Connecting guided imagery and motivational interviewing in meditation class

By Dr. Tamami Shirai

In the fourth and final part of this multi-part blog series on mindfulness-based meditation class, 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?”; in part two, “Relax, release, rebuild through silent meditation”; and in part three, “The importance of ‘checking in’ after silent meditation.”



Experiencing group interaction to learn one’s own uniqueness

After silent meditation and “checking in” with my meditation group at a San Diego hospital’s cardiac pulmonary rehabilitation center, I always lead the application of a single modality within the group. Every time, I introduce a different activity. For example, I introduce guided imagery, including:

  • “Body scan,” which is the gold standard for increasing awareness of participants’ own bodies. By consciously concentrating on specific areas of their body, participants become aware of physical discomforts or rooted emotional distresses they might not have otherwise noticed.
  • “Healing-touch” and “tapping-touch,” which are human touch-based approaches to making mind-body connections. By gently and repeatedly touching or sharing body energy, such as with gentle hand touches on their chakra points, these two modalities enable participants to have a balanced body energy without any intention or effort.
  • “Finding your own values,” “affirmation,” and “gratitude writing,” which are based on positive psychology. By repeating positive or value-defining sentences or by sharing gratifying events, participants are able to replace negative thoughts with positive ones.
  • “Drawings” encourage participants to use their creativity and unconscious abilities by drawing and then observing their own artwork objectively. By doing so, participants are able to notice hidden emotions.

One new discovery in my meditation class has been that people benefit from the “calf-massage” technique, which seems to be a new or rare modality for many of them. Dr. Yoichi Ishikawa, a Japanese medical doctor who invented this technique, has said, “The calf is the second heart for human beings” in that the calf is a major pump for bringing deoxygenated blood back to your heart. If you spend 15 minutes daily massaging your calf (only from the lower ankle end toward the heart direction, no other way), your blood pressure will gradually drop. This technique is simple, not harmful, and easy to use in your daily life, especially if you have hypertension or anxiety attacks.

After experiencing one modality, participants then share their experiences with the activity in the group. It’s important to share their experiences with others because participants see how similar their responses can be. At the same time, it’s also very important to learn that each of us is uniquely different. Group sharing achieves this.

Motivational interviewing, the power of group

What differentiates my meditation class at the cardiac pulmonary rehabilitation center is that it combines mindfulness-based meditation with a coaching model for desired behavioral modifications in the group, specifically in the areas of exercise, diet, and stress. For many years, physicians and healthcare professionals failed to change patients’ behavior in the use of tobacco and alcohol. This failure fueled the conception and development of motivational interviewing in Norway in 1982 by some scholars. The underlying concept of motivational interviewing is that people will not change their behavior unless their own motivation aligns with the change. Participants gradually understand that exercise is mandatory, that they should avoid bad food and stress, and that they need to have a healthy amount of sleep and a quality lifestyle.

Occasionally, I ask participants to establish their own objectives for their health over the next few months. Speaking about their objectives within the group creates a sort of commitment among the other members, and other members may add more information to help each individuals’ needs. Others’ willingness to be healthy and their efforts toward that goal always inspire participants to change their behaviors.

I have found that group work is much more efficient both in terms of cost and outcomes. As the facilitator, I have often observed that participants learn from each other and reduce their harmful behaviors one by one without me lecturing. This is the power of the group. Dr. William R. Miller, the author of Motivational Interviewing, describes the four key aspects of motivational interviewing: partnership, acceptance, compassion, and evocation. All participants act as each other’s partner, listening, understanding, sharing, and sometimes encouraging each other during the group session. I have sometimes observed that participants who showed depressive emotion about their conditions in the group will overcome it or at least try to behave positively when they learn other participants’ difficulties.

For example, “Jeff” had chronic obstructive pulmonary disease (COPD) so severe that it required him to use an oxygen tank while he sat on a waiting list for a lung transplant. He shared his emotional distress in our meditation class on several occasions. Then one day he suddenly told another group participant that “Medical technologies are developing day by day. Your condition will be treatable in three to four years.” I was surprised that Jeff, who had revealed anger over his condition several times in the class, was demonstrating a significant change in attitude by encouraging other participants like a big brother.

Scientific evidence-based, nonreligious meditation class

I use mindfulness techniques, motivational interviewing techniques, and evidence-based science in the class. I update my awareness of the latest peer-reviewed journal articles as often as I can. I also sometimes introduce news articles and new information that I’ve learned from academic conferences.

In addition to my students being well-educated, the class is also not religious and do not identify with a political affiliation. Sometimes physicians have asked me whether a faith-based meditation class is possible in a hospital setting. I answer that if participants all have the same religious background or perspective, sharing their specific faith in a meditation class may work beautifully. However, mindfulness does not take a specific religious form. Mindfulness is universal human nature.

Sometimes participants expect me to teach meditation in an “authentic Asian way.” I could reference the Buddhist/Zen background of mindfulness from Japanese culture. However, I’m not facilitating meditation classes based on the centuries-old cultural context of my home country. Similarly, I’m not trying to teach mindfulness study methods and manners as Japanese learn them from their parents or in Japanese temples. No doubt the current boom in mindfulness and meditation in the West–and the techniques that have been successfully extracted from them–will benefit many people, even in Asian countries. However, mindfulness and meditation techniques were originally parts of a more abundant teaching, which they embody. All take time to learn.


Dr. Tamami Shirai
Dr. Tamami Shirai

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 with more than 350 patient interactions. She is originally from Tokyo, Japan. Dr. Shirai’s research interest is cardiovascular disease and global comparative research. She also served as assistant director research of Lifestyle Medicine Global Alliance.