REALIST WOMEN Study A Virtual Reality (VR) Interven�on for Stress, Resilience, and Blood Pressure Management in Black Women Background: Black women have a higher rate (approximately 60%) of cardiovascular disease (CVD) risk markers (e.g., hypertension) compared to their white female counterparts aged 20 and older (45.4%). Addi�onally, Black women are more likely to suffer from insufficient sleep (less than 6 hours), increasing their CVD risks. Stressors, especially complex and cumula�ve intersec�onal stressors (such as economic strain, caregiver burden, racial stress, and gender discrimina�on) experienced by Black women, are upstream determinants of hypertension and insufficient sleep. To cope with intersec�onal stress, Black women have developed unique forms of resilience. Current psychological and mental health treatments do not specifically address intersec�onal stress. Therefore, to address the intersec�onal distress experienced by Black women, we need behavioral treatments that can provide therapeu�c relief when needed. Innova�on and Approach: Realist Women Study aims to pilot test the effec�veness of a culturally tailored VR-exposure stress management program in addressing intersec�onal stress and improving cardiovascular health in Black women. This K01 study aims to conduct focus group and individual interviews with 16 Black women to develop a community-defined concept of resilience. Addi�onally, the study will assess stress, sleep health, and feedback on using virtual reality (VR) for stress management. It will also explore barriers and mi�ga�on strategies related to immersive technology usage among Black women dealing with the superwoman schema coping (SSC). The Study is a pilot randomized clinical trial with (RCT) a total of 60 par�cipants, focusing on hypertensive Black women. The hypothesis is that par�cipants in the stress management virtual reality (VR-SM) group (n=30) will experience reduced stress (a minimum 12-point reduc�on in cumula�ve intersec�onal stress scores), an increase of at least 0.77 points in CD-RISC scores, more days of sufficient sleep (at least 7), a significant decrease in blood pressure (BP), and adherence to the VR-SM program (using at least 50% of the total modules). This research seeks to address a cri�cal gap in the literature by exploring the feasibility and impact of VR- based interven�ons in this underserved popula�on. Relevance: The Study aims to reduce morbidity and mortality associated with hypertension and insufficient sleep in Black women by providing an innova�ve and accessible VR-based interven�on tailored to their unique needs. This research represents a crucial step in addressing health dispari�es and improving cardiovascular outcomes in this high-risk demographic. This K01 award will provide pilot data for an R01-level RCT to develop a VR-delivered, culturally tailored Mindfulness-Based Stress Reduc�on (MBSR) program to enhance resilience to cumula�ve intersec�onal stress and BP management for Black women. ...