Reducing Stress and Anxiety in the Metaverse: A Systematic

Review of Meditation, Mindfulness and Virtual Reality

Xian Wang∗ Mingming Fan Lik-Hang Lee
Xiaoyu Mo∗ [email protected] [email protected]
[email protected] Hong Kong University of Science and KAIST
[email protected] Technology (Guangzhou) Daejeon, South Korea
Hong Kong University of Science and Guangzhou, China
Technology Hong Kong University of Science and
Hong Kong, China Technology
arXiv:2209.14645v1 [cs.HC] 29 Sep 2022

Hong Kong SAR, China

Bertram E. Shi Pan Hui

[email protected] [email protected]
Hong Kong University of Science and Hong Kong University of Science and
Technology Technology (Guangzhou)
Hong Kong, China Guangzhou, China
Hong Kong University of Science and
Technology
Hong Kong SAR, China

ABSTRACT or a word or a phrase with a passive attitude), the person will

Meditation, or mindfulness, is widely used to improve mental health. feel relaxed, manifesting in better physiological indicators [11].
With the emergence of Virtual Reality technology, many studies Then Ellen Langer introduced mindfulness into the psychology
have provided evidence that meditation with VR can bring health area. With Dr. Jon Kabat-Zinn coining the term mindfulness-based
benefits. However, to our knowledge, there are no guidelines and stress reduction (MBSR), meditation, or mindfulness, is widely used
comprehensive reviews in the literature on how to conduct such as a cognitive therapy approach in practice [24]. Many studies have
research in virtual reality. In order to understand the role of VR provided evidence that MBSR has benefits for people’s stable mental
technology in meditation and future research opportunities, we status and overall human well-being [18].
conducted a systematic literature review in the IEEE and ACM Virtual Reality (VR) technology can create a virtual world for peo-
databases. Our process yielded 19 eligible papers and we conducted ple to explore without latency or viewing perspective limitations.
a structured analysis. We understand the state-of-art of meditation With the VR head-mounted display, users can enjoy an immersive
type, design consideration and VR and technology through these experience [6]. In addition, 3D modeling software allows artists
papers and conclude research opportunities and challenges for the to create and manipulate the environment in many ways. Users
future. can explore different environments that they cannot visit in real
life due to time or space limitations. According to Google Trends
CCS CONCEPTS search, the Metaverse is one of the hottest technology terms in
2021 [53]. The Metaverse is defined as a virtual environment that
• Human-centered computing → Virtual reality.
blends physical and digital universes. In particular, VR is an es-
sential technology for the Metaverse [33]. This realistic 3D virtual
KEYWORDS
environment resembles the actual world, with each user having
Meditation, Mindfulness, Virtual Reality, Literature Review, Inter- their own avatar to live life in the virtual world as if it were the real
action, Metaverse world [33, 40]. Because of this, as in the real world, users’ levels
of stress and anxiety might possibly be alleviated in many virtual
1 INTRODUCTION realms. Mindfulness and meditation are popular approaches for
Meditation, or mindfulness, is grounded in Buddhism, which means lowering people’s stress and anxiety [16, 23]. VR technology or
meditation in a seated position, and Chinese “Chan Xiu”. After it the Metaverse will be able to deliver psychological counseling and
was introduced into China, Taoism and Confucianism also adopted therapy services [20, 22].
it as a cultivation method [9]. In the 1970s, physiologist Benson Theoretically, the attributes of the VR experience are suitable
found that two transcendental meditation practitioners could con- for users to get away from tired daily routines and relax and then
trol their physiological performance through meditation. Based on enter into a meditation state. Many studies have also indicated that
this finding, he proposed the relaxation response, which means meditation in VR brings various health benefits [1, 7, 37, 44, 48].
when a person starts up their “mental device” (focusing on a sound This review aims to understand the latest state-of-art in this area
and how VR technology can assist with specific mindfulness tasks.
∗ Both authors contributed equally to this research.
 Wang and Mo, et al.

Specifically, we aim to answer the following research questions potential of VR technology has not been fully realized at this stage
(RQs): of research. Although the classification of virtual environments
• RQ1: What kinds of meditation or specific mindfulness tasks and multiple sensory modalities by Dollinger et al. provides much
are involved in the current VR meditation prototype? information for this paper, their article does not focus on VR tech-
• RQ2: What factors or variables, corresponding to the medi- nology. In contrast, our work is more focused on VR technology,
tation type or specific task, can be improved or assisted by and the field of human-computer interaction (HCI). The other two
Virtual Reality and relevant technologies? studies do not summarize the design of VR, but only verify that VR
• RQ3: How do VR and relevant technologies assist meditation technology has its therapeutic effects.
or mindfulness? In addition to the mindfulness intervention itself, mindfulness
has proven effective for psychological, physical, chronic pain, relax-
To answer the RQs, we conducted a systematic literature re- ation, and positive change. Studies by Zhang et al., O et al., Riches et
view by following the widely used PRISMA method [38]. Firstly, al., and Kitson et al. [27, 41, 46, 56] have shown that VR technology
we identified related records by searching with keywords in the can also help healthy or clinical groups by practicing mindfulness
ACM and IEEE databases. By examining the title and abstract, 1,018 and thus improving the above symptoms. Because VR is a new
records were screened for irrelevant content, and 37 records re- technology with a strong sense of immersion and largely reduced
mained for the next steps. Next, we examined each article’s title, real-world distractions, clinical patients would be more receptive
abstract, and full text against inclusion criteria. Finally, 18 articles to VR-based treatments, which would reduce their stigma [56], and
were excluded for ineligibility, and 19 were included for the final general populations could be relaxed by using VR to enter natural
analysis to answer the research questions. Regarding RQ1, the re- virtual environments in workplace settings [46]. These early studies
sult indicated that slightly more than half of the articles didn’t have add to our understanding of VR-supported meditation training, but
a detailed description of the specific meditation type or mindfulness their research focuses only on the effectiveness of VR technology
tasks. Meditation sessions were referred to as mindfulness practice, in healthcare, demonstrating that VR technology can be used as a
general meditation, relaxed breath practice, etc. Other mindfulness potential medical tool, but does not provide systematic guidance
tasks are mindful breathing, attention focus, body scan, compassion to future VR program designers on how to design VR mindful-
meditation, etc. Regarding RQ2, all articles discussed strengthening ness practice programs. We, as researchers in the field of HCI, are
the presence of uses via VR visual immersion, while several studies strongly motivated to propose a systematic design framework for
went above and beyond presence by enhancing specific factors that VR-based meditation programs aimed at ameliorating the negative
impact meditation, for example, strengthening the awareness of effects of social stress that people may face in the post-pandemic
breathing. Finally, regarding RQ3, VR technology makes the user era [46].
feel immersive by using a head-mounted display (HMD) to render The reviews by Terzimehic et al. and Sliwinski et al. [50, 52]
some natural environments (water, vegetation, wind and fire) and although not primarily focused on VR technology, the HCI tech-
some virtual objects (clouds, jellyfish, etc.) that are associated with niques and interaction technologies involved in both of their work
the natural environment. Some physiological signal detection de- in mindfulness still provide information for this paper. Many of the
vices (e.g., breath detection) are also used to interact with virtual earlier studies involved sensor technologies to provide biological
objects or to detect the user’s meditation state. and neural feedback to participants, but most sensors were only
used to record participants’ physical states and not for interaction,
2 RELATED WORK whereas these possible sensor-based HCI technologies could pro-
In recent years, there has been an increasing amount of literature vide game-like interactions, which were identified by Sliwinski et
on meditation and mindfulness based on VR or immersive tech- al. [50] as having great potential to improve the mindfulness train-
nology [3, 12, 14, 27, 41, 46, 50, 52, 56], but the vast majority of ing process. This coincides with the view of Dollinger et al. [12]
surveys have focused on how VR technology can help with med- that the current stage of research on VR-based mindfulness does
itation or mindfulness, rather than on VR technology itself, such not fully exploit the full possibilities of VR technology, which has
as how to design an effective meditation VR program. This section motivated our current systematic literature review.
summarizes these studies.
The reviews by Dollinger et al., Failla et al., and Arpaia et 3 METHODOLOGY
al. [3, 12, 14] collectively provide important insights into how VR
technology can be used to improve the practice of mindfulness 3.1 Search & Paper Set Extraction
meditation. Together, these studies suggest that VR-based mindful- The purpose of this paper is to analyze the current state of research
ness interventions can be effective in improving emotional states on meditation or mindfulness practice in VR. By analyzing these
including anxiety, anger, depression, and tension, and because VR studies, we aim to describe the assessment of how meditation is cur-
allows precise control of the auditory, visual, and even haptic and rently performed in VR. Based on this description, we will discuss
olfactory senses of the environment, multisensory immersive VR the kinds of meditation that can be integrated with VR technology,
is more flexible than traditional meditation approaches. However, meditation design considerations, the VR, or related technologies
mainstream VR meditation applications are still based on sound involved, how they can be implemented in VR and the research
guidance and have little active user input (user interaction with the questions that are under-explored. We followed the four-stage pro-
virtual environment relies primarily on biosignals, such as breath- cess of the PRISMA method [38] to conduct a structured review of
ing and heartbeat), therefore Dollinger et al. [12] argue that the full the existing literature. Figure 1 shows the four phases of our review
A Systematic Review of Meditation, Mindfulness and Virtual Reality

process. Our review included papers that met the following four In the third stage, we screened full-text articles for eligibility
criteria: based on four criteria. The reasons for exclusion at this stage are:
a) VR technology. Papers need to address immersive VR tech- (a) although both VR and meditation are involved, meditation is
nology such as head-mounted displays (HMDs) or CAVEs. not the main object of the study (Criteria 4); (b) not include user
b) Meditation or mindfulness. The paper needs to indicate studies’ data (Criteria 3); (c) only virtual technology is involved,
the type of meditation or mindfulness used or the meth- not adopt the real-time rendering immersive VR (Criteria 1).
ods commonly used for meditation such as relaxation and
concentration. 3.2 Analysis & Coding
c) User experiments. The paper needs to report a user study Our coding structure is driven by research questions (see Figure 2).
and related research data. We proposed a coding structure containing three themes. The first
d) Topics. The paper needs to include meditation or mindful- theme is the type of meditation and the specific mindfulness tasks.
ness in VR as one of the main subjects of study. For example, does the study adopt respiration-based meditation or
attention-focus-based meditation?
The second theme is design considerations or impacting vari-
ables, which are crucial elements derived from meditation and en-
hanced by technology. The design consideration means the crucial
elements impacting the meditation experience. Prototype design-
oriented papers will contain one or more design considerations to
promote the user’s meditation experience. For example, a proto-
type will improve the user’s awareness of breath through visual
cues and biofeedback in the virtual environment. The awareness
of breath is the primary design consideration. Impacting variables
mean the variables that an empirical study aims to explore their cor-
relation with meditation experience, for example, are nature-based
environments positively or negatively correlated with meditation
experience. One paper will have both if it proposes a prototype and
examines some variables.
The third theme is VR and related technology. In this theme, the
first sub-theme is VR technology. This review refers to the frame-
Figure 1: Our literature search process, refer to the PRISMA work proposed in Farhah Amaliya Zaharuddin’s team’s work as the
procedure. guide to understanding VR [55]. They define VR as virtual environ-
ments, virtual objects, virtual others, and virtual self-representation.
In addition, we also care about the hardware aspect. Therefore, our
We chose IEEE Xplore and ACM Digital Library as our databases final structure of the third theme is VR and Interactive Apparatus, Vir-
for searching and screening, both of which collect a large number of tual Environments, Virtual Objects, and Virtual Self-Representation.
papers published in the fields of VR and HCI. To focus our search on Another sub-theme is the detection of physiological signals, which
meditation and VR technologies, we selected “meditation”, “mind- is widely used in many other meditation or mindfulness studies.
fulness”, “virtual”, and “VR” as keywords and combinations of them. The first theme highlights meditation, and the third theme high-
To search more precisely, we applied the advanced search function lights VR technology, while the second theme is a bridge connecting
of the two database websites for Boolean commands (see Tab. 1). We mindfulness and technology.
chose “virtual” as a search term to include “virtual reality”, “virtual
environment”, “virtual object” and other related technical terms
that would be involved in VR technology. To focus more on the
latest technology developments, we only contain papers published
within the last 20 years, from 2002 to 2022. To ensure we effectively
focus on solid research findings, we only collect peer-reviewed
Figure 2: Coding structure, driven by research questions.
“research articles”, not including editors, reviews, posters, abstracts,
theses, etc. In addition, we only collect papers published in English.
A total of 1055 results were obtained, and we collated the titles and
abstracts of these publications for the second stage of screening. 4 FINDINGS
In the second stage, we used the above inclusion criteria to
screen the titles and abstracts of 1,055 papers collected in the first
4.1 Meditation type and mindfulness task
stage. Two researchers read and annotated the papers separately (RQ1)
and then discussed their annotations. If there was a conflict about Slightly more than half (10/19) of the articles didn’t have a detailed
whether a paper is qualified to be included, they discussed it to description of the specific meditation type or mindfulness tasks. In
gain a consensus. If they could not reach an agreement, a third these articles, the meditation were referred as mindfulness prac-
researcher joined the discussion to jointly resolve the conflicts. tice [47], mindfulness VR experience [36], general meditation [31],
 Wang and Mo, et al.

Table 1: Boolean instructions for IEEE Xplore and ACM Digital Library

Database Boolean instructions

IEEE Xplore ("Document Title": "meditation" OR "Document Title": "mindfulness") AND ("Document Title": "virtual" OR
"Document Title": "VR") OR ("Abstract": "meditation" OR "Abstract": "mindfulness") AND ("Abstract": "virtual"
OR "Abstract": "VR")
ACM Digital Library Title: ((meditation OR mindfulness) AND (virtual OR VR)) OR Abstract: ((meditation OR mindfulness) AND
(virtual OR VR))

relax breath practice [35], audio-guided meditation, instructed med- sense of connection in an individual to the world [51], and intero-
itation [2] [26], calm and mindful experience [42], meditation sitting ceptive awareness [17]. In RelaWorld, the system presents visual
besides a campfire [32]. In Re:Feel [34], the system is designed to cues to aid attention regulation [30]. Meanwhile, InnerGarden is
promote Asmaul Husna reciting, while there is a lack of details on the only study that mentioned the design consideration to culti-
how reciting is combined with meditation. In ZenVR [15], the cur- vate no-judgment, acceptance, and autonomy [47]. In ZenVR [15],
riculum covers a series of meditation topics covering posture, health, the system contains systematic meditation curriculum, covering
and attention as well as introducing different meditation techniques. a virtual instructor and well-designed knowledge, and compatible
There were insufficient illustrations of meditation techniques. The environments. The work of Yasitha L. et al. [13] aims to reduce
majority of research that has expanded on the particular mindful- user stress efficiently, based on the user’s states by integrating
ness task has focused on mindful breathing [43, 45, 51, 54], i.e., the VR technologies, reinforcement learning, and wearable Arduino
users feel their breath. Among them, the work of Caglar Yildirim components.
and Tara O’Grady [54] integrates paying attention to breathing
and experiencing the present moment without judgement simul- 4.3 Virtual Reality and related technology
taneously. Other meditation types or techniques mentioned in the
(RQ3)
articles are Kasina [39] (a Buddhist technique in Visuddhimagga
scriptures, which means one uses some physical objects for con- 4.3.1 Virtual Reality (VR). This section describes all the tech-
centration before moving to purely mental creations [10]), Stability niques used in the reviewed articles, divided into VR-related tech-
Meditation [17] (focus on the feeling of stability by breath, move- niques (apparatus, virtual environments, virtual objects, virtual self-
ment, attention, and meditation), attention focus and body scan [30] representation, etc.) and detection of physiological feedback-related
(focus the attention by gazing at highlighting balls and feel the parts techniques (EEG detection, etc.). We will discuss the technologies
of the body at the present moment), and compassion meditation [21] involved.
(focus on the empathetic feelings towards others). In the work of VR and Interactive Apparatus. Over the past 20 years, all
Edirisooriya et al. [13], deep muscle relaxation and a visual imagery of the work reviewed used head-mounted displays (HMD) as the
activity are illustrated. hardware device for rendering output from virtual environments
(see Figure 3). Except for the research conducted by Patibanda et
al. [43] and Yasitha L. et al. [13], no HMD model was specified.
Seven works used Oculus products (four of them used Oculus Rift
4.2 Design considerations and impacting DK2 [30, 42, 45, 47], one used Oculus CV1 [36], one used Oculus
variables (RQ2) Quest [15] and one used Oculus Rift 2016 [21]). Six works used
The majority of articles include at least one design consideration, HTC Vive [17, 31, 32, 35, 51, 54], and two used Samsung Gear
which are crucial components drawn from meditation and aug- VR [2, 26]. Two works used inexpensive headsets to cooperate with
mented by technology. Although all articles discussed strengthen- smartphones (Google Cardboard [39] and VR Box [34]).
ing the presence of users via VR immersion, several studies went The majority of research used HMD companion controllers as
above and beyond presence. One-third of the research focused input devices for engaging with the virtual world; however, Roo
only on presence and immersion. They upgraded the presence and et al. [47] employed Kinect and Leap motion to detect participant
immersion by creating multi-sensory experiences [31], providing movement. Numerous research (7/19) use physiological signals as
multi-modal feedback (haptic and vibration) [36], presenting an un- part of the interaction with the virtual world; the corresponding
common visual experience [42], allowing a series of activities [32], devices will be detailed in detail in the next paragraph.
providing a natural VR experience with sound [2], presenting vir- Virtual Environments. Excessive intricacy in virtual worlds
tual objects for concentration [39], and providing synchronized might result in mental weariness and cognitive overload [25]. Sim-
visual and audio guidance [54]. ulation of nature [8] and vague abstract environment [39] help
In addition to the essential presence and immersion characteris- positive meditation, which is confirmed in our review (see Fig-
tics, several articles strengthen other key aspects of the meditation ure 4). Although the design of Ralph Moseley [39] only studied
experience. Several prototypes highlighted the need for breath abstract virtual environments as well as the work of Kazzi et al. [26]
awareness [35, 43, 45]. Several articles enhanced more abstract and did not indicate specific virtual environments, water (ocean [2, 13,
mind-conscious factors, such as interoception and empathy [21], a 30, 36, 45, 47, 54], river [17], underwater world [42, 51], lake [2]),
A Systematic Review of Meditation, Mindfulness and Virtual Reality

Table 2: A summary of the meditation type and design considerations

Article Mindfulness type Design considerations or impacting variables

Min et al. [36] Not specified: Design consideration: a sense of presence;
general mindfulness VR experience session Impacting variables: calm content vs. disturbing content
Jarvela et al. [21] Loving-kindness and compassion medita- Design consideration: empathy and interception
tion Impacting variables:
dyadic vs. solo meditation;
brainwave visualization vs. breathing visualization vs. both vs. no feedback
Lai et al. [31] Not specified: Design consideration: a hybrid composition of sensory experiences
general meditation
Stepanova et al. [51] Mindfulness breath Design consideration: a profound sense of connection in an individual to the whole world through
a self-transcendent experience; Intimate connection; Capacity to care for the environment
Kosunen et al. [30] Focused attention; body scan Design consideration: attention regulation;
Mevleviouglu et al. [35] Not specified: Design consideration: Awareness of respiration
general breath relaxation practice
Andersen et al. [2] Not specified: Impacting variables: An immersive VR experience vs. non-VR experience
An audio guide to meditation
Kazzi et al. [26] Not specified: Impacting variables:
an instructed meditation HMD 3D visual and audio vs. 2D on mobile phone Meditation after physical stress vs. after
mental stress
Paredes et al. [42] Not specified: Design consideration: Engagement and relaxation
a calm and mindful experience Impacting variables:
A static VR content vs. a dynamic VR content
A static car vs. a moving car
Prpa et al. [45] Breath Design consideration: Awareness of breath
Madzin et al. [34] Not specified: Design consideration: Reproduce the Asmaul Husna recite scenario on the self-help application
Asmaul Husna recite
Lee et al. [32] Not specified: Design consideration: Active immersion and concentration
meditation in a campfire setting with a for-
est context
Ralph Moseley [39] Kasina Design consideration: Deep Concentration on the virtual objects (the product of Kasina) in the
virtual environment
Impacting variables: No technical assistant vs. associated audio vs. entrainment and biofeedback
loop vs. Virtual Mind Machine
Roo et al. [47] Not specified: Design consideration: Suitable guidance, minimalist, non-judgement, promoting acceptance,
mindfulness practice promoting autonomy, Tangible interaction, choosing the right reality
Patibanda et al. [43] Breath Design consideration: Self-awareness of breathing and body Focused immersion
Heeter et al. [17] A yoga-based meditation focusing on sta- Design consideration: Interoceptive awareness
bility Impacting variables:
A yoga-based meditation focusing on stability vs. a parallel relaxation mind wandering experience
Eyes closed vs. a 96-degree field of view VR headset experience vs. a 110-degree field of view VR
headset experience
Feinberg et al. [15] Not specified: Design consideration: learner-oriented experience containing a well-designed curriculum and
A series of lesson topics covering posture, virtual environments
breath, and attention as well as different
techniques.
Edirisooriya et al. [13] Deep muscle relaxation for lower stress Design consideration: to improve the awareness of presence, also known as mindfulness, by VR
group and visual imagery activities for environment stimulations, Arduino-based hardware components, and a rewarding mechanism
moderate or high-stress group provision.
Caglar Yildirim and Tara Paying attention to breathing and trying Impacting variables: the immersive visual experience in the virtual environment.
O’Grady [54] to experience the present moment without
judgment.

vegetation (trees [15, 30, 35, 43, 47], flowers [17, 30, 31, 35, 47], and slow movement. Although the work of Kazzi et al. [26] does
forest [13, 21, 31, 32], fields [36], meadows [2, 17, 35, 47]), wind not specify the specific virtual environment they used, and it shows
(wind blowing through vegetation [21, 30, 35, 47, 54], wind blowing that they used vivid and soft colors for the background of the virtual
through ocean, waves [13, 30]) and fire (campfire [21, 32, 47]) are environment. Only the work of Madzin et al. [34] took a different
common features of all virtual scenes used for meditation. The virtual environment from all the others; it built galleries as virtual
abstract environment of Ralph Moseley’s work [39] also metaphor- scenes.
ically represents the information related to water, fire, and wind. Notably, both two studies [35, 36] contrasted calm natural scenes
These virtual environments all point to nature, softness, vividness, with scenes of stressful stimuli. The stimulating scenarios they
 Wang and Mo, et al.

Figure 3: The VR headset models used in the reviewed articles.

of humanoid objects are androgynous, which was intentionally

designed to have no strong identifiers and to consider all genders.
The virtual objects or virtual environments in the six de-
signs [21, 35, 43, 45, 47, 51] changed in response to the participant’s
breathing. The subsequent section will describe specific methods
and feedback for detecting breathing, and this section describes
in detail how the virtual objects are altered with breathing. In the
design of RelaWorld [30], with breathing, virtual objects such as
clouds and the sea will move slowly, and the user exhales, and
the bonfire will be enhanced. In the design of Lift Tree [43], the
user breathes in, the trunk expands, while the user breathes out;
the trunk contracts. The tree will become vivid and colorful as
the user practices breathing (PLB). In the design of Attending to
Breath [45], the user’s position will rise and fall by inhaling and
exhaling. And the jellyfish in the virtual underwater environment
in JeL [51] will respond directly to the user’s breathing, and the
coral will grow with the breathing. In the design of Roo et al. [47],
breathing can control a multitude of virtual objects, such as the
ripple effect of water, the movement of clouds, the flame effect of
a campfire, and even the control of sound effects. If breathing is
detected, some visual effects will be activated in the virtual environ-
ment of DYNECOM [21], such as the bar light on the bridge. The
Figure 4: Virtual environment scenes categorized.
flowers in the virtual environment in the work of Mevlevioğlu et
al. [35] will move according to the user’s breathing. A small number
(1/3) of these virtual objects with respiratory feedback gave only
selected were cluttered and unsettling indoor and moving elevator generalized feedback on the behavior of breathing (e.g., flowers or
surroundings at high heights. These scenes with a high level of trees swaying with breathing), but most (2/3) gave different feed-
detail and rapid action are more likely to produce mental weariness. back on inhalation and exhalation (e.g., inhalation going up and
Virtual Objects. In addition to the virtual environment, the exhalation going down).
variety of virtual objects will be more abundant. Nevertheless, it Depending on the research topics, distinct studies may use dis-
is often connected to the sort of meditation, such as breath and tinct virtual objects. For example, the RelaWorld [30] used a simple
attention. Only the RelaWorld [30] and DYNECOM [21] showed spherical object as the object of detection for focal meditation, while
humanoid objects in the virtual environment; the former was an the work of Min et al. [36] used a heart-shaped symbol and a heart
animated figure, serving as visual guide, to assist body scanning organ model. The design of Lee et al. [32], on the other hand, re-
exercises. The latter were some statues that were avatars of the quires users to have interactive behaviors such as pruning trees.
user in the virtual environment. It is worth noting that both designs
A Systematic Review of Meditation, Mindfulness and Virtual Reality

Figure 5: Example of design for breathing to interact with virtual objects; Following the rhythm of the participant’s breathing,
virtual objects are represented in the form of: a) tree trunks contracting and expanding [43]; b) people moving up and down
in the virtual environment [45]; c) jellyfish moving and coral growing [51]; d) lighting effects on bridges [21]; e) flowers
and grass swaying with the wind [35]; f) clouds and sea moving with the wind, campfires getting stronger and sound effects
changing [47].

And the system changes the size of the campfire according to the real world. And DYNECOM [21] adopted statues as virtual agents
user’s EEG. for users, who can also see virtual avatars of other users (the same
We found that except for the specific requirements of the study, statues) in the virtual environment. In addition to the above virtual
such as the RelaWorld [30] and the design of Min et al. [36], other self-representation, TranScent in Stillness [31] provided olfactory
virtual objects that physiological feedback changes in the general feedback to the user using fragrance, where the user could move
virtual environment need to take comfortable objects, conform around the virtual environment and smell different types of fra-
to their natural state, and have no obvious marking features. For grances at different locations.
example, the study in the work of PAREDES et al. [42] showed Except for the work in DYNECOM [21], the rest of the reviewed
that people do not like to have underwater experiences with scary work does not have a specific avatar designed for the user, who can
animals such as sharks. only feel the self-identification through visual, haptic, or olfactory
Virtual self-representation. We refer to the concept in the feedback. To the best of our knowledge, no work systematically
paper of Döllinger et al. [12], the virtual self-representation as a investigates the relationship between virtual self-representation
specific perceptual subjective body of the user’s avatar in the virtual and meditation.
environment, visual, auditory, or haptic. Virtual self-representation
affects the perception of the body. For example, the breathing be- 4.3.2 Physiological Signals Detection. This section focuses on the
havior in Attending to Breath [45] controlled the vertical position devices used to detect physiological signals in different studies and
of the user’s avatar in the virtual space. In the design of Driving the role of detecting different physiological signals for meditation
with Fishes [42], the user felt like swimming in a virtual ocean in in VR.
a moving car. In addition to the visual experience, the design of Out of the 19 literature we reviewed, 10 studies (52.6%) performed
Min et al. [36] also provided a haptic experience for the user. The measurements of physiological signals, and the types of physio-
haptic experience is achieved through physical feedback from the logical data measured were electroencephalography (EEG) [30, 35],
 Wang and Mo, et al.

heart rate [35, 36, 47], electrocardiogram (ECG) [26], respiratory [21, direct attention, which has limited capacity, according to the no-
43, 45, 47, 51], blood pressure (finger blood pressure [26] or domi- tion of attention restoration. There are four levels of properties
nant arm blood pressure [26, 36]), and skin conductance [35, 36]. of this restorative environment: being away means the environ-
Equipment. The review found no duplication in the devices ment is unique and allows the person to escape the stresses of daily
used to detect physiological signals, and the same signal was also life; fascination means the visual pattern in the environment can
detected using different devices for each study. See Table 3 for a hold the person’s attention; extent means the environment has
specific summary. the scope and coherence that allow the person to remain engaged,
Physiological feedback. From these reviewed studies, we and; compatibility means the environment is conducive to the ac-
found that breathing was the physiological data most susceptible tivity that the individual desires to pursue. These four qualities
to interacting with the virtual environment and providing feedback of environments are more concerned with the outcomes of the
on breathing to the virtual environment or virtual objects. All five person-environment interaction than with defining the environ-
studies reviewed that detected breathing responded to breathing as ment itself [25]. Meditation has comparable elements. Take breath
physiological feedback to the virtual environment and interacted meditation as an example; its processes include sitting, shutting
with the user. Breathing is an important component of meditation one’s eyes, taking deep breaths (being away), concentrating on the
as well [19], where the user involuntarily adjusts their breathing as breath, and counting breaths (fascination and extent). The distinc-
they observe the virtual object or environment change with their tion is that meditation emphasizes the active participation of the
breathing in the virtual environment [43]. individual, which may need training and abilities [25].
EEG is thought to be associated with cognitive processes [28], Meditation and mindfulness have not attained a general agree-
and the author of RelaWorld [30] argues that direct observation ment in psychology or related fields. Bishop [5] provided an op-
of the brain (recording EEG) is more meaningful than recording erational definition of meditation that consists of two elements.
some peripheral physiological indicators such as heart rate or skin One element is the self-regulation of attention to sustain focus
conductance. RelaWorld [30] used EEG directly as physiological on the current experience and permit awareness of mental events
signal feedback, and they used the 𝛼 band as an indicator of concen- occurring in the present moment. The unique attitude toward one’s
tration and the 𝜃 band as an indicator of relaxation to change the experience in the present moment, characterized by openness, cu-
transparency of the bubble in the virtual environment. The paper riosity, and acceptance, is another component.
of Lee et al. [32] also employed EEG as physiological feedback, with In summary, the common characteristics mentioned in numer-
virtual objects campfires changed according to the 𝛼 band of EEG ous disclosures include the separation of daily stressful life, the
waves. reduction of information stimuli requiring high-cognitive resources,
the concentration on specific objects (interoception such as one’s
breath or body parts’ feelings), the awareness of the present mo-
5 DISCUSSION ment, and the maintenance of an attitude of openness, acceptance,
and non-judgment.
5.1 Meditation type and mindfulness task
More than half of the articles do not adequately specify the medita- 5.2 Design considerations and impacting
tion type or specific mindfulness job, such as the meditation type,
variables
how to execute it step-by-step, the senses engaged, and whether or
not the eyes must be closed. Among publications that provide a full According to our results, most articles don’t have a detailed descrip-
explanation of meditation content, concentration breath meditation tion of the meditation tasks. They only achieve being away from
is the most prevalent form. The Kasina, Compassion meditation, the daily stressful life and hold one’s attention to some extent via
and Stability meditation are three specific meditations explored VR’s immersive experience. Reviewing our design consideration
in our collected publications, and their mediators or relevant de- and impacting variables coding results, one-third of articles aimed
sign concerns are centered on the virtual object, empathy, and the only to improve the presence of users, which haven’t released the
sensation of stability [17, 21, 39]. potential of VR. In contrast, some other works are very informative.
Meditation has a lengthy history and several variations due The InnerGarden considered the enhance the user’s acceptance
to its Buddhist origins and introduction to psychiatric treatment. attitude by an irreversible procedure design [47].
Although there are ostensibly basic prerequisites for meditation, The Kasina meditation method corresponds extremely well with
various types/tasks/techniques may be tailored to individual med- the production of virtual scenes and objects [39]. The Attending
itators or design factors. The relaxation response, developed by to Breath system uses the underwater situation and biofeedback
physiologist Herbert Benson and based on transcendental medi- visual signals in the virtual world to improve people’s focus and
tation, comprises four key components: a peaceful atmosphere, a breath awareness [45]. In addition to articles concentrating on VR
comfortable posture, a passive attitude, and a mental device. The technology, certain mobile phone-based works are equally informa-
passive attitude is the lack of judgment that allows any notion to tive. For instance, Pause1 is a smartphone application for interactive
“pass through.” The mental device involves concentrating on a word, meditation, and its design was informed by relaxation response and
sound, phrase, or rhythmic breath [4, 11]. attention recovery theory.
A successor, i.e., another psychologist – Stephen Kaplan, identi-
fied fundamental connections between attention restoration theory
and meditation. Entering a restorative setting will restore one’s 1 https://www.pauseapp.com/
A Systematic Review of Meditation, Mindfulness and Virtual Reality

Table 3: Summary of equipment used to measure physiological values

Physiological signals Equipment

EEG MyndPlay headband [35]; Muse headband [32]
Heart rate MioFuse Smartwatch [47]; Shimmer [21]; PSL-iECG [36]
ECG Nexfin [26]
Respiratory Self-made belt based on tensile sensor [47]; Breathing+ [43]; Thought Technology [45]; Biosignal Plux PZT [51];
QuickAmp [21]
Blood pressure Omron M7 Intelli IT [51]; sphygmoCor XCEL AtCor Medical [26]
Skin conductance ALaxtha PolyG-A [51]; Shimmer [35]

5.3 Virtual Reality and related technology studies may use other terminologies like breath training, deep
Virtual environments are endlessly possible and can be created as breathing, respiration practice, etc. We might miss these insights in
needed to make the meditation environment more interesting. How- these papers. Due to the small number of available publications in
ever, content that is too interesting for positive thinking can distract the selected database, we did not adopt an assessment of the qual-
the user’s attention, which is contrary to the design goal of the ity of a paper before coding it, so the varying quality of collected
system [47]. Future researchers or designers tasked with creating publications might contribute equally to our results, which may
virtual environments for meditation should consider limiting the lead to some bias in the results.
degree of user engagement. Users will focus more on the physical
components of the virtual world than on its engaging content. 6 OPPORTUNITIES & CHALLENGES FOR
According to the survey results, individuals dislike virtual items FUTURE RESEARCH
that may induce fear [42], as well as virtual settings with a spe-
cific height [35] or distracting clutter [36]. Fast-moving scenes Through the systematic literature review, we have identified five
may induce motion sickness in users [17, 42, 45]. Therefore, the opportunities to further leverage VR to improve meditation experi-
design of the virtual environment should be natural and pleasant, ences.
and the user’s posture inside the virtual environment should stay First, researchers must go further into the specific meditation
fixed or move slowly. Designers might think about adding vertical type or mindfulness activity to determine the processes, me-
movement, which is thought to cause less motion sickness than diators, and objectives that are compatible with the appropriate
horizontal movement [45]. technology and maximize the potential of VR and similar technolo-
Prior research provides real-time input of the user’s physiologi- gies. For instance, virtual reality (VR) settings and physiological
cal data to the virtual world, which is then represented by specific detection might be used to improve interoceptive awareness. What
virtual objects. It should be noted that too immediate reactions to kinds of virtual surroundings or activities are most conducive to
physiological changes might increase user anxiety since such quick fostering acceptance and non-judgment in individuals? And, what
responses can divert users’ attention and make it harder for them activities might govern a person’s focus on the present? How about
to grasp the relationship between mental state and environmen- combining mindfulness with other artistic endeavors? Chinese cal-
tal adaption [30]. Furthermore, physiological data like heartbeats, ligraphy might be a suitable starting point, since it is known as
which are fast and uncontrollable by the user, are unsuitable for a mental development exercise (in Chinese: Xiu Shen Yang Xing).
immediate feedback [47]. Consequently, breathing is the optimal When practicing Chinese calligraphy, a person pays close attention
data for physiological feedback and engagement with a virtual to hand movement, the writing brush, and the writing style on the
world. It is sluggish and user-controllable, making it the most pop- paper.
ular approach in the evaluated literature. Researchers may explore Second, future research could examine self-representation
employing a photoplethysmogram (PPG) instead of an electrocar- and environment representation in VR and create a transcen-
diogram (ECG) to record the heart rate for more flexibility [35] dental experience for users, enabling them to engage in profound
when capturing physiological data for further analysis. introspection and life reflection, this is possible with the rapid devel-
opment and vast potential of 3D modeling technology. In addition
to the self-representation of the figure, according to our survey, at
5.4 Methodological Limitations this point in time, the majority of research has used physiological
In this work, we conducted a systematic literature review in two feedback to move objects in virtual settings, such as trees or clouds.
databases (i.e., ACM and IEEE). As meditation, or mindfulness, is Only one of the experiments [21] we analyzed included partial
closely relevant to medical, health, and psychology, other databases physiological data input into the virtual representation of the user.
may provide insightful studies and findings, for example, Pub-Med, If physiological data may be immediately responded to by virtual
ScienceDirect, and Springer. Furthermore, we only used keyword avatars, is it feasible to increase users’ sense of self? This merits
combinations of synonyms for meditation and VR. However, some additional investigation.
 Wang and Mo, et al.

Third, the two research opportunities mentioned above both rest Vive products). Most studies (N=17) involved nature-related envi-
on the exploration of two senses, visual and auditory; is it worth ex- ronments like wind, the ocean, forests, and campfires. The virtual
ploring multisensory stimulation and interaction in virtual reality objects were closely related to the specific meditation type and con-
meditation? In addition to the visual and auditory stimuli that would tained plants, marine animals, and ocean waves. Only a few papers
have been used in the majority of research, haptic and olfactory (N=5) explored self-representation in VR, and users felt their exis-
sensations seem to have a good influence on meditation [31, 36, 47]. tence in VR through multiple senses. More than half of the studies
However, this is not supported by all investigations. In the future, re- (N=10) adopted physiological detection technologies, and EEG and
searchers might try out alternative sensory stimuli to see if various respiration are treated as the most widely used indicators. Other
stimuli help people pay attention and think about things. indicators include blood pressure, heart rate, and skin conductance.
Fourth, future researchers may need to be more concerned with Our review results indicate that the current works have a pro-
the types of interactions meditators have in virtual reality. Inter- found accumulation of utilizing VR immersion to improve users’
action techniques in virtual reality play a key role in enhancing presence (letting them be away from their daily stressful life). Some
presence and immersion [30, 49], but rich engagement with virtual of these works are insightful in combining physiological detection
environments can also contribute to distraction [47]. The ques- with interactive virtual objects. However, meditation contains many
tion of whether virtual environments must be minimalist remains types and adaptations other than breath meditation. VR, 3D model-
contentious [52]. It is also debatable if VR is, in fact, helpful for med- ing, and physiological detection also include ample space to explore,
itation. Nevertheless, it is obvious that VR technology has expanded and it is not convincing that the most advanced rendering technol-
the opportunities for meditation, particularly after COVID-19, and ogy, the most comprehensive multi-sensory stimulation, and the
that the demand for digitally aided meditation has risen [31]. Fu- richest interaction will achieve the best meditation effect. For future
ture studies will face the challenge of determining how to construct research, we should aim to determine the processes, mediators, and
virtual worlds that provide the necessary immersion and sense of objectives of the specific meditation type or mindfulness activity to
concentration for meditation. integrate the appropriate technologies and maximize the potential.
Fifth, according to the findings of our analysis, the great majority
of studies (14/19) concentrated only on individual meditation prac-
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