PROJECT SUMMARY/ABSTRACT Depression and anxiety rank among the largest public health burdens worldwide. While effective first-line treatments like cognitive behavioral therapy have been shown to be effective, there are numerous barriers to accessing this kind of clinician delivered care (e.g., cost, provider availability, stigma). There is a critical need for effective and affordable interventions that can scale and provide mental health support for the millions of individuals around the world with depression and anxiety who are currently underserved. The Phase I project focused on the development and feasibility of Cognitive Behavioral Immersion™ (CBI), defined as the delivery of cognitive behavioral skills training by peer-based coaches in the metaverse. CBI has the potential to deliver effective, affordable, and scalable support to those with depression and anxiety. While there is initial evidence supporting the feasibility of CBI for depression and anxiety, a direct comparison of this modality against its absence or another effective treatment has yet to be conducted and its relative efficacy is unknown. In addition, it is unknown whether immersive virtual reality confers benefits in cognitive behavioral skill training above and beyond flat screens accessing the same content. The proposed Phase II project aims to evaluate the efficacy of an immersive CBI program accessed via VR headsets (CBI-VR) as compared to a treatment-as-usual (TAU) control and a non-immersive CBI condition accessed via flat screens (CBI-flat screen) in a randomized controlled trial. Upon completion of this aim, the proposed project will have further developed the CBI platform as well as tested the efficacy of this program. This will help with eventual partnerships with larger payers and employee assistance programs. The proposed project will also enhance the value proposition for both direct to consumer and business to business phases.