Mobile apps are touted as helpful tools to track and treat mental health difficulties. Growth in this area is particularly relevant for youth and young adults given the pervasive integration of technology into daily life among younger generations. However, there is limited empirical evidence supporting the usability and/or efficacy of mental health apps for youth and young adults with anxiety disorders. This article offers a review of studies that contained qualitative or quantitative data pertaining to a mobile application for the assessment, prevention, or treatment of anxiety in youth. Apps with a broader scope were included if their findings specifically addressed a reduction in anxiety, as were ecological momentary assessment apps that tracked anxiety. In total, 22 articles met full eligibility criteria, providing data on 14 smartphone apps studied with individuals ages 5-28. This review details each of these apps and associated studies, including their features, efficacy data, and app usability. Results indicated that treatment apps have received moderate to high marks in terms of ease of use, acceptability, and overall satisfaction. Assessment apps were rated as easy to use and had moderate to high satisfaction ratings; however, user engagement declined over time. Passive sensing technology provides the potential for smartphone apps to learn user patterns and identify behavioral indicators that map onto changes in mood. Studies reviewed here provide preliminary support for the use of apps as helpful and accessible tools in the assessment and treatment of anxiety in youth. Future directions and apps to watch are discussed. Public Significance StatementThis article reviews the evidence base supporting mobile apps for the assessment and treatment of anxiety in youth and young adults. It provides an early guide for psychologists looking for safe, reliable, and effective mobile tools available to supplement existing treatments.

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BackgroundIndividuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges—aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance—difficulty tolerating premonitory urges—predicted tic severity and tic-related impairment among adults with TS.MethodsParticipants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance—comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model.ResultsAnalyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment.ConclusionThis investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.

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