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Cognitive and Behavioral Practice xxx (2021) xxx–xxx

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Digital Mental Health Interventions for Child

and Adolescent Anxiety
Muniya S. Khanna, The OCD & Anxiety Institute
Matthew Carper, Brown University

Anxiety disorders are the most common mental health conditions in children, with approximately 13% of kids struggling
with excessive anxiety. The vast majority do not have access to effective treatments and there continues to be a disjunction
between treatments that are empirically supported and those that are available in the community. Digital mental health
interventions (DMHI) can increase efficiency, reach, and standardization as well as reduce costs of providing of mental
health care. Here we review the extant research on DMHI, including web- or cloud-based programs, mobile applications
(apps), virtual reality (VR), and digital assessment methods such as ecological momentary assessment (EMA) for the deliv-
ery and/or support of evidence-based care in child anxiety. Preliminary research is promising for these tools to improve
access and efficiency of evidence-based practice. However, ethics and practice guidelines are needed and questions remain
regarding what level and quality of therapeutic involvement is needed to maximize treatment completion and outcomes in
youth and whether DMHIs are contraindicated for certain populations or whether they are similarly effective with those
with comorbid conditions is unclear.

A NXIETY disorders affect up to 13% of the child pop-

ulation (Costello et al., 2005; Ghandour et al.,
2018; Merikangas et al., 2010), making it the most com-
mon psychiatric diagnosis across development, surpass-
ing behavior problems and mood and substance use
disorders. Lifetime prevalence rates for any anxiety dis-
order in children and adolescents in the U.S. is
reported to be almost 32% (Merikangas et al., 2010).
According to the latest epidemiological reports, this
rate is steadily increasing (Bitsko et al., 2018). Over
the last decade, anxiety has overtaken depression as
the most common reason college students seek coun-
seling services. Anxiety causes substantial impairment
in school, family relationships, and social functioning
(Bitsko et al., 2018; Costello et al., 2005; Kendall
et al., 2010). Left untreated, anxiety problems are asso-
ciated with future anxiety disorders, depression, and
substance use problems in adulthood (Beesdo et al.,
2009). However, when anxiety in youth is treated effec-
tively, there can be benefits in reducing subsequent
sequelae (Benjamin et al., 2013).
Keywords: child and adolescent; anxiety; digital mental health
tools; CBT
Evidence supports the efficacy of cognitive-
behavioral therapy (CBT) for anxiety in youth (for
review see James et al., 2018; Weisz, 2010; for illustra-
tive studies see Kendall et al., 2008, and Walkup
et al., 2008), but the vast majority do not have access
to effective treatments and there continues to be a dis-
junction between treatments that are empirically sup-
ported and those that are available/provided in the
community (Merikangas et al., 2011). A widely
endorsed goal is to broaden the range of treatment
delivery models (delivery formats) to bridge the gap
between empirically supported treatments and the ser-
vices typically provided (Beidas et al., 2012; Kazdin &
Blase, 2011). Digital mental health interventions
(DMHI), including internet-based cognitive behavioral
therapy (iCBT), may provide opportunities to reach
many individuals in need of mental health care in a
potentially efficient, cost-effective, and nonstigmatizing
way. DMHI and tools have several practical advantages:
1. Cost: services provided via internet can reduce cost
over conventional face-to-face treatment for patients
and health systems.

1077-7229/20/Ó 2021 Association for Behavioral and Cognitive

Therapies. Published by Elsevier Ltd. All rights reserved.

Please cite this article as: Khanna and Carper, Digital Mental Health Interventions for Child and Adolescent Anxiety, https://doi.org/10.1016/j.
cbpra.2021.05.003
2 Khanna & Carper
2. Availability: computers with internet access and
mobile devices can be available in multiple settings
(e.g., schools, community agencies, hospitals,
homes).
3. Access: online access offers anonymity and privacy,
reducing barriers that may otherwise deter a patient
from pursuing treatment.
4. Treatment integrity: digital interventions can pro-
vide standardized therapy components such as psy-
choeducation, progressive muscle relaxation, and
standardized therapy materials (e.g., role-play activi-
ties), homework assignments, and knowledge
checks.
5. Personalized treatment: while maintaining treat-
ment components in the preferred sequence,
internet-based programs can be customized for each
patient (e.g., modify instructions based on client
responses).
6. Rehearsal: a digital format can facilitate review of
material as needed.
7. Data gathering: a digital format also increases effi-
ciency and reduces cost of record keeping and data
collection. Using internet-based programs, user-
input can be automatically recorded, stored in
secured databases, and monitored regularly.
A variety of approaches exist for intervening with
anxious youth that incorporate digital technology into
the treatment process. In the following section we
review five of the more common categories of DMHI
for youth, including web- or cloud-based programs,
mobile technologies, virtual reality, assessment meth-
ods such as ecological momentary assessment (EMA)
and passive sensors, and stand-alone versus clinician-
assisted programs.
Web- and Cloud-Based Programs
Given the large proportion of youth and parents in
the U.S. who have access to the internet (Pew Research
Center, 2015a, 2015b), treatment developers have
made a variety of digital resources available online.
These resources include parent training interventions
(e.g., Khanna et al., 2017), full intervention packages
(e.g., Khanna & Kendall, 2010; Spence et al., 2011;
Tillfors et al., 2011), and preventative interventions
(e.g., Attwood et al., 2012). A relatively recent system-
atic review concluded that online interventions and
prevention programs are effective for youth anxiety
and depressive symptoms (Clarke et al., 2015). The
authors of this review also concluded that some face-
to-face or web-based support was an important feature
with regards to retention and outcomes.
Randomized clinical trials (RCTs) have also pro-
vided support for web-based interventions for youth
anxiety (Pennant et al., 2015; Podina et al., 2016;
Rooksby et al., 2015). For example, an RCT comparing
online versus clinic delivery of CBT for adolescent anx-
iety found that both the online and clinic delivery for-
mats performed better than a waitlist control, with 78%
of adolescents in the online condition no longer meet-
ing criteria for their primary anxiety disorder at post-
treatment (Spence et al., 2011). These gains were
maintained at both 6- and 12-month follow-up assess-
ments. Additionally, there were no significant differ-
ences in outcomes between the online and clinic
delivery formats.
Web-based programs have also been extended to
primary care settings to improve access to psychologi-
cal treatment. In one study that took place in New Zeal-
and, an online therapist-assisted CBT program was
implemented in primary care settings following a natu-
ral disaster. A large number of families enrolled in the
study and approximately half of those enrolled com-
pleted 4 sessions. Results revealed that youth who com-
pleted more sessions had lower anxiety at their last
session, with most of the improvement occurring early
in treatment (Moor et al., 2019).
Web-based parent interventions for youth anxiety
also exist and have been shown to be helpful at increas-
ing parent knowledge of how to parent anxious youth.
One study examining a web-based parent training pro-
gram (WPT), Child Anxiety Tales, as compared to a
bibliotherapy (BIB) and waitlist control (WLC) condi-
tion found that parent knowledge increased for partic-
ipants in the WPT and BIB conditions, but not for
those in the WLC condition (Khanna et al., 2017). This
study also showed decreases in parent ratings of their
child’s anxiety on one outcome measure, but not the
other, potentially pointing to parents being better able
to identify anxiety symptoms as their knowledge of par-
enting anxious kids increases. However, further
research is needed with clinical populations before
conclusions regarding its efficacy can be drawn.
Mobile Technologies
As smartphone use continues to grow among youth
and adolescents, app developers are teaming up with
researchers to develop a variety of mobile health
(mHealth) interventions for mental health concerns,
including anxiety disorders. These apps vary in their
functionality, with some apps being used as adjuncts
to treatment (e.g., monitoring of homework compli-
ance), others providing in-the-moment intervention
when triggered by various prompts, and others func-
tioning as fully stand-alone treatment packages. Many
apps for youth mental health have not received empir-
ical support, but several have been tested in research
studies (for review, see Bry et al., 2018).
 Digital Mental Health Interventions for Child and Adolescent Anxiety
Anxiety Coach (Mayo Clinic, 2018) is one app that has
received some empirical support in recent years. This
app provides assessments of anxious symptoms, psychoe-
ducational material related to anxiety and exposure-
based treatment, and a useful guide for designing and
executing exposures in one’s own environment (for
review, see Carper, 2017). Anxiety coach has been tested
in several research studies as an adjunct to treatment and
has demonstrated preliminary effectiveness (Whiteside,
2016; Whiteside et al., 2014).
The SmartCAT is another mobile app that has been
developed for youth anxiety and is used as an adjunct
to treatment (Pramana et al., 2014). SmartCAT is an
ecological momentary intervention that reinforces
skills learned in session in patient’s natural environ-
ments. The app also has a clinician portal that allows
bidirectional communication between patient and
therapist. Preliminary support for the effectiveness of
SmartCAT comes from several studies, including an
open trial that showed youth used the app an average
of 5.8 minutes per day and 86% of youth no longer
met diagnostic criteria for an anxiety disorder at 2-
month follow-up (Silk et al., 2020).
Virtual Reality
Over the last decade, technology continues to advance
to the point where virtual reality devices are becoming
more and more ubiquitous. Given that some anxiety tar-
gets are difficult to target directly with in vivo exposures
in many outpatient settings (e.g., public speaking), vir-
tual reality (VR) has been explored as a way to facilitate
exposure and increase adherence to exposure-based
treatments. VR environments can be created to simulate
just about any anxiety-provoking situation. For example,
clinicians in private practice may not have access to live
spiders (for treating spider phobias), crowds willing to lis-
ten to a youth practice a speech (for public speaking
fears), or other exposure-relevant stimuli. Research with
young adults has found that VR environments lead to a
comparable biological stress response (i.e., heart rate
variability and saliva cortisol) as real-world environments
in public speaking exposures (Kothgassner et al., 2016),
highlighting their potential to aid in exposure-based
treatments. Research with adults also has found a high
preference (76% of sample) for VR exposures relative
to in vivo exposures, and that the refusal rate for
in vivo exposures (27%) was much higher than it was
for VR exposures (3%), suggesting VR may be used to
facilitate exposure in patients who would otherwise not
participate in exposure-based treatments (Garcia-
Palacios et al., 2007).
Several programs exist and are in development using
VR to facilitate treatment of youth anxiety (Albano et al.,
2018). One study using VR to treat childhood social anx-
3
iety disorder (SAD) revealed that VR programs were
acceptable, feasible, and credible treatment components,
with both parents and youth indicating it was a high-
quality program and that they would recommend it to
a friend (Sarver et al., 2014). Another small study used
VR environments to reduce specific phobias in youth
with autism spectrum disorder (ASD) and found that
89% of participants were able to face their phobic stimuli
following treatment and approximately half of the sam-
ple completely overcame their phobia at posttreatment
(Maskey et al., 2014).
Assessment Methods
The potential impact of technology on mental
health spans both intervention and assessment. Ecolog-
ical momentary assessment (EMA; Shiffman et al.,
2008) methods have been used for some time to collect
data in patients’ real-world contexts. EMA methods are
being extended to smartphones, allowing for the
remote uploading of data, prompts triggered by passive
data collection, etc. (Estrin & Sim, 2010; Kendall et al.,
2015; Luxton et al., 2011; Mohr et al., 2017). One par-
ticular advantage of EMA methods is that they reduce
retrospective recall bias associated with self-report
questionnaires (Piasecki et al., 2007; Solhan et al.,
2009), increasing measurement precision. Indeed,
EMA methods have been used to examine the process
of change in CBT for youth anxiety (e.g., Silk et al.,
2011; Tan et al., 2012), shedding light on important
aspects of the therapeutic process that may have been
missed with less frequent measurement intervals.
This technology becomes more advanced at a stag-
gering rate. In the mid-20th century, Gordon Moore
published a paper where he argued that the number
of transistors in a dense integrated circuit doubles
every 2 years (Moore, 1965). This was later generalized
to the rate of improvement of all technology and ter-
med “Moore’s Law,” which states that processing speed
(and other markers) advance at a rate of two times
every 2 years. As EMA technologies improve, it will
become easier to collect psychophysiological measures
of psychological constructs and map these more objec-
tive reported measurement strategies onto self-
reported data. For example, researchers could exam-
ine concordance between psychophysiological markers
of habituation and self-reported SUDS ratings. As these
passive data collection methods become more accu-
rate, they can also be incorporated into digital inter-
vention packages where specific interventions are
triggered by changes in psychophysiological arousal
or other data being collected passively.
Smartphone and other device sensors have already
allowed for some passive collection of a variety of psy-
chophysiological data from youth. To address these
4 Khanna & Carper
emerging technologies, the Food and Drug Adminis-
tration has created a digital health action plan to facil-
itate innovation in the area of digital health (U.S. Food
and Drug Administration, 2018). Use of passive data
collection strategies invites inquiry into a variety of sci-
entific topics that were previously much more difficult
to answer. However, as researchers’ use of passive data
collection strategies increases, it will become increas-
ingly important for policymakers to develop regula-
tions around the privacy of these data and for
researchers to have in-depth conversations about the
risks of data breaches with potential participants. As
will be discussed later in the section on future direc-
tions, these passive sensors and other technology-
based assessment measures can be used to trigger inter-
ventions in the moment.
Stand-Alone Versus Clinician-Assisted
A review of the types of digital mental health inter-
ventions for youth anxiety would not be complete with-
out a brief discussion of differences between stand-
alone and clinician-assisted technology packages. The
specific technologies reviewed above can be provided
both with and without therapist support. Given that
youth are often not intrinsically motivated to engage
in exposure therapy and therapeutic work early in tra-
ditional CBT for youth anxiety is focused on facilitating
“buy in” from youth, there is a notion that therapist
support is a necessary aspect of any DMHI (see
Kendall et al., 2015). In their meta-analysis of online
youth mental health prevention interventions, Clarke
et al. (2015) found that while it is difficult to draw
strong conclusions about the type or intensity of guid-
ance and support necessary due to variation in method-
ologies and quality of existing studies, there is evidence
that patient support (either face-to-face or web-based)
improves program completion and program outcomes.
Another meta-analysis concluded that youth benefited
more from minimal therapist involvement than from
significant therapist involvement (Podina et al.,
2016), suggesting there may be more flexibility in
how involved therapists should be than was previously
thought. Future research is certainly needed to deter-
mine optimal levels of therapist support that maximize
therapeutic benefits while minimizing costs and clini-
cian time.
Limitations of DMHI
Like their strengths, the limitations of different
DMHIs for anxiety vary. Though research supports
the potential for these interventions to bring
evidence-based treatments to a broader range of anx-
ious youth and their families without compromising
treatment fidelity or efficacy, it has also raised numer-
ous questions about when and how this category of
interventions can be safely, ethically, and effectively
employed in concert with various other treatment
modalities. Potential challenges include concerns
about privacy, client safety, reimbursement, treatment
integrity as well as the development, or dearth, of ther-
apeutic alliance in computer/internet-assisted treat-
ments. Moreover, when, where, and for whom DMHIs
may be indicated or counterindicated requires clarifi-
cation. The opportunities for offering psychological
interventions through computers and/or over the
internet are developing more rapidly than the legal,
ethical, and regulatory standards required to guide
their use (Van Allen & Roberts, 2011).
The possibility of privacy and security breaches, in
particular, could be a concern. Though a dialogue
about how to manage threats to confidentiality and pri-
vacy through encryption techniques has begun, a con-
sensus has yet to be reached regarding how
computerized interventions can be best integrated
and supported in the current mental health care sys-
tem (Kramer et al., 2013; Schwartz & Lonborg, 2011;
Yuen et al., 2012). As such, the continued development
of regulatory, ethical, financial and legal standards per-
tinent to the delivery of technologically enhanced psy-
chological treatments will be critical to the widespread
adoption of these treatments (Comer & Barlow, 2014).
In the meantime, various professional associations
have provided guidelines with several common themes,
among them the importance and provision of
informed client consent, the necessity of data encryp-
tion and secure password use and the education of
patients at large about the ranging quality of mental
health information and interventions on the internet
(Proudfoot et al., 2011). To these ends, the World
Health Organization has established an international
e-health code of ethics to guide practitioners employ-
ing electronically enhanced methods, and the Euro-
pean Union has established an international
initiative, MedCERTAIN, designed to educate the pub-
lic, evaluate health care sites as well as guide and
encourage website providers to adhere to the World
Health Organization’s e-health ethics code.
Given the newness of DMHIs, researchers suggest
that informed consent should include an in-depth
description of the therapy structure and process, its for-
mat, potential risks, benefits and safeguards, and the
limits of confidentiality, including those incurred by
simply conducting treatment via the internet
(Proudfoot et al., 2011). Informed consent must also
include a discussion of legal requirements, information
about the clinician and clarification of how records will
be collected, stored and protected. Further, given that
these computerized treatments aim to deliver treat-
 Digital Mental Health Interventions for Child and Adolescent Anxiety
ment to families in unconventional, potentially unsu-
pervised settings, such as the home, guidelines for
appropriate patient monitoring, risk screening (e.g.,
suicidality), handling of clinical emergencies, coordi-
nation with local collaborators, and navigation of state
and federal regulations and licensure requirements
will be key.
Whether DMHIs increase or decrease the integrity
of evidence-based treatments can be debated. Though
greater treatment integrity may be facilitated simply by
the standardized nature of computerized programs rel-
ative to face-to-face interventions, poor client adher-
ence in DMHIs may be a significant limitation to
ensuring that youth receive treatment as intended
(Kendall et al., 2011; Richardson et al., 2010). This crit-
icism appears particularly applicable in the case of
computer-based interventions, where dropout rates
have been over 60% in some studies (Cunningham
et al., 2009; March et al., 2009). No matter how faith-
fully information may be delivered via a computer-
program, the integrity of a treatment will likely be com-
promised if treatment is incomplete or cursorily
accomplished. Another challenge to treatment integ-
rity in computer-based programs is the lack of live
opportunities for exposure tasks, though exposure is
considered an essential element of CBT approaches
(Kendall et al., 2011). Therapist flexibility, an impor-
tant component to personalizing and maintaining cli-
ent engagement in CBT treatments (“flexibility
within fidelity”; Kendall et al., 2008), may also be less
in the case of computer-assisted versus face-to-face
CBT programs (Khanna & Kendall, 2010). In sum,
though DMHIs promise an enhanced ability to dissem-
inate standardized treatment materials and protocols
to the community and have been associated with
increased integrity relative to conventional CBT in
some studies, the novelty of this technological medium
may also pose challenges to therapist flexibility, treat-
ment adherence and completion, and particularly the
modeling, guidance, and, in some cases, accomplish-
ment of exposures. These challenges appear accentu-
ated in DMHIs and may make an argument for
computer/internet-assisted approaches for clients
who are likely to drop out of treatment or participate
in a sporadic, limited fashion.
Other challenges that will face the broad dissemina-
tion, implementation, and effectiveness of computer-
ized interventions include the great variety of
providers and clients that these programs are designed
to serve. Children with anxiety disorders are currently
served by a diverse mental health network, comprised
of providers with a broad range of educational back-
grounds as well as variable experiences and receptive-
ness to DMHIs and other evidence-based practices
5
(Ellis et al., 2009). This diversity is only likely to
increase as technology broadens the reach of
evidence-based practice to more remote, often
neglected patient populations (e.g., American Indians,
Alaska Natives, inhabitants of rural Appalachia). With
this variety will come a growing need to provide flexi-
ble, sensitive, and culturally appropriate care within
the context of computerized interventions, a potential
challenge (see Brooks et al., 2013). Many studies have
not included data on participant ethnicities, thus it is
unclear to what extent programs should be tailored
to different cultural or ethnic groups (Richardson
et al., 2010).
Finally, it will be important to consider how DMHIs
may best be presented to current mental health practi-
tioners, payers, and families to ensure their widespread
support and adoption. Notably, there remains a
marked research-to-practice gap between efficacy trials
and study and understanding of how to promote treat-
ments acceptance and implementation in the commu-
nity. Considering how, why, and at what rate
innovations such as computerized interventions may
spread through social and extant mental health net-
works will be critical to ensure that the potential public
health benefits of these treatments are realized
(Dingfelder & Mandell, 2011; Hill et al., 2018). Despite
much progress in the study of DMHIs for adults, one
study suggests that adult practitioners are more likely
to recommend bibliotherapy than computerized inter-
ventions, a trend that may, for the time being, also
appear when considering the dissemination of these
treatments for children (Proudfoot et al., 2011).
Recommendations for Future Research
and Development
The development and use of DMHIs for youth anx-
iety is still in its nascency and much work remains to be
done before DMHIs become a standard part of clini-
cians’ “tool kit.” This is likely due in part to the gap that
exists between research and practice (Westfall et al.,
2007) but is also likely due to a variety of other factors.
Empirical reviews of apps for mental health have noted
that the vast majority do not have much, if any,
research support (Bry et al., 2018).
Several avenues for future research and develop-
ment of DMHIs exist. These include dissemination
and implementation efforts aimed at getting DMHIs
used in the community, harnessing emerging tech-
nologies (e.g., passive sensors, context-triggered assess-
ment and intervention, etc.) and improving
regulations around the use of DMHIs (see Myers
et al., 2008; Myers et al., 2017), and developing part-
nerships with industry to facilitate the ongoing devel-
6 Khanna & Carper
opment and maintenance of DMHIs (see Carper et al.,
2013, and Hill et al., 2018).
Despite support for the efficacy of DMHIs in research
settings and the over 2000 apps that exist and are mar-
keted for anxiety (Chan et al., 2014), these interventions
are rarely used by practicing clinicians, highlighting the
need in the field for a better understanding of factors
that facilitate and/or impede successful implementation
and longer-term sustainability outcomes. The fact that
national surveys have found that more than half of Amer-
icans have downloaded an app related to their health
(Krebs & Duncan, 2015) makes the lack of use in prac-
tice settings particularly problematic.
Gaining an understanding of how to get apps and
other DMHIs that we know are efficacious used in prac-
tice settings remains one of the highest priorities for
future research.
There is great promise for the utilization of DMHIs
in treating child anxiety disorders, but much still to
confirm and clarify regarding the optimal use of these
technologies for the diverse range of youth and provi-
ders they are designed to assist. Computerized treat-
ments merit large-scale, well-controlled trials with
active control groups such as conventional CBTs in
community settings. Such work will be critical to deter-
mining whether or not there is empirical support for
these treatments and therein to establishing their effi-
cacy and effectiveness.
The lack of well-controlled data on DMHI for child
anxiety as arguably contributed to the difficulty in
developing programs that are scalable and sustainable
beyond academic evaluation and that can ultimately
be adopted by health care providers. In an effort to
move the field forward, a group of international
experts in child and adolescent anxiety and DMHI con-
vened for a 3-day workshop that was funded following a
peer-reviewed process at the Lorentz Centre at the
University of Leiden, The Netherlands in October
2017 (#iCBTLorentz Workshop Group). The group
published a consensus statement and recommenda-
tions for the development, evaluation, engagement,
and dissemination of DMHIs for anxiety in children
and adolescents (Hill et al., 2018). Regarding evalua-
tion standards, they recommend “that any new psycho-
logical treatment program, whether iCBT or face-to-
face, should be evaluated via the gold standard (RCT).”
The group made special note of the inherent conflict
of interest that exist in DMHI research and develop-
ment efforts and encourage researchers to both clearly
acknowledge any conflicts and ensure independent
data collection and analysis many different parties are
involved in the development of iCBT, including acade-
mia, industry, CYP, parents, clinicians, funding agen-
cies, and policymakers. When evaluating the
effectiveness of iCBT programs, these different parties
may have different interests in the results and a poten-
tial risk of bias arises in reporting on the results. They
recommend that research groups take measures to
minimize the risk of bias in reporting including prereg-
istration of the effectiveness trial, involving an indepen-
dent statistician to conduct the statistical analyses, and
if feasible, to install an independent data and safety
monitoring board.
RCTs will be needed to determine when and for
whom these treatments may be indicated. Questions
also remain regarding what level and quality of thera-
peutic involvement is needed to maximize treatment
completion and outcomes in youth. Further, whether
DMHIs are counterindicated for any populations or
diagnostic presentations is unclear.
Up to 83% of youth with anxiety disorders may pre-
sent with a second psychological disorder (Cummings
et al., 2014; Kendall et al., 2010; Verduin & Kendall,
2003). Anxiety disorders are commonly comorbid with
depressive disorders (Kaufman & Charney, 2000), aut-
ism spectrum disorders (Kerns & Kendall, 2012), atten-
tion deficit-hyperactivity disorder (Pliszka, 2000),
disruptive or oppositional behavior (Lehmkuhl et al.,
2009) and, in adolescents and young adults, substance
abuse (Deas & Brown, 2006). Whether outcomes from
DMHIs for child anxiety are diminished by these
comorbid presentations, or whether anxiety treatment
has a spillover and beneficial effect on these condi-
tions, also requires further study.
Finally, it will become increasingly important to
develop strong ethical and legal regulations around
the practice of mental health in the digital age. Several
states have already begun to adopt guidelines for allow-
ing clinicians from other states to practice across state
lines if they are providing tele-mental health services.
However, there remains a lack of regulation around
apps for mental health, which is concerning given
the sheer number of apps for mental health that are
on the market now. Whether this regulatory work is
done by state licensing boards, national professional
organizations (i.e., APA), or both remains to be seen.
Information and communication technologies are
ever rapidly evolving, altering the social landscape
and also the avenues by which mental health interven-
tions may reach and improve the lives of youth and
their families. A challenge for researchers and service
providers will be to keep up with the alacrity of these
innovations and communicate their availability to
patients and providers (Carper et al., 2013).
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Address correspondence to Muniya S. Khanna, Ph.D., OCD
& Anxiety Institute, 706 S. Bryn Mawr Ave., Bryn Mawr, PA 19010.
e-mail: muniya.khanna@gmail.com.
Received: December 22, 2020
Accepted: May 6, 2021
Available online xxxx