This research involving human participants was reviewed and approved by the health sciences research ethics board of Western University, Canada. All participants provided informed consent prior to participation. The authors have no potential conflicts of interest to disclose. The authors also note that no adverse events occurred throughout the conduct of this research.

We investigate the potential therapeutic application of virtual reality (VR) technology as an aid to meditation practice among persons varying in posttraumatic stress disorder (PTSD) symptoms. Method: In this within-group mixed-methods study, 96 young adults practiced both VR-and non-VRguided meditations and reported on their experience of positive affect (PA), negative affect (NA), other meditative experiences and perceived satisfaction-credibility of each meditation. Results: Participants reported more PA and greater perceived satisfaction-credibility following the VR as compared to non-VR-guided meditations primarily when the VR meditation was practiced first, before the non-VR meditation, as opposed to vice versa. The experience of NA during meditation practice was infrequent, although persons with increased PTSD symptoms reported increased distress during both VR and non-VR meditation. Conclusions: Further study of therapeutic applications of VR as an aid to meditation practice among people with PTSD symptoms is warranted. Clinical Impact StatementWe explored the therapeutic potential of pairing virtual reality (VR) technology with guided meditation and found that people responded to VR meditations with increased positive affect when VR meditation was practiced before non-VR meditation. Also, those who reported experiencing greater posttraumatic stress disorder (PTSD) symptoms in the past month also reported experiencing greater distress during both VR and non-VR meditation. We advocate for a trauma-informed care approach to meditation practice when conducted in VR among persons with PTSD symptoms.

Objectives The need for remote delivery of mental health interventions including instruction in meditation has become paramount in the wake of the current global pandemic. However, the support one may usually feel within the physical presence of an instructor may be weakened when interventions are delivered remotely, potentially impacting one's meditative experiences. Use of head-mounted displays (HMD) to display video-recorded instruction may increase one's sense of psychological presence with the instructor as compared to presentation via regular flatscreen (e.g., laptop) monitor. This research therefore evaluated a didactic, trauma-informed care approach to instruction in mindfulness meditation by comparing meditative responses to an instructor-guided meditation when delivered face-to-face vs. by pre-recorded 360°videos viewed either on a standard flatscreen monitor (2D format) or via HMD (i.e., virtual reality [VR] headset; 3D format). Methods Young adults (n = 82) were recruited from a university introductory course and experienced a 360°video-guided meditation via HMD (VR condition, 3D format). They were also randomly assigned to practice the same meditation either via scripted face-to-face instruction (in vivo [IV] format) or when viewed on a standard laptop display (non-VR condition, 2D format). Positive and negative affect and meditative experience ratings were self-reported and participants' maintenance of focused attention to breathing (i.e., meditation breath attention scores [MBAS]) were recorded during each meditation. Results Meditating in VR (3D format) was associated with a heightened experience of awe overall. When compared to face-toface instruction (IV format), VR meditation was rated as less embarrassing but also less enjoyable and more tiring. When compared to 2D format, VR meditations were associated with greater experiences of relaxation, less distractibility from the process of breathing, and less fatigue. No differences were found between VR and non-VR meditation in concentration (MBAS). Baseline posttraumatic stress symptoms were risk factors for experiencing distress while meditating in either (VR and non-VR) instructional format. Of those who reported a preference for one format, approximately half preferred the VR format and approximately half preferred the IV format. Conclusions Recorded 360°video instruction in meditation viewed with a HMD (i.e., VR/3D format) appears to offer some experiential advantage over instructions given in 2D format and may offer a safe-and for some even preferred-alternative to teaching meditation face-to-face.

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