Feasibility Study of a Novel App‐Based Anxiety Intervention for Autistic People

TL;DR

A new app called Molehill Mountain was tested to help autistic adults manage anxiety, and it was found to be usable and effective in reducing anxiety symptoms.

Contribution

The study introduces and evaluates a novel, autism-adapted app-based anxiety intervention for autistic people.

Findings

73% of participants found the app easy to use and suitable for anxiety support.

There was a significant reduction in self-reported anxiety symptom severity (mean difference of 2.88).

65% of participants adhered to the full 13-week intervention period.

Abstract

At least 50% of autistic people experience clinically relevant anxiety symptoms. However, reasons for elevated rates of anxiety in autism remain poorly understood and there is a high unmet need for novel and adapted therapies for anxiety that are accessible to autistic people. This study aimed to establish the feasibility of a novel app‐based anxiety management tool (“Molehill Mountain”) that has been developed with, and adapted for, autistic people. A single‐centre, single‐arm feasibility study design was employed, whereby autistic people (≥ 16 years) with mild‐to‐severe symptoms of anxiety were recruited to a 13‐week intervention period (King's College London, UK; clinicaltrials.gov identifier NCT05302167). Of 123 prospective participants screened, 100 (81%) participants aged 16–74 years (n = 69 female) were enrolled within approximately 15 months. n = 76 (76%) completed an anxiety measure at ~15 weeks (Generalized Anxiety Disorder—7 Item Scale; GAD‐7). Most adhered to the full intervention duration: 65% (n = 47), with most using the app weekly (1–6 days per week; 58%). 73% of participants agreed that they found the app easy to use overall and that an app is a good format for offering anxiety support to autistic people. There was a significant reduction in self‐reported anxiety symptom severity with mean difference 2.88 (95% CI 1.88, 3.89; p < 0.001; Cohen's d = 0.45). We found that an autism‐adapted app‐based anxiety management tool is acceptable to the community and associated with reduced anxiety symptom severity in autistic adults, on average. Following optimization to further enhance usability, the efficacy of the Molehill Mountain app for reducing anxiety must now be tested under randomized controlled conditions in a full‐scale clinical trial.

At least 50% of autistic people experience anxiety. There are very few effective support options currently available to autistic people to help them to manage anxiety. Autistic people can also experience more barriers to accessing mental health services, as compared to their non‐autistic peers. To address these issues, we tested whether a digital app‐based anxiety intervention (“Molehill Mountain”) could be relevant and useable for autistic adults aged 16‐years and above. We found that the app was possible to implement, acceptable to participants, and was related to reductions in anxiety symptom severity in some autistic adults. We also identified areas for improvement to the app in future.

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