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Table 2 Chatbot Intervention Topics, Change Techniques and Steps

From: Improving body image at scale among Brazilian adolescents: study protocol for the co-creation and randomised trial evaluation of a chatbot intervention

Topics Change Technique Objectives Technique Steps
Family, friends & body image
1. Banish body talk 1. Define and identify forms of body talk.
2. Identify the consequences of body talk and implement strategies for challenging this dialogue.
• User reflects on their own body talk, by estimating the frequency of engagement (e.g., number of times in preceding week), areas of fixation (e.g., belly; legs; skin colour) and the type of commentary (e.g., compliment, criticism, comparison).
• Bot led deconstruction task (social media post); user considers the use and frequency of body talk and its impact on the person posting and their followers.
• User generates alternative comments that focus on non-appearance aspects in the image (e.g., their affect; the activity, the location); user commits to engaging in this behaviour over the coming week. 
2. Dealing with provocative people 1. Identify people that negatively impact your body image.
2. Explore how and when to use assertiveness strategies to address the unhelpful behaviours of others.
• Bot led discussion on how others impact our body image and how these behaviours are framed (e.g., concern, helpful advice, friendly teasing).
• User identifies those who negatively impact their body image.
• Bot introduces and applies the RIGHTS assertiveness model to an example scenario.
• User invited to practice the RIGHTS model with the bot.
Social media & body image
1. The messages behind the media 1. Develop media literacy skills in critically analysing and evaluating media content and the motivations of content creators (e.g., influencers, industry brands).
2. Identify and implement strategies that challenge unrealistic media images and messages, and create safe social media environments.
• Bot led discussion on media literacy; user identifies how media images are manipulated and the motivations of content creators.
• Dove Selfie; user watches a 75-second clip on photo editing strategies, indicates their emotive reaction and identifies newly learnt strategies.
• Bot describes strategies for creating a realistic, diverse and inclusive social media environment; user commits to engaging in one behaviour in the next week.
2. Unfair-to-compare 1. Define and identify examples of the cognitive distortion, ‘Unfair-to-Compare’.
2. Implement strategies that challenge and reduce upward comparison making.
• Bot led discussion on the internalisation of appearance ideals and upward comparison making.
• User reflects on their engagement with this thinking style and the consequences associated with upward comparison making.
• Bot describes strategies for challenging the ‘Unfair-to-Compare’ thinking style.
3. A whirlpool of comparisons 1. Identify thoughts and behaviours that contribute to the cycle of comparison making.
2. Identify and implement strategies to stop the cycle from starting or worsening.
• Bot led discussion on the cycle of comparison making; whirlpool analogy.
• User identifies their comparison making behaviours and the consequences of these behaviours for themselves and others.
• Bot describes strategies for exiting the whirlpool.
4. The magnifying glass 1. Define and identify examples of the cognitive distortion, ‘The Magnifying Glass’.
2. Identify and implement strategies that reduce selective attention on disliked body parts, while increasing attention towards areas that are liked and appreciated.
• Bot led explanation of selective attention and its role in maintaining body image concerns.
• User reflects on their areas of fixation (e.g., stomach, legs, body hair).
• Bot describes strategies for reducing selective attention.
• User invited to engage in a guided mirror exposure task; if unable to in the moment, the audio is saved for a more appropriate time.
Body appreciation and functionality
1. Beauty bound 1. Define and identify examples of the cognitive distortion, ‘Beauty Bound’.
2. Identify and implement strategies that reduce self-imposed body image rules that prevent life engagement.
• Bot led discussion on self-imposed body image rules and limitations; the importance of focusing on the body’s functionality (i.e., what it can do and experience) when attempting to overcome body image rules.
• Visualisation activity; user recalls personal example of Beauty Bound thinking (e.g., thoughts, feelings, behaviours and outcome); then visualises the scenario without self-imposed boundaries (e.g., thoughts, feelings, behaviours and outcome); user identifies the differences.
2. Expand your horizon 1. Define body functionality and identify the different forms of functionality.
2. Describe the importance of our own body’s functions.
• Bot led discussion on body functionality (i.e., what the body can do and experience).
• Functionality activity; user provided with categories of functionalities and the associated experiences / activities: sensation (i.e., touch, taste, sight); physical activity (e.g., running, cycling, jump-rope), creativity (e.g., cooking, photography, drawing) and self-care (e.g., petting animals, meditation, having a bath).
• User selects their most important experience/ activity within each category.
• User then reflects on one experience / activity in-depth (e.g., describe what dancing allows the person to experience and why it’s important to them).