Table 1.

Virtual Reality Body-Image Rescripting Protocol

Phase 1: interview	During a clinical interview, the patient is asked to relive the contents of the allocentric negative body image and the situation(s) in which it was created and/or reinforced (e.g., being teased by my boyfriend at home) in as much detail as possible. The meaning of the experience for the patient was also elicited.
Phase 2: development of the VR scene	The clinician reproduces the setting of the identified situation (e.g., the corridor of the classroom where my boyfriend teased me) using one of the different scenes available in the free NeuroVR software (http://www.neurovr.org) The available scenes are as follows:
	• apartment
	• kitchen
	• office
	• school
	• restaurant
	• pub
	• supermarket
	• beach
	• swimming pool
	• city square
	• garden
	• the body-image room (in which the patient can select her/his ideal and perceived body from a list of predefined body shapes and compare them with her/his own real body)
Phase 3: allocentric experience of the VR scene	The patient is asked to re-experience the event in VR from a first-person perspective (the patient does not see his/her body in the scene), expressing and discussing his/her feelings.
	The patient is then asked what needed to happen to change their feelings in a positive direction. The questions asked follow the Socratic approach, for example, “What would need to happen for you to feel better? How does it look through the eyes of a third person? Is there anything you as a third person like to do? How do the other people respond?”
	The main cognitive techniques used in this phase, if needed, are as follows:
	• Countering: Once a list of distorted perceptions and cognitions is developed, the process of countering these thoughts and beliefs begins. In countering, the patient is taught to recognize the error in thinking and substitute more appropriate perceptions and interpretations.
	• Label shifting: The patient first tries to identify the kinds of negative words she uses to interpret situations in her life, such as bad, terrible, obese, inferior, and hateful. The situations in which these labels are used are then listed. The patient and therapist replace each emotional label with two or more descriptive words.
Phase 4: egocentric experience of the VR scene	The patient is asked to re-experience the event in VR from a third-person perspective (the patient sees his/her body in the scene), intervening to both calm and reassure his/her virtual avatar and to counter any negative evaluation.
	The main cognitive techniques used in this phase, if needed, are as follows:
	• Alternative interpretation: The patient learns to stop and consider other interpretations of a situation before proceeding to the decision-making stage. The patient develops a list of problem situations, evoked emotions, and interpretative beliefs. The therapist and patient discuss each interpretation and, if possible, identify the kind of objective data that would confirm one of them as correct.
	• Deactivating the illness belief: The therapist first helps the client list her beliefs concerning weight and eating. The extent to which the illness model influences each belief is identified. The therapist then teaches the client a cognitive/behavioral approach to interpreting maladaptive eating behaviors and shows they can be understood from this framework.