Evaluation of the smartphone Clear Fear App for young people experiencing anxiety: An uncontrolled pre- and post-follow-up design (Preprint)

Abstract

Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, reducing the risk of long-term illness into adulthood, particularly with rising rates of anxiety and depression in young people.

We aimed to assess the usability, acceptability, safety and effectiveness of a new app, Clear Fear (CF) developed to help children and young people manage symptoms of anxiety using the principles of Cognitive Behavioural Therapy (CBT).

The CF app was developed to provide cognitive behavioural strategies to suit anxiety disorders. The app was evaluated using an uncontrolled pre- and post-follow-up design over a 9-week period to assess the app and its effects. The study comprised three phases: i) Baseline (Stage 1); ii) Post-app familiarisation (Stage 2); and iii) Follow-up (Stage 3). Eligible participants were aged between 16-25 years, with mild to moderate anxiety, but not currently receiving treatment and/or in contact with specialist mental health services or using other inventions or apps to help monitor or manage their mental health. A community sample was recruited via adverts, relevant websites and social media networks. Eligible participants completed standardised, self-reported tools and questionnaires at each study stage. These measured probable symptoms of anxiety (GAD-7), depression (MFQ) and emotional/behavioural difficulties (SDQ), and feedback on the usability, accessibility and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon Signed-Rank test. Qualitative data derived from open-ended questions were coded and entered into NVIVO (version 10) for analysis.

48 young people entered the study at baseline, with 37 (or 77.1%) completing all outcome measures at follow-up. The sample was mostly female 77.1% (or 37). The mean age was 20.1 years (SD=2.1). 47.9% (or 23) of participants reached the threshold for probable anxiety disorder, 56.3% (or 27) participants scored positive for probable depression, 75.0% (or 36) scored ‘very high’ on the SDQ total score for emotional/behavioural difficulties. The app was well received offering reassurance, practical and immediate help to manage symptoms, encouragement to seek help and generally found easy to use. A small minority found the app difficult to navigate. The app revealed statistically significant reductions in probable symptoms of anxiety (t1=2.6, 95% CIs 0.41-3.53, P=.014), depression (z=2.3, P=.019) and behavioural/emotional difficulties (t2=4.5, 95% CIs 3.67-9.65, P=<0.001)

The CF app was found to be usable, acceptable, safe and effective in helping to manage symptoms of anxiety, depression and emotional/behavioural difficulties.

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