Effects of virtual reality mindfulness interventions on depression and anxiety: a meta-analysis

Background: Depression and anxiety are common mental health problems that frequently co-occur with trauma-related disorders and often develop following traumatic or stressful events, substantially impairing quality of life. Mindfulness-based interventions have been shown to reduce these symptoms; however, their widespread implementation is often limited by poor accessibility and low adherence. Virtual reality (VR) may enhance mindfulness delivery through immersive experiences, but the overall efficacy of VR-based mindfulness interventions and the factors influencing their effectiveness remain unclear.Objective: This exploratory meta-analysis aimed to evaluate the effectiveness of VR-based mindfulness interventions in reducing depressive and anxiety symptoms and to explore potential moderators (population, region, immersion level, and intervention duration).Methods: A systematic literature search was conducted in PubMed, Web of Science and other databases up to 2025. Randomized controlled trials (RCTs) investigating VR-based mindfulness interventions for depression and/or anxiety were included. Meta-analyses were conducted using RevMan 5.4, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs).Results: Fifteen RCTs involving 864 participants were included. VR-based mindfulness interventions were associated with significant reductions in depressive and anxiety symptoms. Subgroup analyses indicated larger effect sizes among older adults (SMD = -1.40, p = .005) and in studies conducted in Eastern regions (SMD = -1.07, p < .00001). Both immersive and semi-immersive VR formats were effective. Interventions of short duration (≤4 weeks) and moderate duration (>6 to ≤8 weeks) showed benefits, and session lengths of ≤30 min were associated with greater symptom reduction (SMD = -0.93, p = .005).Conclusions: This exploratory meta-analysis suggests that VR-based mindfulness interventions are associated with reductions in depression and anxiety symptoms, moderated by intervention duration and regional cultural context. These findings support the potential of VR-based mindfulness as an accessible adjunctive approach, though high-quality studies with longer follow-up are needed to confirm sustained effects and improve generalizability.