Table 2 The content of sessions in the intervention group [28]

1

The evaluation of obsessions and compulsions, internal and external triggers of anxiety related to OCD, psychoeducation about OCD and CBT, and goal setting.

Homework: Reviewing the therapeutic goals, changing or adding them if necessary.

2

The evaluation of motivation and monitoring the previous session homework, psychoeducation about the difference between obsessions and compulsions, explaining the cognitive behavior, conceptualization of OCD and the rationale of VRERP.

Homework: Evaluation of obsessions and compulsions, self-monitoring, making a list of all rituals.

3

The evaluation of motivation and monitoring the previous session homework, psychoeducation about negative automatic thoughts (NAT) and their evaluation, anxiety hierarchy and preparing it.

Homework: Challenging with NAT.

4

Monitoring the previous session homework, challenging with NAT related to overestimation of threat and magical thoughts, VRERP according to hierarchy, discussing about the patient’s experience and learning during the exposure.

Homework: Exposure to feared stimuli in daily life according to in-session exposure, challenging with NAT related to overestimation of threat and magical thoughts, practicing to stop rituals.

5

Monitoring the previous session homework, examining the exposure process during the week and obstacles, answering the patients’ questions, reviewing the progress of goals, challenging with NAT related to responsibility and vulnerability to injury, VRERP according to higher hierarchy, discussing the patient’s experience and learning during the VR exposure.

Homework: Repeating daily exposure to new situations according to hierarchy, challenging with NAT related to responsibility and vulnerability to injury, practicing to stop rituals.

6

Monitoring the previous session homework, examining the exposure process during the week, monitoring safety seeking and avoidance behaviors, challenging with thoughts related to avoidances and rituals, VRERP according to higher hierarchy, discussing about the patient’s experience and learning during the VR exposure.

Homework: Exposure during the week, challenging with thoughts related to avoidances and rituals, practicing to stop rituals.

7

Monitoring the previous session homework, examining the exposure process during the week and obstacles, answering the patients’ questions, reviewing the progress of goals, educating about cognitive techniques such as examining the evidence and pie chart, VRERP to higher hierarchy, discussing the patient’s experience and learning during the VR exposure.

Homework: Exposure during the week, challenging with NAT by examining the evidence and pie chart.

8

Monitoring the previous session homework, examining the exposure process during the week and obstacles, answering the patients’ questions, reviewing the progress of goals, cognitive technique about the difference between possibility and probability, VRERP to higher hierarchy, and discussing the patient’s experience and learning during the VR exposure.

Homework: Exposure during the week, challenging with NAT by learned techniques.

9

Monitoring the previous session homework, examining the exposure process during the week and obstacles, answering the patients’ questions, reviewing the progress of goals, reviewing progress in identifying and correcting NAT, VRERP to higher hierarchy, discussing the patient’s experience and learnings during the VR exposure, encouraging the patient to use cognitive skills to deal with stressors.

Homework: Exposure during the week, challenging with NAT by learned techniques.

10

Monitoring the previous session homework, examining the exposure process during the week and obstacles, answering to the patients’ questions, and reviewing the progress of goals, VRERP to higher hierarchy, discussing about the patient’s experience and learning during the VR exposure.

Homework: Exposure during the week, challenging with NAT by learned techniques.

11

Monitoring the previous session homework, examining the exposure process during the week and obstacles, answering the patients’ questions, reviewing the progress of goals, VRERP to the highest hierarchy, discussing the patient’s experience and learning during the VR exposure, preparing the patient to termination, reviewing the learned techniques, evaluating next possible stressors and coping skills to overcome stressors,

Homework: Exposure during the week, challenging with NAT by learned techniques.

12

Reviewing the therapeutic goals, education about lapse and relapse, relapsing prevention strategies, reviewing all treatment sessions and changes, encouraging the patient to exposure and plan for it, and to use learned techniques.

Homework: Encouraging the patient to use all the learned skills and techniques.