Findings of this review revealed that the adaptive and personalized games can improve and enhance the experience of the players/students and the rehabilitation of patients through the dynamic modeling of distinct personality characteristics, e.g., personal interests and exhibited emotions. The aim of this survey is to address research concepts and problems that are related to the dynamic modeling of the players’ characteristics, the impact of adaptive games on their experience and the dissemination of the relevant research. This process resulted in 109 relevant papers, which in turn were taxonomized according to the type of adaptation/personalization approach they employ in order to tailor games to each individual player. To this end, a systematic review process was followed in order to search in the database Scopus for relevant work within the addressed research scope. This paper attempts to provide a detailed overview of the latest advancements in the field of game difficulty adaptation and experience personalization within the years 2005–2021 from the perspective of dynamic difficulty adjustment and procedural content generation. Our paper provides an initial, important step towards a novel, broadly applicable, and widely accessible digital approach for the treatment of social anxiety. 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. Further, we show that the effect of streaming on expected fear was similar for participants who can be considered socially anxious. In Study 2, we show that the prospect of streaming led to elevated fear, a necessary property for effective exposure therapy. 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. ![]() We select demand and performance visibility from these characteristics to showcase how to manipulate them for experiences of gradual exposure. We first propose a framework describing requirements for exposure therapy and how game streaming can fulfill them. In this paper, we propose game streaming as an exposure therapy paradigm for social anxiety, supporting it with data from two studies. However, the need to personalize exposure scenarios and simulate audiences are barriers to treating social anxieties through digital exposure. 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. Together, these findings indicate our emotion-based approach works as intended and provides good player experience, thus representing a useful tool for game developers to easily implement reliable DDA. While the dialog-based self-reports did not positively affect player experience, they yielded high accuracy. ![]() The results show that our emotion-based DDA approach works as intended and yields better player experience than constant or increasing difficulty approaches. The study further explored how self-reports of emotional state can be integrated in dialogs with non-player characters to provide less interruption. We conducted a user study with 66 participants investigating performance and effects on player experience and perceived competence of this approach. In comparison to earlier DDA techniques based on affect, we use parameterized difficulty to define difficulty levels and select the suitable level based on players' frustration and boredom. In this paper, we propose an approach of emotion-based DDA that uses self-reported emotions to inform when an adaptation is necessary. However, in some cases it can be difficult to assess when adjustments are necessary. Research has shown that dynamic difficulty adjustment (DDA) can benefit player experience in digital games.
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