In the third part of a multi-part blog series, Saybrook alumna Dr. Tamami Shirai discusses her experiences with group meditation. In part one, she discussed “Mindfulness of McMindfulness: Can we learn from the West adopting Asian cultures?” and in part two “Relax, release, rebuild through silent meditation.”

Increasing participants’ awareness

After leading silent meditation at a San Diego cardiac pulmonary rehabilitation hospital, I always initiate a “checking in” process with the meditation group. I intentionally ask several questions: “How is your physical and your emotional condition today?” “What kind of self-care did you do in the last seven days?” “How is your exercise routine going?” “How is your diet recently?” One by one, the group members respond to them. The “checking in” questions I periodically ask are based on Michael Arloski’s coaching model for lifestyle modifications and are also rooted in the humanitarian contribution of Abraham Maslow.

The purpose of “checking in” is to increase participants’ awareness of their conditions and remind them to pay attention to making ideal lifestyle modifications. In other words, my questions are not the kind to be answered easily with “I am fine.” Participants carefully examine their conditions and activities over the past several days, and then describe their physical and emotional conditions. Specifically, participants in cardiac pulmonary rehabilitation sometimes suffer anxiety and/or depression due to their conditions. Thus, asking about their emotional condition is an important element of concern.

One participant, “Laura,” is in her early 50s and previously had valve replacement surgery. (Her annual medical checkup resulted in needing surgery without any early symptoms.) She gradually described that she feels miserable about herself in the rehabilitation center’s exercise room. Laura felt many other participants at the rehabilitation center looked much older than her and believed their conditions were much milder, such as having cardiac arrhythmia or with a few stents. However, she gradually learned there were several people who had also undergone open-heart surgery like herself, including a heart transplant patient, survivors from dissection of aorta, and a “Stent Champion” with over 25 stents. Laura stopped feeling self-pity and started speaking with other participants in the center’s exercise room.

For most people, including Laura, the process of physical recovery coincides with psychological recovery. Meditation class provides a safe place where people can begin to understand that this tragic event is not just about themselves.

Modifying lifestyle 

Participants in my meditation class know that they should come to the rehabilitation center two or three times a week for exercise. Even when they are not feeling well, they try to come at least once a week—as their numbers of days of exercise will be an indicator of the depth and effectiveness of their self-care activity. Of course, they can perform other kinds of self-care besides exercise, such as receiving a massage, having quality time with family, ensuring they get enough sleep, and so forth. I encourage them to do whatever contributes to their well-being.

Today, weight control and diet are the most important elements for managing all chronic disease. After the holiday season, I always ask, “What kinds of treats did you eat during the holiday season?” It’s always fun to confess (myself included) to each other that “I had meatloaf” or “I had cheese.” My purpose is not to make anyone feel guilty about what they ate during the holiday. It’s to encourage them to understand a healthy and unhealthy diet because there is some confusion about diet and many people don’t have the latest correct knowledge. I encourage my participants to see a dietician or nutritionist if necessary, and also share new information from conferences that may be beneficial to them.

Transformation by speaking about yourself

What I have learned from my participants is that they need to talk about themselves. The safe environment of our meditation class allows them to increase awareness of their well-being; to exchange experiences with each other; and to speak about themselves, including both positive and negative emotions. Some days participants who are holding onto a deep sadness from a personal loss say they want to opt out of the “checking in” question. But in the following weeks I will encourage them again in hopes they may be brave enough to tell the group about their deep sadness.

“Emily,” another participant, had a stroke that left her with a speech problem. She was quiet in the first few meditation classes, but gradually she began using our “checking in” session to practice her speech. Once participants decide to engage during “checking in,” the time for change begins. Because she was courageous enough to share her mind-set during “checking in,” Emily began to feel more comfortable about unveiling her emotions and became a regular participant.

I have observed repeatedly that participants’ acts of small courage or determination bring new transformation into their lives. In the group setting, one participant’s openness or honesty invites other participants to be more open. Ultimately, we all learn that we are not the only people who are suffering. We all have similar experiences, both good and bad. It is always a beautiful moment to observe a group member’s transformation toward his or her well-being. Witnessing human growth is powerful and moving. My cardiac pulmonary rehabilitation center is a place for all of us to learn to recover from life-threatening events, share the stages of life, and to experience our potential to grow.

Dr. Shirai is a postdoctoral researcher at the School of Medicine, University of California San Diego. She is a researcher, educator, and advocate of lifestyle medicine, and the facilitator of a meditation class at a cardiac pulmonary rehabilitation in San Diego. She is originally from Tokyo, Japan. Dr. Shirai also serves as assistant director research of Lifestyle Medicine Global Alliance (LMGA).