PROJECT SUMMARY Hemodialysis (HD) is a taxing procedure with extensive illness burden and arduous self-care demands. As such, more than 30% of HD patients experience elevated symptoms of depression—and, research shows that comorbid depression is associated with adverse kidney disease outcomes, greater risk of hospitalization, and decreased survival rates. Current interventions to treat depressive symptoms in HD patients are resource intensive, infrequently administered, and often involve delivery of psychotherapy by highly-trained clinicians via multiple face-to-face communications. There remains a critical scientific gap for easily disseminatable and efficient strategies to improve emotional well-being profiles of HD patients in the U.S. and around the world. Our objective in this small R01 study is to design a virtual reality (VR) platform that fully immerses users into a fictitious lifelike environment, to deliver our evidence-based positive psychological intervention and to test whether it improves the emotional well-being of HD patients with comorbid depression. For instance, during the module focused on mindfulness/meditation, we will use a head-mounted display to fully immerse and transport HD patients to an open field beside a calming stream where they will engage in a 12-minute guided meditation. As such, we propose to conduct a 2-arm randomized controlled trial in which HD patients (N=84) will be randomly assigned to receive either our JovialityTM VR-based positive psychological intervention or an active control condition (i.e., educational television programming). We hypothesize that chairside delivery of psychotherapeutic treatment in HD patients using a VR environment will prove feasible and will result in significant improvements in depressive symptoms, quality of life, and dietary adherence, with lower evident rates for missed HD sessions and lower hospitalizations—all while serving as a more cost-effective and far- reaching platform that will greatly expand dissemination. Knowledge gained from completion of the proposed research will result in the first VR software application to deliver psychotherapy to HD patients, while simultaneously allowing them to leave the confines of the clinic and virtually travel to distant regions of the world.