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Hammond et al

Original Paper

Psychoeducational Social Anxiety Mobile Apps: Systematic Search
in App Stores, Content Analysis, and Evaluation
Trent Ernest Hammond1, BSc (Hons), BSocSc (Psy); Lisa Lampe2, MBBS, PhD; Andrew Campbell3, BA, MAppSc,
PhD; Steve Perisic4, DipSocWrk; Vlasios Brakoulias5, MBBS (Hons), PhD
1

Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Kingswood, New South Wales, Australia

2

School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia

3

Cyberpsychology Research Group, Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The
University of Sydney, Camperdown, New South Wales, Australia
4

Mental Health Outreach Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia

5

School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia

Corresponding Author:
Trent Ernest Hammond, BSc (Hons), BSocSc (Psy)
Nepean Clinical School
Faculty of Medicine and Health
The University of Sydney
62 Derby Street
Kingswood, New South Wales, 2747
Australia
Phone: 61 431931448
Email: trent.hammond@sydney.edu.au

Abstract
Background: The wide use of mobile health apps has created new possibilities in social anxiety education and treatment.
However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose
appropriate apps to use on smartphones and tablets.
Objective: This study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores,
report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify
whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety.
Methods: This systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews
and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google
Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the appstores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of theapps.
Results: In the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness intheir names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation,
the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 werepriced between US $2.95 (Aus $3.99) and US $3.69 (Aus $5.00). Among the evaluated apps, 3 were intended for treatment
purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple
purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according
to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned
well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the
MARS app subjective quality subscale (section E).
Conclusions: The psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, healthprofessionals, and other community members. However, given that none of the apps appeared to contain empirical information
or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. Appaccessibility could be improved by developing apps that are free and available for a wider range of operating systems, both

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between and within countries and regions. Information communication and technology professionals should collaborate withacademics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps.
(JMIR Mhealth Uhealth 2021;9(9):e26603) doi: 10.2196/26603
KEYWORDS
anxiety; app; cell phone; mobile app; mobile phone; SAD; smartphone; social anxiety; social phobia; tablet

Introduction
Background
Social anxiety disorder (SAD) is characterized by the avoidanceof social interactions that involve perceived scrutiny by others
and potential embarrassment [1]. Signs and symptoms of SAD
include avoidance of social activities because of anxiety,blushing, problems in making conversation, being unable tothink of anything to say, reduced eye contact, nausea, rapid
heartbeat, sweating, and dizziness [2]. People with SAD tend
to experience problems in their daily activities [3], have poorer
educational outcomes [4,5], are less productive at work, andsubsequently have decreased employment prospects [1]. Surveys
have reported that between 82.2% (n unavailable; total survey
N=43,093) [6] and 88% (73/83) [7] of people with SAD had adiagnosis of at least one other mental disorder during the
12-month period before completing the surveys.
National surveys in the United States and Australia (countries
with similar sex ratios and age structures) [8] suggest that SAD[9] affects tens of millions of people worldwide [10,11]. The
US National Comorbidity Survey Replication [10] andAustralian National Survey of Mental Health and Wellbeing(NSMHWB) [11] reported that SAD is common, with 12-monthprevalence rates estimated at 6.80% (631/9282) for people aged
18 years and over and 4.70% (752,719/16,015,300) for people
aged 16-85 years, respectively. At the time of writing this paper,
there were no recent nationally representative statistics inAustralia (ie, statistics published after 2008) regarding theprevalence of subclinical social anxiety. Despite changes to
SAD diagnostic criteria in the Diagnostic and Statistical Manualof Mental Disorders, fifth edition [1] since the National
Comorbidity Survey Replication and NSMHWB, the prevalenceof SAD is considered unlikely to have changed [12].
Approximately half of people with mental health problems (eg,
SAD) do not receive treatment for 15 years [1]. Early access toempirical information, clinical assessment, and efficacious
treatment has the potential to decrease the severity andpervasiveness of social anxiety. Ubiquitous commercial mobile
apps may be helpful if used adjunctively with psychoeducational
interventions that provide educational materials, screening
assessments, feedback, or advice regarding treatment [13].
Commercial mobile apps are developed by commercial,
for-profit organizations but are not necessarily paid apps as
many contain advertising. Psychoeducational apps have thepotential to empower people, promote positive behaviors,
facilitate personal symptom management, and enhancecommunication between clients and mental health professionals[14-16].

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We identified no published empirical research specifying thereasons why people use or do not use social anxiety apps.
However, 2 studies on health apps in the United States provide
some insight. A web-based survey of 811 people showed theimportance people place in considering content, ease of use,
cost, encryption, responsive features, customization, privacy
policy, and research evidence [17]. A cross-sectional survey
identified that iPhone (iOS operating system) and Samsung(Android operating system) smartphone users stop using apps
because they find them to be boring or they do not trust how
their personal information will be used or managed. People also
stop using health apps because it is burdensome to enter data,
they become disengaged, or there are hidden costs [18].
At Stockholm University, academics developed an app called
Challenger [19], which was available for iPhones only in
Sweden’s Apple App Store. The app includes several
customizable features to enhance user engagement during
internet-based cognitive behavioral therapy (CBT), such as
gamification (eg, challenging board games with self-carerewards), personal skills training, goal setting, social interactions
between end users, and notifications. Given the strong evidencebase for CBT in treating anxiety disorders [20], Challenger has
the potential to substantially enhance the ongoing managementof social anxiety.
Of 52 anxiety apps, 2 social anxiety apps, including
psychological techniques, were identified in a systematic reviewof the Romanian Apple App Store and Google Play Store(although app and developer names were not published) [21].
The top features of the anxiety apps included text, audio,
worksheets, diaries, and animations. The main psychotherapeutictechniques suggested by these apps include progressive muscle
relaxation, breathing, and emotional regulation. Two-thirds ofthe apps were free to download from the app stores; theremainder were between US $0.99 and $8.71 in price.
In another study, 7 psychoeducational and exclusively social
anxiety apps in the New Zealand iTunes Store (now Apple App
Store), Google Play Store, and Windows Store (now Microsoft
Store) were reviewed [22]. Most of these psychoeducationalapps were not universally accessible across mobile platforms
and devices (ie, Apple [iOS], Google [Android OS], andMicrosoft [Windows OS] smartphones and tablets). Nonecontained expert information, had an evaluation of effectivenesspublished, or were developed by medical or not-for-profit
institutions. Although specific psychoeducational apps were
not identified in the published article, the names and platformsof all apps reviewed have been provided. Given that most apps
are not accessible to people in Australia, it is difficult to
substantiate these research findings. Further, the apps in thisstudy were not physically downloaded and reviewed
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individually, meaning limited conclusions can be drawn
regarding the content, purpose, and media within the apps.
The objectives of this study were to (1) review the social anxiety
apps in the two most popular Australian mobile app stores (ie,Apple App Store and Google Play Store); (2) report the content,
technical properties, and descriptive features of the apps,
including their platforms, purpose, and media; (3) evaluate
psychoeducational app quality using the Mobile App Rating
Scale (MARS) [23]; and (4) recommend the use of any quality,
evidence-based apps to others who may benefit in thecommunity.

What This Paper Adds
This paper makes a significant contribution to the limited
academic literature and informs potential end users, mobile app
developers, mental health clinicians, and academics about thecontent and quality of psychoeducational social anxiety apps.
To our knowledge, this is the first peer-reviewed study to report
the quality evaluation findings of commercial psychoeducationalsocial anxiety apps. We are also the first to publish findings
regarding the purposes, mobile platforms, and media of social
anxiety apps available for download from Australian app stores.
Our study uses an existing methodological framework previously
used by New Zealand [22] and Australian [24] researchers toassess the quality of psychoeducational social anxiety apps
available in Australia. Our research findings could inform
mobile app developers of ways to improve the design, features,and content of social anxiety apps and avoid potential
technological problems before development begins. Empiricallyinformed, high-quality apps could then lead to enhanced user
engagement, knowledge about social anxiety, increased
help-seeking behavior, earlier treatment, and improved mental
health.

Methods
Overview
The systematic app search and evaluation described in this paper
focused on readily available commercial psychoeducational

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Hammond et alsocial anxiety mobile apps in Australia for smartphones andtablet devices. Therefore, apps were excluded if they were only
accessible to specific organizations or clinical research
participants; for example, an app in the United States, which is
the only app we identified to be clinically proven to reducesocial anxiety [25], was excluded because it was only accessible
to study participants in that country during the randomized
controlled trial.

DesignOverview
This systematic stepwise app search and evaluation was
informed by the methodology of 2 studies: one investigatedcommercial social anxiety apps in New Zealand, and the otherevaluated the quality of medication adherence apps in Australia[22,24]. The app search and selection strategy in our study was
guided by the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) [26].
The key steps in our study involved (1) systematically searching
for, identifying, and selecting psychoeducational social anxiety
apps in the Australian Apple App Store and Google Play Store;(2) downloading, using, and reviewing relevant apps; (3)reporting technical and descriptive information available in theapp stores, an online app warehouse, and individual apps; (4)evaluating app quality using the MARS [23]; and (5) deciding
whether to recommend apps to end users. Data were managed
using Microsoft Excel spreadsheets (Version 16.27 for Mac).
Searches across all categories in the app stores occurred between
August 13 and 25, 2019. Depending on the operating system
required for app compatibility, apps were downloaded to an
Apple iPad (iOS version 12.3.1, sixth Generation MR7F2X/A)
or Samsung Galaxy tablet (Android version 4.4.4, SM-T560).
At that time, the most recent software packages were installed
for these devices before apps were downloaded and installed.
The four steps of the app search, review, and selection process,outlined in Figure 1, included app identification, screening,exclusion, and inclusion.

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Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart: app search, review, and selection process.

Step 1: App Identification
TEH conducted 3 separate keyword searches in 2 app stores forapp names and descriptions containing the keywords social
anxiety, social phobia, and shyness, which yielded 6 keyword
groups. The exact app names and version numbers identified(if available) for each of the 6 search groups are listed in
Multimedia Appendix 1. The app operating systems, keywords
searched, and dates of data extraction have been provided.
Owing to character limits of app names in the Apple App Store,
the full names of 34 iOS apps were identified by web searchusing partial app names and other identifying information
provided in the stores. English app names were then sorted
alphabetically (numbers and special characters [eg, # and %]excluded), and then app names in all languages were comparedand counted for each group.

Step 2: App Screening
Data from all groups in Multimedia Appendix 1 were integrated
into Multimedia Appendix 2. Columns were added to identify
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then sorted alphabetically across the 2 app stores. Excel
conditional formatting highlighted duplicate app names, whichwere subsequently reviewed. App names, versions, anddevelopers were considered in determining duplicates. The
number of duplicates and unique apps was added up for eachapp store and overall.

Step 3: App Exclusion
Individual app names, descriptions, languages, purposes,
intended audiences, screenshots, and relevant videos in the appstores were reviewed. Exclusion categories were developed
based on the World Health Organization’s definition of health[27] and the American Psychiatric Association’s key SAD
diagnostic criteria [1], outlined earlier in this paper. According
to the World Health Organization, “health is a state of complete
physical, mental and social well-being and not merely theabsence of disease or infirmity” [27]. Therefore, apps were
excluded if they did not have an English name or description;
were completely unrelated to health; did not have a specificfocus on social anxiety but focused more generally on healthand wellness, mental health, physical health, or social health;
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or if they were intended for personal entertainment. The number
of apps excluded for these reasons was counted in each app
store and added up overall. The reasons for exclusion for theapps reviewed during step 3 are provided in Multimedia
Appendix 2.

Step 4: App Inclusion
The remaining apps were reviewed by viewing app store
websites and an app clearing warehouse website, specifically,
app images, detailed descriptions, and related commentaries.
Psychoeducational apps and apps targeting social anxiety are
identified in Multimedia Appendix 2. The apps evaluated using
the MARS [23] are listed in Multimedia Appendix 3, including
their names, version numbers (if available), platforms, andassociated websites.

Collection of App Technical and Descriptive
Information
The App Classification section of the MARS [23] was completed
for each mobile app evaluated. Although most information was
obtained from the app stores and individual apps, some
information was collected by searching various app stores andan app warehouse website. Additional information was collected
for each app and is available in Multimedia Appendix 2,
including the purpose (eg, multipurpose, self-assessment,
supportive resources, or therapeutic treatment) and media type(eg, text and audio, text and visual, or text only).

Evaluating Apps Using the MARSThe MARS [23] consists of an app quality rating scale (sections
A-D), an app subjective quality scale (section E), and an
app-specific scale (section F). The app quality rating scaleassesses various dimensions of app quality, including
engagement (section A), functionality (section B), esthetics(section C), and information (section D). The 19 items of thescale were rated on a 5-point scale from inadequate to excellent.
Sections A to D have an internal consistency of α=.90 and aninterrater reliability intraclass correlation coefficient of 0.79.
The app subjective quality scale has 4 items with different rating
scales that assess whether one would recommend apps to others,
how many times apps may be used for a 12-month period,
whether one would pay for apps, and overall star ratings. The
app-specific scale has 6 items that assess the perceived impact
of apps on the user’s awareness, knowledge, attitudes, intention
to change, help-seeking behaviors, and actual behavior change.
However, given that the interrater reliability has not been
determined for the app subjective quality scale and theapp-specific scale, the initial quality assessment of apps in ourstudy was predominantly based on the app quality rating scale.
Apps were also assessed using the app subjective quality scale
to supplement the findings and provide app developers withadditional useful information in developing innovative social
anxiety apps. The app-specific scale was not used in our study
because the items were out of scope; it would be better suited
to assess the perceptions of people with social anxiety (ie, howsocial anxiety apps could impact their knowledge, attitudes, andbehaviors).

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Hammond et al
Two raters (TEH and SP) with knowledge regarding mobile
apps, backgrounds in mental health, and training in using the
MARS independently evaluated 12 psychoeducational social
anxiety apps. This involved using each app for at least 15
minutes, reviewing information about the apps in the app stores,
and then completing both the app quality rating scale and theapp subjective quality scale. After evaluating all apps, TEH and
SP discussed their individual ratings for the individual apps,
particularly ratings that were substantially different (ie, 2 ormore points different on the rating scales). This consultation
stage ensured that key aspects of the apps and different opinions
were considered before finalizing app ratings. Individual appscores of TEH and SP for the app quality rating scale and theapp subjective quality scale were manually entered into separate
Excel spreadsheets. Scores were averaged overall for eachdimension of the app quality rating scale and items of the app
subjective quality scale.

Results
App Technical and Descriptive Information
A total of 1043 apps were identified in the mobile app stores,of which 12 (1.15%) psychoeducational social anxiety apps
were included for evaluation (Apple App Store=301 apps, 3
included for evaluation; Google Play Store=742 apps, 9 included
for evaluation). Figure 1 presents the PRISMA flowchart for
progress through the selection process and demonstrates why
only 12 apps were downloaded and evaluated using the MARS.
The updated version numbers and exact production dates wereavailable for 11 apps. Most were updated between 2016 and2018. The earliest app was first released in 2011. The mostrecently updated apps in 2018 and 2019 were downloaded fromthe Google Play Store. The apps in the Apple App Store were
updated during 2016 and 2017.
At the time of download, all apps were affiliated withcommercial developers, as opposed to not-for-profit
organizations. Only 5 were rated by app users (1 was rated by
an Apple app user; 4 were rated by Android users), which had
an overall mean rating of 4.2 out of 5 stars (SD 0.7). Most apps(n=9) targeted all age groups; however, 3 targeted adolescentsand adults. In total, 9 apps were free to download. An app in
the Apple App Store was priced at US $3.32 (Aus $4.49). The
prices of the 2 other apps in the Google Play Store were US$2.95 (Aus $3.99) and US $3.69 (Aus $5.00).
All 12 apps were psychoeducational; however, their intended
purposes differed. Five apps were for multiple purposes, 1 wasfor self-assessment, 3 contained supportive resources, and 3
had a therapeutic aim.
Similarly, the media of each app differed markedly. Of the 12
apps evaluated, 25% (3) were text and audio, 42% (5) were text
and visual, and 33% (4) were text only. All apps contained
advertisements for various products and services. App technicaland descriptive information, including content focus, theoreticalbackground, and therapeutic strategies, are listed in Multimedia
Appendix 4.

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Shyness (Iaks Solutions). Individual and mean app quality
ratings for each item in sections A to D are provided in
Multimedia Appendix 5. The mean quality ratings of the apps
are presented in Table 1.

App Quality Evaluation
MARS App Quality Rating Subscale (Sections A-D)
The top 5 ranked apps using the MARS included 3 Apple apps
and 2 Android apps. From highest to lowest quality, they
included Beat Social Phobia with Andrew Johnson, Social
Anxiety Test (Mood Tools), Social Anxiety Test (Eddie Liu),
Social Anxiety Test-Psychological Test and How to Overcome

The measures of central tendency (mean, median, and mode)and dispersion (SD and range) of overall app quality and thefour app dimensions are presented in Table 2.

Table 1. Mean app quality ratings (including the 4 dimensions of engagement, functionality, esthetics, and information)a.

a

App name

Operating system

Quality

Engagement

Functionality

Esthetics

Information

Beat Social Phobia with Andrew Johnson

iOS

4.10

4.40

4.50

3.67

3.83

Social Anxiety Test (Mood Tools)

Android

4.07

3.20

4.75

4.33

4.00

Social Anxiety Test (Eddie Liu)

iOS

3.94

3.00

4.50

4.00

4.25

Social Anxiety Test - Psychological Test

iOS

3.56

2.70

4.00

4.17

3.38

How To Overcome Shyness (Iaks Solutions)

Android

3.54

3.10

4.38

3.33

3.33

Beat Social Phobia

Android

3.33

3.60

3.88

2.83

3.00

Social Anxiety Disorder (Afradad Media)

Android

3.25

2.00

3.88

3.83

3.30

Social Anxiety Hypnosis

Android

3.10

2.20

4.13

2.33

3.75

How To Overcome Shyness (The Almighty Dollar) Android

3.09

2.40

3.63

3.33

3.00

How To Overcome Shyness (Dierre09)

Android

2.75

1.90

4.00

2.50

2.60

Social Anxiety Disorder (Bedieman)Android

2.69

1.70

3.63

2.17

3.25

Recognize Social Anxiety Disorder

Android

2.49

1.60

3.63

2.50

2.25

Developer names are in parentheses for apps that share the same name.

Table 2. Measures of central tendency and dispersion of aggregate app quality ratings (including the four dimensions of engagement, functionality,
esthetics, and information).

a

Variable

Quality

Engagement

Functionality

Esthetics

Information

Value, mean (SD)3.33 (0.54)

2.65 (0.84)

4.07 (0.38)

3.25 (0.76)

3.33 (0.58)

Value, median (range)

3.29 (4.10-2.49)

2.55 (4.40-1.60)

4.00 (4.75-3.63)

3.33 (4.33-2.17)

3.32 (4.25-2.25)

Value, mode

N/Aa

N/A

3.63

2.50 and 3.33b

3.00

N/A: not applicable.

bBimodal.

Regarding the central tendency measures for the apps, thequality ratings were mean 3.33 (SD 0.54) and median 3.29;
there was no mode. These ratings showed that the quality of theapps according to the MARS was acceptable. The measures ofdispersion demonstrated the similarity between app quality inAustralian app stores. The highest-ranked app had a quality
score of 4.10 and the lowest-ranked app had a score of 2.49
(range 1.61).
These results indicated that the strongest determinant of higher
quality social anxiety apps was their functionality, as evidenced
by a mean rating of 4.07 (SD 0.38). Specifically, most apps
scored positively for performance, ease of use, and responsive
taps, swipes, and scrolls (gestural design). Most components
and functions of the top 5 social anxiety apps functioned

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correctly. These apps were relatively easy to use because of
their clear labels, icons, and instructions.
Poorer app quality ratings were recorded for end user
engagement, specifically for entertainment, customization, andinteractivity. These results suggest that commercial
psychoeducational social anxiety apps are not particularly fun
to use. None of the apps evaluated in our review usedgamification to entertain end users. Furthermore, most of theseapps do not allow users to customize settings and preferences
for app features, such as sound, content, and notifications.

MARS App Subjective Quality Subscale (Section E)
The mean subjective quality app ratings in Tables 3 and 4 aresimilar to the mean app quality ratings in Tables 1 and 2.

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Table 3. Mean subjective quality ratings of the appsa.
App name

Operating system

Subjective

Recommendation

12-month
usage

PaymentStar
ratingqualityaBeat Social Phobia with Andrew Johnson

iOS

3.88

4.00

3.50

4.00

4.00

Social Anxiety Test (Eddie Liu)

iOS

3.50

4.00

3.50

3.00

3.50

Social Anxiety Test (Mood Tools)

Android

3.50

4.00

3.50

3.00

3.50

Social Anxiety Hypnosis

Android

3.38

3.50

3.50

3.00

3.50

How To Overcome Shyness (Iaks Solutions)

Android

2.75

3.00

3.00

2.00

3.00

Beat Social Phobia

Android

2.50

3.00

3.00

1.00

3.00

Social Anxiety Disorder (Afradad Media)

Android

2.25

2.50

2.50

1.00

3.00

How To Overcome Shyness (The Almighty Dollar)

Android

2.13

2.50

2.50

1.00

2.50

Social Anxiety Disorder (Bedieman)Android

2.00

2.50

2.00

1.00

2.50

Recognize Social Anxiety Disorder

Android

1.50

1.50

1.50

1.00

2.00

Social Anxiety Test - Psychological Test

iOS

1.50

2.00

1.50

1.00

1.50

How To Overcome Shyness (Dierre09)

Android

1.38

1.50

1.50

1.00

1.50

Developer names are in parentheses for apps that share the same name.

Table 4. Measures of central tendency and dispersion for app aggregate subjective quality ratings.

aVariable

Subjective quality

Recommendation

12-month usage

Payment

Star rating

Value, mean (SD)2.52 (0.88)

2.83 (0.91)

2.63 (0.83)

1.83 (1.11)

2.79 (0.81)

Value, median (range)

2.38 (3.88-1.38)

2.75 (4.00-1.50)

2.75 (3.50-1.50)

1.00 (4.00-1.00)

3.00 (4.00-1.50)

Value, mode

1.50 and 3.50a

2.50 and 4.00a

3.50

1.00

3.00 and 3.50a

Bimodal.

The app subjective quality ratings for section E of the MARS
are available in Multimedia Appendix 6.

Discussion

Of the top 5 apps, 4 (identified in Table 1) were rated moderately
in terms of app subjective quality. From the highest- to thelowest-ranked app, they included Beat Social Phobia withAndrew Johnson, Social Anxiety Test (Eddie Liu), Social Anxiety
Test (Mood Tools), Social Anxiety Hypnosis, and How toOvercome Shyness (Iaks Solutions). The mean app subjective
quality of the 12 apps was 2.52 (SD 0.88), the median was 2.38,
and there were 2 modes (1.50 and 3.50). These measures ofcentral tendency showed that most of the apps’ subjective quality
ratings were similar and centered around the mean. The
measures of dispersion, including the range of 2.50 (3.88-1.38),
showed little variability between the subjective quality scores.

Overview

The app subjective quality ratings showed that independent
raters (TEH and SP) would consider recommending 50% (6/12)of the psychoeducational apps to others, based on their personal
experiences (mean 2.83, SD 0.91). However, none of the apps
would definitely be recommended, and given that this measure
has not been tested for validity and consistency, we cannot
professionally recommend that others use the apps. Raters (TEHand SP) would consider using 50% (6/12) of these apps oncein a 12-month period if they were relevant to their needs andwants (mean 2.63, SD 0.83). However, raters typically did notwant to pay for the apps (mean 1.83, SD 1.11). Most appsreceived a star rating of at least 3 out of 5 (mean 2.79, SD 0.81).
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In our discussion, we outline the principal research results,
considering our research objectives, which were to review thepsychoeducational social anxiety mobile apps in the AustralianApple App Store and Google Play Store; describe the apps, theirplatforms, purpose, and media; evaluate the apps using the
MARS [23]; and recommend the use of any quality
evidence-based apps to others. We describe the problems
encountered when researching psychoeducational social anxiety
apps and challenge commercial app developers to enhanceexisting apps and design new apps that meet users’ needs andwants. App development opportunities include enhancing theefficiency of locating social anxiety apps in app stores,
improving international access to apps, and decreasing
app-device incompatibilities. Further, we discuss descriptive
and technical considerations for psychoeducational social
anxiety apps, the lack of empirical evidence, and some potential
limitations of mobile app reviews.

Principal Findings
There was a large number of apps available in the app stores,
and they varied in quality. It is of interest that on the MARS[23], the range of scores between the top 5 and lowest quality
apps was greater for the app subjective quality scale (section
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E) than the app quality rating scale (sections A-D). Considering
all MARS ratings in our study, the 3 highest quality apps were
Beat Social Phobia with Andrew Johnson, Social Anxiety Test
(Mood Tools), and Social Anxiety Test (Eddie Liu).
The difference in app ratings between the 2 subscales of the
MARS could be attributable to scale design and the type andnumber of questions in each subscale. For example, the app
subjective quality scale consists of 4 items, each with different
rating scales. Averaging scores across these 4 items makes itchallenging to interpret the results. The app quality rating scale
has a higher level of face validity because it taps into a wider
range of app dimensions, as opposed to only user preferences
and potential future actions.
However, there is more to consider when evaluating apps thanfeatures and content. For instance, none of the social anxiety
apps evaluated in this study appear to have been designed basedon empirical evidence, and none have been evaluated todetermine clinical effectiveness. App end users should provide
constructive feedback to developers by contacting them directly(eg, by locating their contact details in the app stores), providing
star ratings, and writing informative and honest reviews in theapp stores. Similarly, app developers should work
collaboratively with potential end users and clinical populations
to identify and best meet their needs and desires.

Challenges for Commercial Social Anxiety App
Developers
Our results highlighted the challenges in locating good-quality
psychoeducational apps focused specifically on social anxiety
in Australian mobile app stores. The initial search of the Google
Play Store and Apple App Store revealed 1043 app names, basedon keywords in app names and descriptions selected for theirapparent relevance to social anxiety, thus representing the typeof keywords consumers might use. However, the hit rate (truepositives) for psychoeducational social anxiety apps was only
1.15% (12/1043). This poor hit rate is consistent with a reviewof 1154 apps in the New Zealand mobile app stores, which
identified 13 psychoeducational social anxiety apps [22] witha hit rate of 1.13%. As the proportion of misses (false positives)
exceeds 98% in both studies, the keywords in social anxiety
app names and descriptions need to be improved. Unlike
researchers and app developers, other app users do not typicallyhave the time and patience to run systematic searches forrelevant apps and often do not have knowledge regarding how
to identify all relevant apps in the app stores.
Access to commercial psychoeducational social anxiety apps
is limited because of end users’ geographic locations. On thebasis of the findings of the New Zealand review [22], only 2 of
the 12 apps in our research were available in June 2016 in the
New Zealand Google Play Store and iTunes Store (potentiallydifferent versions). It is noteworthy that in Australia, we wereunable to download apps from the New Zealand Google PlayStore and Apple App Store. The social anxiety apps identified
by our New Zealand colleagues include Social Anxiety Hypnosis
and Beat Social Phobia with Andrew Johnson. Developers,
legislators, and intellectual property regulators should consider
opening up web-based markets to increase access to apps. Thisisparticularly
importantforwell-conceptualized
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psychoeducational social anxiety apps. For example, Challenger,
which was developed at Stockholm University, is only available
in Sweden’s Apple App Store [19].
Psychoeducational social anxiety apps are less common forApple iPhones and iPads than for Android smartphones andtablets. In our study, only 25% (3/12) of the apps could be used
on iOS devices, compared with 75% (9/12) of the apps forAndroid devices. Only 2 apps were available for both Apple
and Android devices, namely, Beat Social Phobia and Social
Anxiety Test. This has created an additional barrier for people
with Apple devices to access psychoeducational social anxiety
apps. Although the Android software for apps was relatively
current at the time of review, iOS software for the Apple apps
was updated 3 years before the review. Considering potential
app-device incompatibility problems, people may have difficultyin downloading and accessing apps on newer, recently updated
iPhones and iPads. However, given that 9 of the apps were free
and the other 3 were reasonably priced, according to ourstandards, it is unlikely that there are financial barriers to accessthe apps.

Descriptive and Technical Considerations
The technical properties and descriptive content of thepsychoeducational social anxiety apps, including their platforms,
purposes, and media, have been described in the Results sectionof this paper. However, we believe it is important to highlightthe need for empirically informed apps and reliable app quality
assessment tools.
The apps reviewed in our study were intended to be
psychoeducational; however, most contained outdated
information about social anxiety and did not appear to be
informed by empirical research evidence. Similar to earlier
findings [22], there is no evidence that social anxiety apps inAustralian app stores were developed by reputable not-for-profit
institutions. All apps evaluated in our research were developedby commercial, for-profit organizations and contained
advertising to promote often unrelated products and services.
Although advertising may be included in mobile apps forfinancial gain, it may also be necessary to cover the costs ofdeveloping and maintaining apps, as app development can be
expensive, and funding is limited. Further, the social anxiety
apps contained insufficient information to confirm whether thecontent was based on expert knowledge and experience.
Challenger is the only publicly available, empirically-based
psychoeducational social anxiety app we identified in ourliterature review [19]. On the basis of the authors’ descriptionof Challenger’s features and technical specifications, we could
not identify any social anxiety apps in Australian app stores ofcomparable quality. Raters TEH and SP were unable to evaluate
the quality of Challenger using the MARS because the app was
not available for download from the Australian app stores.
Although the clinical effectiveness of Challenger in managing
social anxiety has not been evaluated, it is the first commercial
social anxiety app that uses gamification, goal setting, and CBTto engage end users. App developers should consider
Challenger’s technical and descriptive features, particularly
when conceptualizing new evidence-based and empiricallyevaluated apps.
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The completion rate, validity, and reliability of app store reviewsin terms of determining app quality are questionable. Only
41.7% (5/12) of the social anxiety apps evaluated in our researchwere reviewed and rated by Apple App or Google Play Storeapp users. The moderated reviews in the app stores allow users
to provide star ratings and post comments about the apps.
However, only 2 of the 5 apps rated to be the highest in quality
in our study (out of the 12 apps) received high-quality app store
ratings in the app stores. For example, the average MARS app
quality ratings in our study for Beat Social Phobia with Andrew
Johnson (mean 4.10) and Social Anxiety Test (Mood Tools)(mean 4.07) were similar to the Apple App Store and Google
Play Store, with ratings of 5 and 4.5 stars, respectively. As theseapps have been available in the Australian app stores for several
years and have been downloaded more than 10,000 times, we
expected more than a few dozen reviews. Further, most app
store reviews consisted only of star ratings rather than ratingsand comments; therefore, it was not possible to verify
quantitative ratings with qualitative data.
One potential explanation for these varied findings could be thedifferent backgrounds (socioeconomic, cultural, and linguistic),
perceptions, and expectations of Australian app users. Although
the app raters TEH and SP are highly experienced in using
mobile health apps and work in mental health settings, othersin the Australian community may not be as objective and could
find it difficult to provide detailed feedback when reviewing
mobile apps. Furthermore, unlike the mobile app stores whichallow app users to provide general written feedback, the itemsin the MARS allow raters to focus on specific aspects of apps,
thereby allowing for more rigorous evaluation. Another potential
reason for the varied quality ratings between the app stores andthe MARS could be that raters (TEH and SP) reviewed all
psychoeducational social anxiety apps in the two most popular
Australian app stores. People in the community may be more
selective in providing positive feedback for apps if they are
more engaged app users (people who are disengaged may simply
delete the app). It is also possible that the small number of
web-based app reviews could be related to commercial
developers wanting to positively market their apps to increase
downloads and, therefore, advertising revenue. However, it isimportant to note that this comment is based on anecdotal
feedback from app users and the professional experiences of
the app raters (TEH and SP).

Strengths and Limitations
This is the first peer-reviewed systematic app review in whicha published search strategy [26] was used to identify commercial
social anxiety mobile apps in Australia. To the best of ourknowledge, no other study has evaluated the quality ofcommercial social anxiety apps using a validated assessment
inventory. The MARS is a suitable and useful tool for the
purpose of quality assessment of social anxiety apps. However,mobile app raters need to have a good understanding of theterminology of the MARS items and substantial experience inusing apps. The findings in our study would be very useful forthe public in identifying suitable social anxiety apps and fordevelopers in designing high-quality apps that are engaging,
functional, esthetically pleasing, and contain appropriate
information.
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Hammond et al
As our study involved reviewing the two most popular app
stores in Australia, we believe that most of thepsychoeducational social anxiety apps in Australia have beenreviewed. However, the Apple App Store and Google Play Store
have limited search parameters, making it challenging to identify
relevant apps using keywords alone. Although our researchfindings are relevant to international app developers, they may
only be directly transferrable to smartphone and tablet apps
available in those app stores. We also acknowledge that otherpsychoeducational social anxiety apps are available, such as
Microsoft, Amazon, Aptoide, F-Droid, and AppBrain apps.

Conclusions and Future Recommendations
The psychoeducational social anxiety apps available fordownload from the Australian Apple App Store and Google
Play Store are of acceptable quality, either free or inexpensive
to access, and contain some useful features and content that
may assist people experiencing social anxiety or those whoknow someone with social anxiety. However, these apps appear
to contain substantial amounts of outdated and nonempiricalinformation, which is concerning given there is no evidence tosuggest that they are practically useful in managing social
anxiety. These apps could potentially cause harm to end users
by indirectly or directly encouraging people to self-diagnose
psychiatric disorders using web-based inventories (which weredeveloped more than 20 years ago) and make personal decisions
based on anecdotal evidence and untested treatment options.
Further work should focus on the development of tailored apps
to meet the needs and desires of end users through researchers
and app developers working collaboratively with mental healthprofessionals, people with social anxiety, and people who know
others with social anxiety. Information gleaned from co-design
workshops, interviews, focus groups, web-based panels, andevidence-based information from peer-reviewed academic
research could lead to the development of app prototypes thatare high in quality; contain best practice strategies to managesocial anxiety; and designed with suitable data collection,
security, and sharing capabilities. Data collection options tobetter understand social anxiety could include (1) optimizing
validated screening tools (eg, questionnaires and inventories)
by considering internet and social media use, (2) mental healthtracking systems to allow for efficacy testing, and (3) qualitative
data collection tools to understand end users’ experiences, forexample, personal diaries and open-ended questionnaires.
Furthermore, it is time consuming to locate all the potential
psychoeducational social anxiety apps in popular app stores,
which could potentially increase stress and anxiety for those
who are trying to find the right app for their circumstances. App
developers could enhance the ease of locating apps byincorporating keywords more specific to social anxiety in app
descriptions and names and avoiding broad keywords thatencompass mental health problems more generally.
Finally, app compatibility can be enhanced across several mobile
app platforms (not just iOS and Android devices). App
developers could consider designing hybrid apps to be used
across different devices and operating systems or separate
versions of the same native app to be downloaded to devices
with specific operating systems.
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Hammond et al

Acknowledgments
Funding for JMIR’s Article Processing Fee (APF) US $2,500.00 (AUD $3,453.11) was provided to TEH to publish this paper
from a combination of the following three funding sources: (1) JMIR Karma Credits US $171.00 (AUD $236.19), JMIR Publications
Inc, 2021; (2) GO Scholarship US $1,809.96 (AUD $2,500), GO Foundation, 2020; and (3) Alan Duncan Memorial Grant US$519.04 (AUD $716.92), New South Wales (NSW) Education Council, 2020. We thank each of those organizations for supporting
the publication of our valuable research. The authors also acknowledge The University of Sydney Nepean Clinical School and
NSW Health for providing in-kind access to electronic resources, including library databases and computer hardware. The authors
thank the collaborators at Western Sydney University and the University of Newcastle, who provided guidance for the app searchmethodology.

Authors' Contributions
TEH reviewed the published literature and social anxiety apps in mobile app stores, collected and analyzed the data, and wrote
the vast majority of this paper. TEH and SP evaluated the quality of commercial psychoeducational social anxiety mobile apps.
SP, LL, AC, and VB provided feedback and comments regarding the manuscript before the publication of this paper.

Conflicts of Interest
None declared.

Multimedia Appendix 1
Apps searched by keyword, device, and app store.
[XLSX File (Microsoft Excel File), 52 KB-Multimedia Appendix 1]

Multimedia Appendix 2
App list per app store and exclusion reasons.
[XLSX File (Microsoft Excel File), 95 KB-Multimedia Appendix 2]

Multimedia Appendix 3
Psychoeducational social anxiety apps evaluated.
[DOCX File , 17 KB-Multimedia Appendix 3]

Multimedia Appendix 4
App technical and descriptive information.
[DOCX File , 32 KB-Multimedia Appendix 4]

Multimedia Appendix 5
Quality ratings (sections A-D) aggregate and individual raters.
[XLSX File (Microsoft Excel File), 3142 KB-Multimedia Appendix 5]

Multimedia Appendix 6
Subjective ratings (section E): aggregate and individual raters.
[XLSX File (Microsoft Excel File), 19 KB-Multimedia Appendix 6]

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Abbreviations
CBT: cognitive behavioral therapy
MARS: Mobile App Rating Scale
NSMHWB: National Survey of Mental Health and Wellbeing
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
SAD: social anxiety disorder

Edited by L Buis; submitted 18.12.20; peer-reviewed by H Alyami, O El-Gayar, M Hamidzadeh; comments to author 24.03.21; revised
version received 17.06.21; accepted 25.06.21; published 21.09.21
Please cite as:
Hammond TE, Lampe L, Campbell A, Perisic S, Brakoulias V
Psychoeducational Social Anxiety Mobile Apps: Systematic Search in App Stores, Content Analysis, and Evaluation
JMIR Mhealth Uhealth 2021;9(9):e26603
URL: https://mhealth.jmir.org/2021/9/e26603
doi: 10.2196/26603
PMID:©Trent Ernest Hammond, Lisa Lampe, Andrew Campbell, Steve Perisic, Vlasios Brakoulias. Originally published in JMIR
mHealth and uHealth (https://mhealth.jmir.org), 21.09.2021. This is an open-access article distributed under the terms of theCreative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution,and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited.
The complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyrightand license information must be included.

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