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Horror is a popular video game genre, which has the ability to induce strong emotions such as fear and anxiety. Horror game sound partly derives from movie soundtracking, but the interactive and immersive nature of video games and game music challenges the traditional beliefs concerning the meaning and importance of sound design and soundtracking. In this review article, we discuss the relationship between the sonic design of horror games and experienced anxiety. We combine musicological and ludological viewpoints with clinical and neuropsychological ones to create a multidisciplinary overview of the subject. We will also discuss the paradox of how we can enjoy fear and anxiety inducing media, despite those emotions having a very negative association. Finally we will discuss the possible advantages of combining music and video games for the study of emotions in music, video games and psychology.