Explore LLM-enabled Tools to Facilitate Imaginal Exposure Exercises for Social Anxiety

TL;DR

This paper investigates the use of an LLM-enabled tool, ImaginalExpoBot, to support imaginal exposure exercises in social anxiety therapy, demonstrating its potential to generate personalized, vivid exposure scripts.

Contribution

It introduces and evaluates a co-designed LLM-based tool for facilitating imaginal exposure in social anxiety treatment, highlighting its benefits and limitations.

Findings

Supports preparation for anxiety-provoking situations.

Enables immediate, user-specific scenario adaptation.

Identifies limitations in continuity and customization.

Abstract

Social anxiety (SA) is a prevalent mental health challenge that significantly impacts daily social interactions. Imaginal Exposure (IE), a Cognitive Behavioral Therapy (CBT) technique involving imagined anxiety-provoking scenarios, is effective but underutilized, in part because traditional IE homework requires clients to construct and sustain clinically relevant fear narratives. In this work, we explore the feasibility of an LLM-enabled tool that supports IE by generating vivid, personalized exposure scripts. We first co-designed ImaginalExpoBot with mental health professionals, followed by a formative evaluation with five therapists and a user study involving 19 individuals experiencing SA symptoms. Our findings show that LLM-enabled support can facilitate preparation for anxiety-inducing situations while enabling immediate, user-specific adaptation, with scenarios remaining within a therapeutically beneficial "window of tolerance". Our participants and MHPs also identified limitations in continuity and customization, pointing to the need for deeper adaptivity in future designs. These findings offer preliminary design insights for integrating LLMs into structured therapeutic practices in accessible, scalable ways.