The Inner Compass: Four Foundational Practices for Whole Health Therapy

Mindfulness and meditation are not just for hippies anymore. They are now known to be an integral part of whole-health, evidence-based treatments that support a healthy mind and body.

Period. Full stop.

Mindfulness, meditation, breath practices, visualization and imagery, and somatic awareness have roots that stretch back hundreds of years across many Eastern traditions. While these practices entered mainstream Western culture through the counterculture movement of the 1960s and '70s, they have quietly gained momentum among people whose lives are a far cry from the carefree, barefoot, hand-holding, free-spirited, down-with-the-establishment, altered-consciousness-seeking groups that brought so much attention to these practices during that era.

I'm grateful to those early adopters who helped introduce these traditions to a wider audience. Today, we have the opportunity to understand them through a different lens. Decades of scientific research have shown that these practices can support nervous system regulation, emotional well-being, cognitive function, and long-term resilience. They are no longer viewed solely as alternative practices, but as evidence-informed tools that can complement whole-health, evidence-based mental health care.

Together, these practices form what I call The Inner Compass: a collection of accessible, whole-health interventions that help clients reconnect with themselves and strengthen the work we already do in therapy.

So let's dive in with The Inner Compass!

The Inner Compass

One of the primary goals of integrating whole-health practices into therapy is to help clients "Return to Yourself," become aware of what is happening internally, or as I like to say, "what is happening inside your skin." After all, we can't intentionally influence what we don't first notice. To help clients develop that awareness, I use a framework I call The Inner Compass.

The Inner Compass is my framework for four foundational whole-health practices that help guide clients back to presence, regulation, and, often, meaningful change. These foundational practices are:

• Meditation and mindfulness

• Breath practice

• Somatics and interoception

• Visualization and imagery

One of the cool things about these practices is that they are not mutually exclusive. Sometimes we mix and match to build on a client's existing habits, activities, or strengths. Often, we integrate multiple practices at once. For example, we might use the breath as an anchor while cultivating mindful awareness of bodily sensations. Because these practices can be adapted in countless ways, they offer tremendous flexibility and can be integrated into many different therapeutic approaches. Let's dive in with a brief overview of the four foundational practices, which brings us to a question I frequently hear from clients:

What exactly is the difference between mindfulness and meditation, the first two Inner Compass foundational practices?

Foundation 1: Meditation and Mindfulness

Like most people, you may notice that I sometimes use the terms mindfulness and meditation interchangeably. Jon Kabat-Zinn, PhD is widely credited with bringing mindfulness into mainstream Western medicine through his development of Mindfulness-Based Stress Reduction (MBSR). He described mindfulness as paying attention, on purpose, to the present moment, without judgment.

One of the simplest ways I think about the distinction is this: mindfulness is the WHAT, and meditation is the HOW. Mindfulness is the state or quality of awareness we are cultivating. Meditation is the intentional practice through which we cultivate that awareness. Through regular meditation, clients learn to notice thoughts, emotions, and bodily sensations with curiosity rather than immediately reacting to them.

As researchers have worked to better understand mindfulness and meditation, they have also needed ways to categorize different types of practice. While these categories help organize the research, they are not mutually exclusive, and many practices naturally overlap. Here are the "differences" and what some research has found regarding the benefits:

• Focused Attention: Concentration on a single object, like a candle flame. Ooishi et al. (2021) found that Focused Attention decreased heart rate and increased relaxation but had no significant effect on cortisol.

• Open Monitoring: Nonjudgmental observation of emotions, thoughts, and sensations. Ooishi et al. (2021) found that Open Monitoring increased physiological arousal, as evidenced by an increase in heart rate and a decrease in cortisol, suggesting a state of alert awareness rather than simple relaxation.

• Loving-Kindness/Compassion: Cultivating loving feelings toward oneself and others. Crego et al. (2025) found multiple positive effects, including improvements in anxiety, depression, perceived stress, positive and negative affect, and psychological flexibility, among other outcomes.

• Daily Living Mindfulness: Bringing mindful awareness to everyday activities, such as washing dishes, walking, or cleaning. Wenzel et al. (2023) discuss how mindful awareness and acceptance during daily activities produce significant increases in positive affect, particularly when cognitive reappraisal of the activity or behavior is absent.

• Contemplative Practice: Reflecting on a meaningful question, value, or spiritual concept. For example, Bruce et al. (2018) summarize evidence for a positive relationship between spiritual contemplation and compassion, which, in turn, has positive effects on stress reduction, allostatic load, and depression.

• Communal (Relational) Mindfulness: Practicing mindful awareness with others through shared silence, presence, or co-regulation. In a systematic review and individual participant data meta-analysis, Galante et al. (2023) concluded that communal mindfulness practices significantly reduce psychological distress, defined as unpleasant mental or emotional experiences including anxiety and depression.

While each category has unique characteristics and emerging areas of study, together they form the foundation of many mindfulness-based interventions used in both research and clinical practice. For example, Mindfulness-Based Cognitive Therapy (MBCT) has a long history of demonstrating improvements in anxiety and depression. Some of the foundational work includes Segal, Williams, and Teasdale (2002) and Williams, Teasdale, Segal, and Kabat-Zinn (2007).

One point I really want to emphasize is the word nonjudgmental. When guiding clients through mindfulness practices, our goal is not to change their experience. Instead, we invite them to observe it with attentive, nonjudgmental curiosity. As simple as that sounds, it is often one of the hardest skills to develop.

In many ways, this goes against both human nature and the achievement-oriented culture many of us have been raised in. We instinctively evaluate, fix, and judge our experiences. Most clients also arrive in therapy hoping for change, so it makes perfect sense that they approach mindfulness with the same mindset. Learning to simply notice what is happening without immediately trying to change it can take years of practice.

And guess what? That's okay. Like physical fitness, nervous system regulation is something we cultivate over time. Regular practice strengthens these skills, making them more accessible when life inevitably becomes stressful.

Foundation 2: Breath Practices

Breath practices use intentional breathing patterns to influence the autonomic nervous system, allowing us to shift both physiological and psychological states. Depending on the technique, they can help regulate arousal, improve focus, promote relaxation, or increase present-moment awareness. One of the reasons I appreciate breath practices so much is that clients often experience a noticeable shift within just a few minutes. That immediate feedback can increase both confidence and motivation to continue practicing.

I find it helpful to think about breath practices from two perspectives: their physiological breathing pattern and their therapeutic intention.

Physiological breathing patterns include:

1. Slow-paced breathing: Activates the parasympathetic nervous system, promoting relaxation, emotional regulation, and vagal tone (e.g., diaphragmatic breathing).

2. Controlled retention: Modulates CO2, enhances focus, and supports both calm and alert states (e.g., box breathing).

3. Rapid breathing: A two-stage activation of the sympathetic and then parasympathetic nervous systems that can induce altered states of consciousness followed by a rebound that may facilitate emotional processing and integration (e.g., Holotropic Breathwork or the Wim Hof Method).

Clinical note: I do not personally use or recommend rapid breathing practices with my psychotherapy clients. Although I personally have the training to facilitate these practices, they push up against what I feel comfortable doing within the scope of my psychotherapy license. In my opinion, they warrant thoughtful consideration of medical safety, clinical competence, scope of practice, and potential liability before being incorporated into psychotherapy.

Breath practices can also be categorized by their therapeutic intention:

1. Regulation-focused: Helps individuals intentionally shift arousal up or down (e.g., diaphragmatic breathing). Research has demonstrated physiological changes, including reductions in stress hormones, as well as improvements in emotional state and attention following regulation-focused breathing practices (Ma et al., 2017).

2. Processing-focused: Seeks to facilitate emotional release, trauma processing, or access to memory (e.g., Holotropic Breathwork, which I do not use clinically).

3. Awareness-focused: Enhances mindfulness, present-moment awareness, and interoception. These practices are often integrated into meditation and trauma-sensitive mindfulness. In a small sample of military veterans, Seppala et al. (2014) found reductions in PTSD symptoms and anxiety following an awareness-focused breathing intervention.

4. Spiritual or transformative: Oriented toward spiritual awakening or transformation, as seen in shamanic traditions and some forms of Pranayama yoga. Although not a breath practice, research on other contemplative practices with similar transformative intentions has also been encouraging. For example, Transcendental Meditation, a meditation practice rather than a breath practice, demonstrated significant improvements in overall psychological distress, anxiety, depression, anger or hostility, and coping (Nidich et al., 2009).

Although the breath practice literature is still developing, the evidence continues to grow, and the findings thus far are very promising. Like mindfulness, breath practices are highly adaptable. They can be integrated into a wide variety of therapeutic approaches and tailored to meet clients where they are, making them one of the most versatile whole-health interventions available to therapists.

Foundation 3: Interoception and Somatics

Interoception is the body's sensory system that tells us what is going on internally. So it signals when we are hungry, have to go to the bathroom, are in pain... basically any sensation generated inside the body. Somatic practices encourage attention to interoceptive information, the internal sensations and cues, to build awareness, safety, and connection with the body. We encourage 'noticing' these sensations with presence and curiosity. This is important because the body often gives us the first signals that we are undergoing a change in emotional state. The sooner we recognize it, the earlier we can regulate it.

Through somatic practices, we can help clients strengthen their emotional processing (e.g., by identifying muscle constriction or a 'knot in the stomach' as signs of increased tension or anxiety). Somatics is also useful for helping clients re-inhabit their bodies after experiencing trauma. Effective somatic practices include (again, notice how these practices are not mutually exclusive from the ones I discussed above):

• Body Scan: Placing non-judgmental attention to sensations on or within our body, and progressively directing it from one part of the body to another. Research is ongoing, not yet robust, but promising (Gan et al., 2022).

• Yoga: Originating in India, it's generally described as a mental, physical, and spiritual practice aimed at cultivating a union among the mind, body, and spirit. Asana practices (poses) are only one limb of the eight limbs of yoga. The other seven limbs include other things like meditation and mindfulness. The research supports Asana's effectiveness in reducing depression and, to some extent, anxiety (Wu et al., 2023). Please note, while I have my 500-hour yoga teaching certifications, I maintain separation between my yoga practice and my psychological therapy practice.

• Tai Chi: Combines Chinese martial arts and meditation to build mind-body connections. The practice employs concentration, balance, muscle relaxation, and breathing to promote healing. Research supports improved depression and some anxiety benefits (Wu et al., 2023).

Foundation 4: Visualization and Imagery

Visualization and imagery practices engage the imagination to evoke specific mental, emotional, and even physiological states. One of the remarkable aspects of imagery is that the brain often responds to vividly imagined experiences in ways that resemble real ones, making visualization a powerful tool for influencing emotion, behavior, and nervous system regulation. As I often tell clients, the brain often doesn't know the difference between reality and imagination. Our nervous system doesn't just respond to what is happening around us, it also responds to what our mind is "seeing."

In some imagery practices, the clinician guides the visualization, while in others, the client creates their own imagery. Practices may include visualizing calming scenes, supportive figures, memorable safe environments, future successes, or protective imagery.

Visualization and imagery are among my favorite whole-health interventions because they are remarkably versatile. Research supports their effectiveness in reducing anxiety, depression, pain, and PTSD, while also improving performance in areas such as athletics. If you're interested in exploring the literature further, I recommend Beizaee et al. (2018) and Giacobbi et al. (2017) as excellent starting points.

One of the greatest strengths of visualization is its gentleness. It supports client agency and can be especially valuable when directing attention toward a client's body when it feels unsafe, overwhelmed, or simply inaccessible. Rather than asking clients to immediately notice difficult sensations, visualization gives clients the ability to create safety (internally). For many trauma survivors, that can make all the difference.

It is also important to remember that not everyone has the capacity for vivid visualization or mental imagery. Some clients experience little or no imagery, while others find imagery activating rather than regulating. When that happens, our role is not to convince clients to try harder or suggest they are "doing it wrong." Instead, we normalize their experience, remain curious, and pivot to another intervention that better fits their strengths, preferences, and nervous system.

The Triad of Change

In Cognitive Behavior Therapy, we talk about the triad of change, shown here:

In Cognitive Behavior Therapy, we talk about the triad of change: Thoughts, Emotions, and Behavior, all connected in a continuous feedback loop.

We know that, as a continuous feedback loop, when change occurs at any one of the 3 corners, there will likely be a change in at least one of the other two. That is true with respect to signaling within the nervous system. So, by using the Inner Compass foundations, we can help clients first develop a strong recognition and attunement to what is happening within their autonomic nervous systems. Then, when we give them foundational tools that develop intentionality in thought and behavior, we give them a strong sense of emotional control. That control enables our clients to see the systemic patterns of functioning that do not serve them well and to initiate changes they can sustain.

Behavior is the easiest point of entry into nervous system change management. To learn more about using these techniques, or dive deeper into lifestyle-as-medicine and whole health therapy, please join me in The Whole Therapist™.

See you on the inside,

Dr. Shanti M. Pepper

References

Beizaee, Y., Rejeh, N., Heravi-Karimooi, M., Tadrisi, S. D., Griffiths, P., & Vaismoradi, M. (2018). The effect of guided imagery on anxiety, depression, and vital signs in patients on hemodialysis. Complementary Therapies in Clinical Practice, 33, 184-190. https://doi.org/10.1016/j.ctcp.2018.10.008

Bruce, M. A., Skrine Jeffers, K., King Robinson, J., & Norris, K. C. (2018). Contemplative practices: A strategy to improve health and reduce disparities. International Journal of Environmental Research and Public Health, 15(10), 2253. https://doi.org/10.3390/ijerph15102253

Galante, J., Friedrich, C., CoMinT Collaboration, et al. (2023). Mindfulness-based programmes for mental health promotion in adults: A systematic review and individual participant data meta-analysis. Nature Mental Health, 1(8), 594-607. https://doi.org/10.1038/s44220-023-00081-5

Gan, R., Zhang, L., & Chen, S. (2022). The effects of body scan meditation: A systematic review and meta-analysis. Applied Psychology: Health and Well-Being, 14(3), 1062-1080. https://doi.org/10.1111/aphw.12366

Giacobbi, P. R., Jr., Stewart, J., Chaffee, K. B., Jaeschke, A.-M., Stabler, M., & Kelley, G. A. (2017). A scoping review of health outcomes examined in randomized controlled trials using guided imagery. Progress in Preventive Medicine, 2(7), e0010. https://doi.org/10.1097/pp9.0000000000000010

Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874

Nidich, S. I., Rainforth, M. V., Haaga, D. A. F., Hagelin, J., Salerno, J. W., Travis, F., Tanner, M., Gaylord-King, C., Grosswald, S., & Schneider, R. H. (2009). A randomized controlled trial on effects of the Transcendental Meditation program on blood pressure, psychological distress, and coping in young adults. American Journal of Hypertension, 22(12), 1326-1331. https://doi.org/10.1038/ajh.2009.184

Ooishi, Y., Fujino, M., Inoue, V., Nomura, M., & Kitagawa, N. (2021). Differential effects of focused attention and open monitoring meditation on autonomic cardiac modulation and cortisol secretion. Frontiers in Physiology, 12, 675899. https://doi.org/10.3389/fphys.2021.675899

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guilford Press.

Seppala, E. M., Nitschke, J. B., Tudorascu, D. L., Hayes, A., Goldstein, M. R., Nguyen, D. T., Perlman, D., & Davidson, R. J. (2014). Breathing-based meditation decreases posttraumatic stress disorder symptoms in U.S. military veterans: A randomized controlled longitudinal study. Journal of Traumatic Stress, 27(4), 397-405. https://doi.org/10.1002/jts.21936

Wenzel, M., Blanke, E. S., Rowland, Z., Neubauer, A. B., Brose, A., & Kanske, P. (2023). The costs and benefits of mindfulness and reappraisal in daily life. Affective Science, 4(2), 260-274. https://doi.org/10.1007/s42761-022-00178-7

Williams, J. M. G., Teasdale, J. D., Segal, Z. V., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. Guilford Press.

Wu, Y., Yan, D., & Yang, J. (2023). Effectiveness of yoga for major depressive disorder: A systematic review and meta-analysis. Frontiers in Psychiatry, 14, 1138205. https://doi.org/10.3389/fpsyt.2023.1138205