Brief Interactive Virtual Reality Mindfulness Training with Real-Time Biofeedback for Anxiety Reduction: A Pilot Study.

Recent advancements in virtual reality (VR)-enhanced mindfulness training have demonstrated efficacy in reducing anxiety, particularly among novice practitioners and university students. However, existing VR mindfulness interventions predominantly rely on static natural environments without incorporating interactive elements, limiting their capacity to engage users dynamically. To address this gap, this study introduces an innovative interactive VR mindfulness system, where real-time heart rate variability (HRV) biofeedback dynamically modulates the virtual environment (e.g., fog dissipation, auditory cues, and visual transformations), creating a responsive and immersive experience. We investigated the effects of a single five-minute interactive VR mindfulness session on anxiety, mindfulness states, and HRV, compared to traditional audio-based mindfulness and an non-intervention control. Seventy-five university students with recent anxiety symptoms were randomized into three groups: interactive VR mindfulness (VR-MG), traditional mindfulness (MG), and control (CG). Prior to and following the five-minute intervention, anxiety, mindfulness levels, and physiological data (HRV) were measured for all three groups, with repeated measures analysis of variance performed. The results showed that the five-minute VR mindfulness interactive training significantly improved participants' anxiety levels, enhanced their mindfulness states, and effectively increased HRV, whereas traditional mindfulness and control conditions showed no significant HRV changes. Overall, this study indicates that brief VR mindfulness interactive training has significant effects on improving anxiety and mindfulness states, as well as enhancing HRV, highlighting its potential for psychological health interventions.