How Mindfulness May Change the Brain in Depressed Patients

I’ve seen the benefits of Mindfulness practice in my own life and in the lives of my clients for many years. Scientific studies continue to affirm the benefits with an increasing frequency of studies and an expanding set of tools.

As Alvin Powell describes in his recent article in Mindful magazine,

The number of randomized controlled trials — the gold standard for clinical study — involving mindfulness has jumped from one in the period from 19951997 to 11 from 20042006, to a whopping 216 from 20132015.
randomized controlled trials

Rising scientific interest in the benefits of mindfulness practice

The tools used to study the effects of mindfulness also continue to increase. For example,  Harvard researchers are using brain scans to explore how 8-weeks of training in present-moment awareness might break the cycle of self-rumination. Findings from this research may add to growing evidence that mindfulness can help sufferers of depression, chronic pain, and anxiety.

Researchers are quick to note that well-designed, well-run studies confirm mindfulness effects similar to other existing treatments, but not necessarily better results than existing treatments. Why, then, is there so much interest in mindfulness? As  Benjamin Shapero, an instructor in psychiatry at Harvard Medical School (HMS) and a psychologist at Massachusetts General Hospital’s (MGH) Depression Clinical and Research Program explains, “Many people don’t respond to the frontline interventions.  Individual cognitive behavioral therapy is helpful for many people; antidepressant medications help many people. But it’s also the case that many people don’t benefit from them as well. There’s a great need for alternative approaches.”

To better understand how mindfulness works in the brain, Shapero and his colleague Gaëlle Desbordes, are using functional magnetic resonance imaging (fMRI), which not only takes pictures of the brain, as a regular MRI does, but also records brain activity occurring during the scan. They are studying clinically depressed patients, performing functional magnetic resonance imaging scans before and after an eight-week course in mindfulness-based cognitive therapy, or MBCT.

During the scans, participants complete two tests, one that encourages them to become more aware of their bodies by focusing on their heartbeats (an exercise related to mindfulness meditation), and the other asking them to reflect on phrases common in the self-chatter of depressed patients, such as “I am such a loser,” or “I can’t go on.” After a series of such comments, the participants are asked to stop ruminating on the phrases and the thoughts they trigger. Researchers will measure how quickly subjects can disengage from negative thoughts, typically a difficult task for the depressed.

I encourage you to read Powell’s complete article and to check back for the results of these ongoing studies.

With so much public interest in Mindfulness and increased activity in the scientific community, I predict that we will soon have a much greater understanding not only of how Mindfulness benefits us, but also how it works, and for which problems it is most effective.

Mindfully yours,

Dr. Pamm

Can Mindfulness Help You to Stop Drinking?

Regain Freedom with Mindfulness Practice 

Whether you’ve been struggling with addiction or are just wondering if you have a drinking problem, consider mindfulness practice as a way to free yourself from dependence on alcohol.

I’ve long believed and taught my clients that it’s possible to develop and bring mindfulness into all activities of daily life, both internal and external. Keri Wiginton’s recent article in The Washington Post reveals how she learned to focus more on the present moment and was able to break her unwanted drinking habit.

Keri credits mindfulness techniques with identifying what triggered her cravings. By observing those behaviors in a non-judging way and being in the moment with those cravings, she was able to stop “pairing stress-relief with Shiraz” and felt fewer urges to use alcohol.

Benefits she experienced from mindfulness practice include

  • fewer urges to use alcohol
  • feeling more present in the evenings
  • uninterrupted sleep
  • no morning mood swings

Her results are not unique, but have been duplicated in controlled studies. As she notes,

Practicing just 11 minutes of mindfulness — like paying attention to your breath — helped heavy drinkers cut back, according to a study out of University College London. Brewer showed that using awareness techniques were more effective than the gold-standard behavioral treatment at getting people to quit smoking.

Drinking too much isn’t the only habit that can be relieved with these techniques. Any behavior that gets in the way of your happiest life could benefit from mindfulness practice.

Mindfully yours,

Dr. Pamm

Meditation Helps Us Avoid Regrets and Live Life Fully

Rather than making resolutions at the start of this new year, my clients and I are focusing our intentions on making it a year of no regrets. We’re inspired by Mindful magazine’s recent review of Bronnie Ware’s book The Top Five Regrets of the Dying: A Life Transformed by the Dearly Departing. Nurse Ware describes the feelings she consistently heard while giving palliative care to the terminally ill:

  1. “I wish I’d had the courage to live a life true to myself, not the life others expected of me.”
  2. “I wish I hadn’t worked so hard.”
  3. “I wish I’d had the courage to express my feelings.”
  4. “I wish I’d stayed in touch with my friends.”
  5. “I wish I’d let myself be happier.”[1]

It does take courage to live a life true to one’s self, but as author Bronnie Ware explains, “… nothing could be as painful as lying on your deathbed with that regret.”[2] How do we find that courage? Nurse Ware attributes her meditation practice as her source of strength when caring for the dying:

[Meditation] taught me not to judge. I had compassion and respect for whatever that life had been like. I think regret is a very harsh judgment on yourself. The dying people who were expressing regrets to me already had their own judgment. They certainly didn’t need mine. Through meditation I also learned mindfulness and being very present with the people. That’s probably a large part of why our relationships became so personal. When you have a listener that’s obviously present and truly listening, it does give the person permission to open up. And it wasn’t just the dying people I was looking after, it was the family dynamic. All the stuff that comes up for the family being left behind, there’s some truly irrational behavior, a lot of fear and drama. I think meditation really helped me stay calm. I was often the unofficial mediator in the family, and I think meditation is the key to my success in that role.[3]

Ware believes in the power of meditation for all of us to avoid regrets at life’s end:

I think if you can develop compassion for yourself, you’re not going to have regrets. Rather than judging yourself for something you did or didn’t do and having regrets about it, you can actually look back on it later with compassion for who you once were. I think in our busy lives, without meditation, it’s very easy to be ruled by your busy mind, by fear and others’ expectations. I think once you do connect with that part of yourself with a regular practice, there comes a time when your heart speaks too loudly for you to ignore.[4]

Regarding the regrets expressed by her patients, Ware predicts that some of these sentiments may change over time, based on evolving gender roles, generational attitudes toward counseling and therapy, and the widespread use of the Internet and social media to stay connected with friends. I encourage you to read the complete interview on


Dr. Pamm



[1] “Nurse Reveals Top 5 Regrets of the Dying,”, Dec. 2014.

[2] Ibid.

[3] Ibid.

[4] Ibid.

New Mindfulness Group Meets Tuesday Evenings

I’m delighted to offer an Intensive Mindfulness Psychotherapy Group on Tuesday evenings. Each group session will provide an opportunity to deepen your mindfulness practice with guided meditation and a time of sharing how your meditation practice is evolving. This mindfulness psychotherapy group will provide a safe environment for deeper exploration into your meditation practice as well as emotional and spiritual discovery and affirmation.
We’ll meet on Tuesdays from 5:30-7:00 p.m. The minimum commitment is 3 months and can accommodate up to 8 men and women. Previous mindfulness training is required for admission to this group.

RAIN: Four steps that help when we feel overwhelmed

It’s easy to feel overwhelmed as we go about our daily activities, attempting to meet the expectations of our employers, our families, our friends, our communities, and ourselves.  When life’s challenges seem to be ganging up on us, we can remember to be mindful by “RAINing” some compassion and loving self-care on our lives.

RAIN is an easy-to-remember tool for practicing mindfulness. It has four steps:

Recognize what is going on;
Allow the experience to be there, just as it is;
Investigate with kindness;
Natural awareness, which comes from not identifying
with the experience.1

Awareness and kindness are keys to this process. Without them, we may begin to feel unworthy, falling into the trap of self-judgment and belief that something is fundamentally flawed within us. Most of us wouldn’t treat a dear friend so harshly, yet we will do it to ourselves.  This is when we may feel the “squeeze of anxiety or the weight of depression,” as Tara Brach observes in this month’s post on Mindful.org2.  Describing the RAIN concept, she explains that

Compassion fully blossoms when we actively offer care to ourselves. To help people address feelings of insecurity and unworthiness, I often introduce mindfulness and compassion through a meditation I call the RAIN of Self-Compassion.3

I encourage you to read Ms. Brach’s excellent article in its entirety. I especially like the way she describes recognition of the situation:

Like awakening from a dream, the first step out of the trance of unworthiness is simply to recognize that we are stuck, subject to painfully constricting beliefs, emotions, and physical sensations. Common signs of the trance include a critical inner voice, feelings of shame or fear, the squeeze of anxiety or the weight of depression in the body.4

She goes on to describe “allowing” as “taking a life-giving pause,” where we simply let the situation be, just as it is, rather than reacting in one of three typical ways: “piling on judgment; numbing ourselves to our feelings; or by focusing our attention elsewhere.”5 In that space of allowance we find freedom and power.

Investigating our feelings about a situation allows us to find truths that lead us to unconditional self care, healing, and resilience. We can develop “a heartspace where everything that is, is welcome.”6  This process can be difficult, bringing recognition of current suffering or memories of past suffering to the surface.  Brach shares a personal story of using RAIN to reach acceptance of her own chronic illness. She recognized that she felt trapped in both the symptoms of the illness and her own aversion to her reactions to the illness. She was able to allow those feelings to be and grieve the loss of her health, finding peace through compassion for herself.

When we’ve done the first three steps of RAIN, we’re rewarded with “N”: natural, loving awareness. Intentional recognition, allowance, and investigation allow us to simply rest in natural awareness, coming home to our true nature. As Brach concludes,

We each have the conditioning to live for long stretches of time imprisoned by a sense of deficiency, cut off from realizing our intrinsic intelligence, aliveness, and love. The greatest blessing we can give ourselves is to recognize the pain of this trance, and regularly offer a cleansing rain of self-compassion to our awakening hearts.7



Dr. Pamm

1Tara Brach, Feeling Overwhelmed? Remember “RAIN”,, August 2014.


3 Ibid.





Video Workshop: Mindfulness As Self Care with Dr. Pamela Cappetta

I taught this workshop on Mindfulness as Self Care to a group at the School of Education at the College of William and Mary in Williamsburg, VA on Jan. 25, 2014. We recorded the sessions and offer them to you here in three short sections totaling 45 minutes. I hope it will be 45 minutes well spent on your journey to greater calm and focus in your life.


Dr. Pamm

Mindfulness as Self Care, part 1

Mindfulness as Self Care, part 2

Mindfulness as Self Care, part 3

Mindfulness Is a Way of Life

I’m gratified by the peace and joy that I see in my Mindfulness Practice students as they learn to work with stress and their emotions. Through Mindfulness techniques they’re able to decrease their reactions to the stress and achieve tranquility in their lives. Mindfulness is gaining wide adoption in our society, as shown by many recent articles in the mainstream media. Why this growing focus on mindfulness?

Some supporters note the hectic pace of our daily lives, which tend to be overscheduled and rife with distractions and information overload.  More than ever before, it seems, we look for tools and skills to maintain our sense of self amidst the noise and demands for our attention. Ironically, the “time saving” devices we use can be part of the problem. As Kate Pickert says in the February 3, 2014 issue of Time Magazine (paywall):

“In a time when no one seems to have enough time, our devices allow us to be many places at once–but at the cost of being unable to fully inhabit the place where we actually want to be.”

That constant pull away from the place where we actually want to be can take a toll on our sense of wellbeing, draining our resilience and frustrating our intentions to live life fully. Mindfulness practice can help! As Pickert observes,

“If distraction is the pre-eminent condition of our age, then mindfulness, in the eyes of its enthusiasts, is the most logical response. Its strength lies in its universality. Though meditation is considered an essential means to achieving mindfulness, the ultimate goal is simply to give your attention fully to what you’re doing. One can work mindfully, parent mindfully and learn mindfully. One can exercise and even eat mindfully. The banking giant Chase now advises customers on how to spend mindfully.”

It’s true that whatever we’re doing, we can do it with intentional awareness. Even when we’re not “doing” something (maybe especially when we’re simply “being”), we can be intentionally aware of our own thoughts and feelings.

I like to describe Mindfulness as “waking up to what is.” It’s a non-judging awareness in the present moment. It’s possible to bring mindfulness into all activities of daily life, both internal and external. Practitioners enjoy lower stress and greater calmness, in the mind and the body. We gain insight and wisdom into the habits of judging, thinking and reacting that are at the core of stress reactions.

If the promises of improved wellness for mind and body seem too good to be true, consider the medical evidence that support these claims. In 1979 Jon Kabat-Zinn, the best-known proponent of mindfulness practice in this country, joined with three physicians to open a stress-reduction clinic at the University of Massachusetts that was based on meditation and mindfulness.

“Almost immediately, some of the clinic’s patients reported that their pain levels diminished. For others, the pain remained the same, but the mindfulness training made them better able to handle the stress of living with illness. They were able to separate their day-to-day experiences from their identity as pain patients.”[i]

Kabat-Zinn’s program eventually became the curriculum that’s now used by hundreds of Mindfulness teachers. Numerous studies have been funded by Congress and the NIH to evaluate the effectiveness of MBSR [Mindfulness Based Stress Reduction]:

“… scientists have been able to prove that meditation and rigorous mindfulness training can lower cortisol levels and blood pressure, increase immune response and possibly even affect gene expression. Scientific study is also showing that meditation can have an impact on the structure of the brain itself. Building on the discovery that brains can change based on experiences and are not, as previously believed, static masses that are set by the time a person reaches adulthood, a growing field of neuroscientists are now studying whether meditation–and the mindfulness that results from it–can counteract what happens to our minds because of stress, trauma and constant distraction. The research has fueled the rapid growth of MBSR and other mindfulness programs inside corporations and public institutions.”[ii]

Whether you’re seeking tools to cope with chronic pain, or to find clarity, or to restore your sense of balance and inner peace, I urge you to consider Mindfulness practice. There are many resources available to help you get started:


Dr. Pamm



[i] Pickert, Kate. “The Mindful Revolution,” TIME, Feb. 3, 2014.

[ii] Ibid.

Mindfulness Workshop for Counselors & Health Care Providers

At the College of William and Mary on January 25, 2014, Dr. Pamela Cappetta will teach health care professionals how to practice mindfulness.  Dr. Pamm explains, “as professional helpers we often practice great care for others, but forget the importance of healthy self-care. This workshop will introduce you to mindfulness and will provide you with an opportunity to put into practice the basics of paying attention on purpose in the present moment—non-judgmentally.”

When: 9:30 a.m. to 2:30 p.m., Saturday, January 25, 2014

Where: College of William and Mary, Williamsburg, VA

Cost: $50 per participant

Register: email Amy Williams

Mindfulness Workshop Flyer 2014


Dr. Pamm’s Stress Management Tactics Referenced

Learn how a young woman coping with a rare disease learned to manage stress with mindfulness practice during the holidays:

“A Proactive Approach To Holidays For People With Chronic Diseases”

Dr. Pamm’s advice for stress management is good any time of  year:

• Adjust your perspective: Set your intention daily to be positive and hopeful.

• Identify and understand your personal stressors.

• When you feel yourself getting stressed, stop and take deep breaths.

• Adopt a healthy lifestyle through diet, exercise and good sleeping habits.

• Talk to your doctor if you find yourself overwhelmed by stress.

Interview for Williamsburg Neighbors Magazine, Sept. 2013

Dr. Pamm was interviewed by Rachel Sapin for the September 2013 issue of Williamsburg Neighbors magazine. Check out her thoughts on Reducing Stress through Mindfulness.

Dr. Pamm to Teach at Woman’s Quest Wellness Symposium Nov. 9, 2013

Register now for the Woman’s Quest Wellness Symposium on Nov. 9, 2013. Organized by the Greater Williamsburg Area United Way, this one-day event covers a wide range of topics to help women achieve and maintain wellness in mind, body, and spirit. Dr. Pamela Cappetta will teach mindfulness skills at 11:00 a.m. The full day of events will be held at Kingsmill Resorts from 8:30 a.m. to 5:00 p.m. and costs $99.

Mindfulness Meditation: Self-care for Busy People

Notice your breathing as you begin to read this article. Take a few nice breaths and notice if you can feel the texture of your breath as it crosses over your lips or through your nostrils. Notice your thoughts. Are you judging whether this piece will catch your attention or if you will stop reading now? Are you thinking about what has to be done when you finish this article?

If you followed the suggestions above you have already begun to practice mindfulness. Mindfulness is practiced by paying attention to purpose in your life as it unfolds moment by moment. By using a lens of non-judgment and curiosity we can begin to view our lives with more acceptance and compassion. There is evidence that this practice helps decrease automatic responses to stress and increase neuroplasticity in the brain (new brain cells).

Mindfulness is often done in a formal meditation but can be done anywhere and anytime as a form of self-care. By becoming committed to this simple practice of paying attention and “naming and noting” the present moment experiences, we become aware of patterns of thought that disrupt our peacefulness. Return to your breath over and over to keep the ever wandering mind in the present moment.

Notice your body. Are you sitting down or standing up as you read? Do you have any aches or pains in your body? Notice the clothing you have on today. Do you like the colors and textures of the clothing?

Notice your emotions. Are you feeling: Peaceful? Anxious? Calm? Rushed? Sad? Joyful? Sleepy?

One of my favorite homework assignments for myself and my clients is to watch the wind blow for ten minutes daily. Often folks look at me like I am crazy when I make this suggestion. Try it. Watching the wind blow is a simple process. You have time.

Watch your breath and notice the way you feel when you breathe. Notice your surroundings. Look at the colors of objects around you. If you can’t get outside, notice the air from a fan blowing. Notice how the breeze or stillness of the air touches your skin.

Becoming an active member of your self-care team will be time well spent!!

This post by Dr. Pamela Cappetta was first published on Behavioral Health Matters.

Behavioral Health Matters web site