Efficacy of Virtual Reality-Based Mindfulness Interventions: Systematic Review and Meta-Analysis.

Abstract

Virtual reality-based mindfulness interventions (VRbMIs) increasingly populate studies as scalable tools for stress and emotion regulation. However, findings across psychological outcomes are heterogeneous, and methodological variation in intervention design, outcome measurement, and reporting practices limits cross-study comparability and cumulative synthesis. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020-compliant systematic review and meta-analysis was conducted to evaluate the psychological effects of VRbMIs published between 2023 and 2025, examining methodological quality and outcome consistency across diverse study designs. A PRISMA 2020-compliant systematic search was conducted across PubMed, PsycINFO, Scopus, Semantic Scholar, and CORE from January 2023 to April 2025. Eligible studies included quantitative VRbMIs reporting psychological outcomes. We assessed risk of bias using the Mixed Methods Appraisal Tool and conducted random-effects meta-analyses using Hedges g where data were sufficient. VRbMIs were associated with a large, statistically significant reduction in negative affect and a statistically significant increase in state mindfulness, while effects on depression, stress, and anxiety were small to moderate and nonsignificant. Trait mindfulness was described narratively rather than meta-analyzed and showed limited, inconsistent change across studies. For anxiety, we included 13 studies contributing 27 effect size estimates in the quantitative synthesis. A random-effects model indicated a small-to-moderate, nonsignificant pooled effect (g=0.44, 95% CI -0.08 to 0.96; t 26=1.74; P=.09), with substantial between-study heterogeneity (Q 26=381.60; P<.001; τ2=0.96). Physiological outcomes were reported across a subset of studies and generally aligned with self-reported psychological findings; however, inconsistent measurement and incomplete reporting precluded quantitative synthesis. This analysis represents 35 studies with a combined sample of approximately 1550 participants (1 study did not report sample size). VRbMIs demonstrate statistically significant short-term benefits for negative affect and state mindfulness, with consistently positive but nonsignificant trends toward improvement in stress, anxiety, and depression. Effects on positive affect and trait mindfulness were small and less consistent. Physiological findings were promising but limited by inconsistent reporting. These results support the use of VRbMIs as accessible tools for emotional regulation across diverse populations, while highlighting the need for larger trials, standardized outcome reporting, and more rigorous control conditions to strengthen the evidentiary foundation of this rapidly evolving field.