, helping patients reframe their perspective. Annie emphasizes, “Different can be okay.”
After 24 years of providing rehabilitation psychotherapy, Annie understands that recovery is a slow and deliberate process. She explains the concept of building new neural pathways through repeated attempts to do something—physically or through visualization. “These pathways grow very slowly,” she tells her patients. “But if you attempt something 10,000 times, eventually, you’re going to succeed. You’re creating a new groove.” Patients often come to recognize the fruits of their efforts, telling her, “Thank you for encouraging me to do this over and over.” The moment they realize they are making progress—taking steps they once thought impossible—hope and possibility emerge.
Annie connects this process of repetition to the practice of Dharma, where cultivating new ways of being happens gradually and with patience. However, she acknowledges the challenge of letting go. Patients often cling to their old identity, longing for how life used to be. “Letting go is hard,” she says. “But it’s essential for growth.”
She teaches her patients that surrendering to what is out of their control is not the same as giving up. She reassures them: “You’re still fighting for recovery by focusing on what you can do. Surrendering means accepting what you cannot change while putting your energy into what you can.” Annie recognizes a profound turning point in recovery when patients approach this place of surrender.
“I call it the beautiful place. It’s when patients reach the point where they say, ‘I can’t do it anymore,’ and they break down. They’re crying, and everything feels like a mess. I hold space for them in that moment, letting it all unfold. Then, we begin to talk about what makes this so difficult—the attachment to how things were before.”
Annie helps her patients realize that their deepest struggle is not just the physical impairments caused by the brain injury but also their attachment to memories of their life before the injury. When they begin to release that attachment, Annie sees new growth. She believes that it’s in these moments that true recovery begins.
Voices asked Annie how working with people in such challenging circumstances impacted her Dharma practice.
"My Dharma practice has evolved since the beginning of working with this population; I didn't know how challenging this could be and how horrible these stories could be. Early on, I didn’t know how much people's lives will change and never return to normal. All I would do was cry and say that that wasn’t helping them.
Now, with my mindfulness practice, I can have more awareness of what's rising and passing in me. And I can be compassionate instead of feeling like I have to be a certain way. When my eyes well up when someone else's does, I can stay present with them and myself."