A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe
Open accessAbstract
Adolescence is associated with heightened vulnerability to symptoms of depression and anxiety. In-person and computerised cognitive behavioural therapy (CBT) are effective treatment options, yet uptake and engagement remain low. Smartphone delivery of CBT offers an alternative, highly accessible method of delivering CBT. However, there is no freely available CBT smartphone application (app) specifically designed to reduce depression and anxiety symptoms in adolescents. The aim of this study was to design a new CBT smartphone app (ClearlyMe) that targets depressive and anxiety symptoms in adolescents. We engaged in a rigorous co-design process with adolescents (n=36), parents (n=15), and mental health professionals (n=32). Co-design involved: (1) discovery of users’ needs, views and preferences by conducting focus groups, (2) defining app features through ideation workshops and user consultations, (3) designing therapeutic CBT content and visual features, and (4) testing prototypes. Users were involved at every step and the process was iterative, with findings carried forward to ensure continued refinement of concepts and features. We found a preference for vibrant, cheerful colours and illustrations and non-endorsement of gamification and chatbots, which contrasted with findings from other studies. Preferences were largely consistent between the three user groups. However, adolescents preferred an app that could be used autonomously without professional support, whereas mental health professionals desired a product for use as a therapy adjunct to support CBT skill development. The importance of co-design, and particularly the inclusion of all stakeholders throughout the entire co-design process, is discussed in relation to the design of ClearlyMe. Key learning aims: (1) To understand the co-design process that underpins the development of a new CBT smartphone app for youth with elevated symptoms of depression and anxiety. (2) To understand adolescent, parent and mental health professionals’ key preferences regarding the features and functionality of a CBT smartphone app for adolescents with elevated symptoms of depression and anxiety. (3) To understand how ClearlyMe has been designed as both a therapy adjunct and stand-alone program, and how it can be incorporated into day-to-day clinical practice.
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Previous studies with participatory approaches when developing CBT interventions for youth anxiety have primarily focused on digital interventions.
“When developing CBT interventions for youth anxiety, previous studies with participatory approaches have primarily been focused on digital interventions [18–23].”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [19]
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BackgroundMethodSelf-citationCalear, A. L., Batterham, P. J., McCallum, S. M., Banfield, M., Moore, E., Johnson, N., & Morse, A. R. (2024) · JMIR Formative Research · doi:10.2196/48945 · Cited by 4 · see citing works
“Control over how and when to interact with content is an important concern for young people in the design of online mental health interventions [16,21].”
BackgroundKikas, K., O'Moore, K., Miller, R. K., Matheson, J.-A. T., Li, S., Varghese, K., Baldwin, P., Cockayne, N., Whitton, A. E., & Newby, J. M. (2025) · JMIR Human Factors · doi:10.2196/69499 · Cited by 3 · see citing works
Self-citationEylem, Ö., Poulter, S., Ashcroft, K., Robinson, T., Mane, P., Islam, M., Condell, J. V., & Leavey, G. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-083554 · Cited by 2 · see citing works
Peden, A. E., Alonzo, D., Tran, T. P., Ivers, R., & Franklin, R. C. (2025) · Journal of Agromedicine · doi:10.1080/1059924x.2025.2485926 · Cited by 1 · see citing works
“16,27,28 Further, taking the time to visit regional and rural areas for a resource aimed largely at adolescents in these communities was vitally important, given the scope of rural–urban differences, including in injury risk.”
Ozturk, C. S., & Demir, K. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01613-9 · Cited by 1 · see citing works
“Inspired by psycho-therapy models such as CBT and Mindfulness-Based Cog - nitive Therapy (MBCT), this content can be integrated into therapy or used independently [ 27].”
Thapar, S., Quesada, D., & Knaüper, B. (2025) · JMIR Formative Research · doi:10.2196/69532 · Cited by 2 · see citing works
“The incorporation of the perspectives of multiple stakeholders can potentially promote the acceptability of the tool while enhancing uptake and retention [103,121].”
How Artificial Intelligence is Opening New Horizons in Mental Health Education?
Cai, H., & Yu, X. (2025) · International Conference on Computer Science and Technologies in Education (CSTE) · doi:10.1109/cste64638.2025.11092208 · Cited by 1 · see citing works
“For example, stress management techniques, emotional regulation methods or positive thinking meditation guidance can help students cope with various psychological challenges[3].”
Lynch, K. J., Shatte, A. B. R., Muller, J. L., George, K., Rossini, G., Anson, A., Hala, C., Dimmock, J. A., Hutchinson, D. M., & Teague, S. J. (2026) · Journal of Medical Internet Research · doi:10.2196/91778 · Cited by 1 · see citing works
“…risks for perinatal well-being, including exposure to misinformation, information overload, racism, and maladaptive social comparisons [21-23], underscoring the need for careful, evidence-informed, and culturally appropriate intervention design to maximize benefits while mitigating harm [24].”
Sicouri, G., Daniel, E. K., Salemink, E., Mackinnon, A. J., Allsop, A., & Hudson, J. L. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-078652 · Cited by 1 · see citing works
Isaksson, A., Åhlén, J., Hasson, H., & Eriksson, L. (2026) · BMC Primary Care · doi:10.1186/s12875-026-03191-y
“Across these studies, the number and composition of involved stakeholders have varied, from only including service users (children and/or parents) [21–23] to also involving service providers [19, 20, 24] or CBT experts [18].”
A Medical Device That Can Be Used for Psychotherapy in the Metaverse
Yao, Y., Tang, E., Pan, X., Xie, Y., Huang, Z., Li, M., & Zhu, M. (2023) · Frontiers in artificial intelligence and applications · doi:10.3233/faia220735
CALMA: Support Companion for Managing Anxiety in Students
Pérez, J. C. L., Soriano, E. M. C., Crisantos, C. C., & Calvo, M. D. R. P. (2024) · Avances en Interacción Humano-Computadora · doi:10.47756/aihc.y9i1.187
“En particular, se identificó que los estudios se centraron en el tratamiento específico de la ansiedad [6, 10, 12], mientras que otras investigaciones [4, 8], se orientaron al apoyo general de la salud mental.”
Pellizzer, M. L., Radünz, M., Pennesi, J., Zhou, Y., & Wade, T. D. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101945
Kartiani, A. (2024) · Medicor Journal of Health Informatics and Health Policy · doi:10.61978/medicor.v2i2.747 · Cited by 2 · see citing works
Zambon, T., Ceccarini, C., & Prandi, C. (2025) · Biannual Conference of the Italian SIGCHI Chapter (CHItaly) · doi:10.1145/3750069.3750096
“Like Mellow [30] and ClearlyMe [34], our approach emphasizes the active involvement of end-users, iterative design cycles, and attention to context-specific needs.”
Alves, R. R., Lembor, V. H. D. S., & Macedo, A. A. (2025) · Brazilian Symposium on Multimedia and the Web · doi:10.5753/webmedia.2025.16183
Smartphones as School Mental Health Allies
Gomez, M. G. A. (2026) · IGI Global eBooks · doi:10.4018/979-8-3373-9250-9.ch010
Mendes, J. A. D. A., Lucassen, M. F. G., Adams, A., Mahamud, A., Hitcham, L., Ito‐Jaeger, S., Aicardi, C., Nielsen, E., Roberts, L., Townsend, E., et al. (2026) · Research Involvement and Engagement · doi:10.1186/s40900-026-00969-3
- Authors
- Li, S. H., Achilles, M. R., Spanos, S., Habak, S., Werner-Seidler, A., & O’Dea, B.
- Affiliations
- Black Dog Institute (AU)
- Corresponding author
- Li, S.H.
- Venue
- The Cognitive Behaviour Therapist
- Publisher
- Cambridge University Press (CUP)
- Published
- 2022
- Volume
- 15
- ISSN
- 1754-470X (ISSN-L)
- OpenAlex
- W4285240613
- Cited by
- 39
- References
- 68
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 15 · 2023: 2 · 2022: 2
- FWCI
- 7.49
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Cognitive Behaviour Therapist (publishedVersion, cc-by-nc-nd)
- Funders
- National Health and Medical Research Council (1197074)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, mobile application, adolescent depression, adolescent anxiety, co-design, user preferences, mobile application design, mental health professionals, parents, gamification, chatbots, digital mental health
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