Social anxiety is a prevalent problem that affects many people with varying severity; digital exposure therapy-which involves controlled exposure to simulations of feared social situations alongside cognitive restructuring-can help treat patients with anxieties. However, the need to personalize exposure scenarios and simulate audiences are barriers to treating social anxieties through digital exposure. In this paper, we propose game streaming as an exposure therapy paradigm for social anxiety, supporting it with data from two studies. We first propose a framework describing requirements for exposure therapy and how game streaming can fulfill them. We select demand and performance visibility from these characteristics to showcase how to manipulate them for experiences of gradual exposure. With Study 1, we provide evidence for these characteristics and support for the framework by showing that a game's demand affected expected fear of streaming games. In Study 2, we show that the prospect of streaming led to elevated fear, a necessary property for effective exposure therapy. Further, we show that the effect of streaming on expected fear was similar for participants who can be considered socially anxious. These findings provide evidence for the essential effect of exposure therapy, which serves as a first step towards the validation of streaming as a social anxiety treatment. Our paper provides an initial, important step towards a novel, broadly applicable, and widely accessible digital approach for the treatment of social anxiety.
Lung physiology and controlled exposure study design
