Table 2.

The VR body image rescripting protocol (adapted from Riva, 2011).

Phase 1: Interview	During a clinical interview, the patient is asked to relive the contents of the negative body image and the situation/s in which it was created and/or reinforced (eg, “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 (eg, “the corridor of the classroom where my boyfriend teased me”) using one of the different scenes available in the free NeuroVR software.
Phase 3: Egocentric 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 was needed to happen to change the feelings in a positive direction. The main cognitive techniques used in this phase, if needed, are: Countering: Once a list of distorted perceptions and cognitions is developed, the process of countering these thoughts and beliefs begins. 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: Allocentric 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 both to calm and reassure his/her virtual avatar and to counter any negative evaluation. The therapist follows 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 would like to do? How do the other people respond?” The main cognitive techniques used in this phase, if needed, are: Alternative Interpretation: The patient learns to stop and consider other interpretations of a situation before proceeding to the decision-making stage. Deactivating the Illness Belief: The therapist first helps the client list his/her beliefs concerning weight and eating.