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After 8 weeks of use, the self-guided cognitive behavioral therapy (CBT) mobile app, Clear Fear, was found to produce statistically significant reductions in the cohort’s levels of anxiety, depression, and emotional behavioral difficulties, a new study published in JMIR Formative Research finds.
Researchers found that 92% of the 37 young people aged between 16 and 25 years with anxiety disorder who used Clear Fear, the National Health Service (NHS)–approved, evidence-based mental health mobile app designed to help children and young people manage anxiety, said that the app helped to reduce their feelings of anxiety, and 87% said it helped reassure them when feeling anxious.
Alongside reducing feelings of anxiety, 84% found the app easy to use, and over 70% used it frequently over the 9 weeks.
The pilot study provides promising evidence of the usability, acceptability, safety, and effectiveness of the Clear Fear app for young people with anxiety, particularly those who are unable to access immediate treatment. This innovation has the potential to provide accessible, immediate, cost-effective, and evidence-based support for young people’s mental health, complementing existing stretched traditional support services and alleviating the pressure on them.
A total of 949,200 children were referred to the NHS’s Child and Adolescent Mental Health Services (NHS CAMHS) in the United Kingdom in 2022/23 [1], and in the following year, 200,000 were referred for anxiety in particular at a rate of over 500 anxiety referrals per day [2]. As an exceptionally in-demand and overstretched service, just 30-40% of the children and young people who need mental health support from the NHS actually receive it [1,3].
The study, published in JMIR Formative Research, is the first to measure the effectiveness of Clear Fear, the app developed by clinical psychologist Dr Nihara Krause, MBE, in collaboration with young people. Having recorded over one million downloads, Clear Fear uses evidence-based CBT techniques in a youth-friendly format, providing young people with accessible and practical tools to effectively manage their symptoms of anxiety.
Furthermore, unlike many apps designed for profit by monetizing users’ personal medical data, Clear Fear has been developed and is maintained by a charity, stem4, ensuring a safe, responsible, and ethical digital environment for young people.
Dr Nihara Krause, MBE, founder and chief executive of youth mental health charity stem4, commented:
“8 per cent of the 11.9 million children in England were referred to CAMHS in 2022/23, and most were unable to access talking therapies to treat symptoms of anxiety. This study shows that the Clear Fear app provides an effective, accessible, and scalable solution for managing anxiety, which young people are willing to engage with.
“By integrating evidence-based Cognitive Behavioural Therapy (CBT) techniques into a user-friendly digital format, Clear Fear empowers young people to take control of their mental health while reducing reliance on overstretched healthcare and educational systems.
“If we were to place Clear Fear into the hands of 100,000 more young people in the UK, which we are aiming to achieve via partnerships with schools, it could help the escalation of difficulties, provide young people and schools with tools to manage anxiety symptoms, and potentially free up waiting list spaces within CAMHS.”
Anxiety treatment via CAMHS costs the NHS an estimated £2338 per child [4]. Meanwhile, untreated anxiety in schools is a costly and growing problem across the United Kingdom, contributing to repeated school absences, which incur estimated costs of over £1 billion per year between education, health care, and justice systems [3].
Amanda Collyer, student support and wellbeing ambassador, Howard of Effingham School, said:
“There is a massive need for schools to support students struggling with anxiety every day, but our teachers often struggle with time, resources and even the expertise to provide the help every student needs. Having a clinically validated resource like Clear Fear, which students can access instantly, will make a real difference. We’re excited to start using it in our school to provide immediate, evidence-based support when it’s needed most.”
Anonymous participants in the Clear Fear study said:
“I liked the way the app asked what you were afraid of and then what you could do to battle it. I liked the way the questions made you face your fears and really think about it and not hide them.”
“I liked using the immediate help feature and doing the breathing activities and panic attack feature because it helped to calm me down while having a panic attack. I also liked the safety net feature to remind myself what help I could get.”
Clear Fear for Schools
stem4 is working in partnership to embed Clear Fear within individual schools across the United Kingdom, scaling up access and reducing the strain on education and health resources. Get in touch at enquiries@stem4.org.uk to find out more or to register your interest in becoming a participating school.
Original article:
Samele C, Urquia N, Edwards R, Donnell K, Krause N. Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre– and Post–Follow-Up Study. JMIR Form Res. 2025;9;e55603.
URL: https://formative.jmir.org/2025/1/e55603
doi: 10.2196/55603
– Ends –
A pilot study ‘Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre– and Post–Follow-Up Study’ (Samele C, Urquia N, Edwards R, Donnell K, Krause N) was published in JMIR Form Res (DOI: 10.2196/55603).
For further information, please contact enquiries@stem4.org.uk
References
- Children’s Commissioner. (2024). Press Notice: Over a quarter of a million children still waiting for mental health support, Children’s Commissioner warns. https://www.childrenscommissioner.gov.uk/blog/over-a-quarter-of-a-million-children-still-waiting-for-mental-health-support/
- Children’s Commissioner. (2024). Children’s Commissioner responds to new figures on children referred to mental health support for anxiety. https://www.childrenscommissioner.gov.uk/blog/childrens-commissioner-responds-to-new-figures-on-children-referred-to-mental-health-support-for-anxiety/
- Children & Young People’s Mental Health Coalition. (2025). Future Minds: Why investing in children’s mental health will unlock economic growth. https://cypmhc.org.uk/wp-content/uploads/2025/02/Future-Minds-Report-2025-WEB.pdf
- British Association of Social Workers. (2017). Briefing: Children’s Mental Healthcare in England. https://basw.co.uk/policy-and-practice/resources/briefing-childrens-mental-healthcare-england
About the Clear Fear App
The Clear Fear app aims to support young people in managing symptoms of anxiety early in their stage of development. It does this by:
- Providing cognitive behavioural strategies to suit anxiety disorders.
- Encouraging self-monitoring and self-management while building resilience.
- Teaching alternative, adaptive ways to deal with anxiety.
The app provides a first step for young people looking for immediate techniques to help manage anxious thoughts and behaviours for longer-term change. It is also designed to be easily accessible for those who do not meet the criteria for mental health services or are currently on a waiting list to receive appropriate treatment for an anxiety disorder. The app does not replace specialist treatment but can be used in addition to it.
For more information on the Clear Fear app, visit the website here.
About stem4’s Library of Evidence-Based Apps
Clear Fear is one of five evidence-based apps developed by UK charity stem4 to address a range of mental health challenges in young people. Together with Calm Harm, Move Mood, Worth Warrior, and Combined Minds, stem4 is leading the way in providing comprehensive, evidence-based digital mental health support for young people.
For more information, visit stem4’s Clear Fear website.
Special Thanks
stem4 is grateful for the support of:
- Comic Relief and the Paul Hamlyn Foundation for funding the development of Clear Fear.
- The Nominet Reset Mental Health programme for supporting the app’s evaluation.
- Informed Thinking for their support in the study.
- The young people whose feedback and participation drive our mission to innovate and improve mental health care.
About JMIR Publications
JMIR Publications is a leading open access publisher of digital health research and a champion of open science. With a focus on author advocacy and research amplification, JMIR Publications partners with researchers to advance their careers and maximize the impact of their work. As a technology organization with publishing at its core, we provide innovative tools and resources that go beyond traditional publishing, supporting researchers at every step of the dissemination process. Our portfolio features a range of peer-reviewed journals, including the renowned Journal of Medical Internet Research.