(PS8-82) Modified Care: The Impact of Parasocial Interaction on Adherence Intentions and Knowledge Acquisition in Unguided Digital Interventions for Socially Anxious Individuals

Abstract Text: Title: Modified Care: The Impact of Parasocial Interaction on Adherence Intentions and Knowledge Acquisition in Unguided Digital Interventions for Socially Anxious Individuals


Social Anxiety Disorder (SAD) is a prevalent and impairing condition characterized by intense fear of social situations. While Cognitive Behavioral Therapy (CBT) is an effective treatment, nearly half of adults with SAD avoid seeking care due to stigma, cost, or fear of judgment. Internet-based CBT (ICBT) offers a more accessible alternative, but unguided versions suffer from high attrition rates. Success in ICBT is related to knowledge acquisition, as users must understand CBT principles to apply techniques effectively. However, strategies to enhance learning in digital therapy remain underexplored. Parasocial interaction (PSI), where individuals form one-sided relationships with media figures, may be a promising solution to increase adherence, and knowledge retention in digital therapy by fostering a perceived bond with the program instructors. This effect may be particularly beneficial for socially anxious individuals, who often prefer less emotionally demanding interactions. This study examined whether a PSI-inducing ICBT psychoeducational video improved digital therapy adherence intentions and knowledge acquisition. A total of 254 participants (MAge = 24.94, SD = 12.21) were recruited and randomly assigned to watch either a PSI-inducing or non-PSI-inducing psychoeducational CBT video. The sample was predominantly female (74.4%) (Male = 16.9%; Nonbinary/third-gender = 8.7%). The PSI-inducing video successfully elicited greater parasocial interaction (M = 17.82, SD = 5.44) than the non-PSI-inducing video (M = 16.52, SD = 6.32; β = 0.22, p = .040). Contrary to expectations, social anxiety was negatively correlated with PSI engagement (β = -0.27, p < .001). Linear regression analyses indicated that higher PSI scores predicted greater intention to adhere to digital therapy (β = 0.16, p = .013). However, PSI was unexpectedly associated with reduced knowledge retention (β = -0.20, p = .001). Finally, the interaction between PSI and social anxiety did not significantly increase participants’ intention to adhere to an online therapy program (β = -0.001, p = .017), or knowledge retention (β = 0.000, p = .690). The negative relationship between PSI and knowledge retention suggests cognitive overload, where engagement with the media figure diverts cognitive resources from processing information. The negative relationship between PSI and social anxiety supports the Social Enhancement Hypothesis (SEH), which suggests that social deficits in the real world extend to the parasocial realm. While PSI modestly improved adherence intentions, it did not enhance knowledge retention and was less effective for individuals with high social anxiety. This underscores the need to integrate PSI carefully into digital interventions to maximize engagement without compromising educational effectiveness. Clinically, tailoring digital interventions for socially anxious individuals may require strategies beyond PSI. Future research should examine PSI's long-term effects and ways to optimize engagement and retention.