An Internet-Based Virtual Reality Intervention for Enhancing Self-Esteem in Women With Disabilities: Results of a Feasibility Study.

Purpose: To examine the feasibility of an online self-esteem enhancement group program for women with disabilities. Method: A sample of 19 racially and ethnically diverse, community-living women with physical disabilities, 22 to 61 years old, participated in a 7-session interactive group intervention (extending Hughes et al., 2004) in the 3-D, immersive, virtual environment of SecondLife.com, using avatars with voice and text communication. Baseline and postintervention questionnaires were administered online. Criteria for determining feasibility were (a) enrollment, (b) engagement, (c) acceptability, and (d) improvement on measures of self-esteem, depression, self-efficacy, and social support. Results: We attained our enrollment goal and engagement exceeded expectations. Acceptability was positive; participants gave "helpful" and "enjoyable" ratings of 3.21 and 3.27, respectively, (mean on a 1 to 4 Likert scale, where 4 = high) to 5 intervention components-session materials, group sharing and discussion, relaxation exercises, action planning, and group excursions. Significant increases from baseline to postintervention were found on the Rosenberg Self-Esteem Scale (p = .02; Cohen's d = .60) and the Center for Epidemiologic Studies Depression Scale = 10 (p = .005; Cohen's d = .74), with a trend toward significance on the Generalized Self-Efficacy Scale (p = .08; Cohen's d = .42). The intervention did not significantly affect the measure of social support. Implications: An intervention to enhance self-esteem may have a corollary benefit on depressive symptomatology. Offering psycho-educational, small group interventions using online virtual worlds shows promise for circumventing disability-related and environmental barriers to accessing mental health services experienced by women with mobility limitations, and should undergo further development and testing.