Effects of Virtual Reality-Based Mindfulness Training on ADHD Symptoms and Emotion Regulation in Male Adolescents: A Randomized Clinical Trial

Abstract

Background and Aim: Attention-Deficit/Hyperactivity Disorder (ADHD) in adolescents, particularly males, is characterized by inattention, hyperactivity, impulsivity, and difficulties in emotion regulation and executive functioning, which can negatively impact academic performance and social life. Pharmacological treatments have limited effects on improving emotion regulation and executive functions, highlighting the potential of mindfulness-based interventions as complementary non-pharmacological approaches. The present study was conducted to examine the effectiveness of virtual reality–based mindfulness training on ADHD symptoms and emotion regulation difficulties in male adolescents with this disorder.

Materials and Methods: This randomized controlled clinical trial was conducted on 50 adolescent boys with ADHD in Karaj, Iran. After confirming the DSM-5 diagnosis and screening with the SNAP-IV, participants were randomly assigned to either a mobile-based immersive virtual reality mindfulness training group using the Samsung Gear VR headset (n=25) or a control group (n=25). The intervention was delivered over eight weeks with two sessions per week. ADHD symptoms, emotion regulation difficulties, and executive function were assessed at three time points—pre-test, post-test, and two-month follow-up—using the SNAP-IV, DERS, and BRIEF questionnaires. Data were analyzed using repeated- measures analysis of variance.

Results: In this randomized clinical trial, 50 male adolescents with ADHD were randomly assigned to a virtual reality–based mindfulness intervention group (n=25) and a control group (n=25). The two groups did not differ significantly in terms of age and educational grade (P>0.05). Repeated measures ANOVA showed that virtual reality–based mindfulness training significantly reduced symptoms of inattention and hyperactivity in the intervention group compared with the control group at post-test and two-month follow-up (P<0.05). In addition, significant reductions were observed in emotion regulation difficulties in the intervention group (P<0.001). Regarding executive functioning, a significant improvement was found based on parent reports in the intervention group (P=0.002), whereas no significant difference was observed between the groups based on teacher reports (P=0.835). These effects remained stable at the two-month follow-up.

Conclusion: VR-based mindfulness training can serve as an effective non-pharmacological intervention to reduce ADHD symptoms and enhance emotion regulation and aspects of executive functioning in male adolescents, and may be considered a complementary approach alongside standard treatments.