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

TY - JOUR

T1 - Feasibility Study of a Novel App-Based Anxiety Intervention for Autistic People

AU - Oakley, Bethany

AU - Boatman, Charlotte A.

AU - Baldoza, Saffron

AU - Hearn, Amy

AU - Larkworthy, Colin

AU - Kent, Rachel

AU - Ozsivadjian, Ann

AU - Doswell, Sophie

AU - Dittner, Antonia

AU - Roestorf, Amanda

AU - Rawal, Dhara

AU - Carter, Ben

AU - Simonoff, Emily

AU - Baldoza, Saffron

AU - Hearn, Amy

AU - Larkworthy, Colin

AU - Judd, Adrian

AU - Savage, Marianne

AU - The Molehill Mountain Advisory Group

N1 - Publisher Copyright: © 2025 The Author(s). Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.

PY - 2026/1/31

Y1 - 2026/1/31

N2 - 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.

AB - 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.

KW - anxiety

KW - autism

KW - CBT

KW - digital tools

KW - intervention

KW - mental health

KW - mHealth

UR - https://www.scopus.com/pages/publications/105025134051

U2 - 10.1002/aur.70153

DO - 10.1002/aur.70153

M3 - Article

C2 - 41392571

AN - SCOPUS:105025134051

SN - 1939-3792

VL - 19

JO - Autism research

JF - Autism research

IS - 1

M1 - e70153

ER -