Technology Configurations and Adherence in Virtual Reality-Based Mindfulness: A Systematic Review of Headsets, Wearables, Software, and Therapeutic Applications

Immersive virtual reality (VR) may support mindfulness and related therapeutic skills, but the contribution of wearable sensors and external hardware to adherence remains un-certain. This systematic review narratively synthesized randomized trials published from 1 January 2020 to 10 November 2025 that evaluated VR-based mindfulness or meditation in therapeutic populations. Four bibliographic or publisher sources were searched. Technology configuration, adherence, engagement, safety, and clinical outcomes were extracted, and methodological quality was appraised with the Joanna Briggs Institute checklist. Fifteen reports were included in the current synthesis. Hardware and software reporting was inconsistent, and no trial directly compared an otherwise-equivalent VR intervention with versus without an added wearable or peripheral. Retention was frequently described as high or attrition as low, but adherence definitions and denominators varied; discomfort, cybersickness, technical barriers, clinical events, and time demands were also reported. Physiological peripherals were used mainly for measurement or biofeedback. Because populations, interventions, comparators, and outcome definitions were hetero-generous, no meta-analysis was undertaken. The evidence supports feasibility in several therapeutic settings but does not establish a causal effect of added hardware on adherence or clinical outcomes. Future trials should preregister hardware-specific hypotheses, report complete technology and safety specifications, and directly compare otherwise-equivalent VR configurations.