Online talking therapy approved for use in England

Nine online talking therapy treatments for anxiety or depression have been approved by the National Institute for Health and Care Excellence (NICE).

Anxiety is one of the most common mental health problems, and is the focus of this year’s Mental Health Awareness Week. One out of every six people in England say they experience a common mental-health problem such as anxiety or depression in any given week.

In 2021-22, more than half a million people were referred to Talking Therapies (previously known as Improving Access to Psychological Therapies, or IAPT) for problems such as body-dysmorphic disorder, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder and a variety of phobias.

The new digital therapies will be based on cognitive-behavioural therapy (CBT), a widely used treatment for common mental illnesses. They will be delivered via a website or an app, which NICE says will offer a more convenient way of accessing support for some people. They could also free up resources and help reduce the wait for care.

The therapies were approved using NICE”s early value assessment process, which provides rapid recommendations on promising health technologies that have the potential to address national unmet need. NICE assessed the early evidence on these technologies to decide if earlier patient and system access in the NHS is appropriate while further evidence is generated.

The new NICE guidance recommends six digital therapies to treat adults with anxiety disorders and three to treat those with depression, including Beating the Blues, Deprexis and Space from Anxiety.

Therapy must be the ‘right one’ for the individual

Before treatment starts, the individual will have a formal assessment with a trained clinician or practitioner but after that, there will be much less face-to-face interaction with the therapist. For the depression therapy, the patient will have 90 minutes with a therapist rather than the usual eight hours, and for anxiety, the patient will have four hours with the therapist rather than the typical 10 hours.

Mark Chapman, NICE’s interim director of medical technology and digital evaluation, said: “One of our priorities is to get the best care to people fast while at the same time ensuring value for money for the taxpayer – these digitally enabled therapies do both.”  The choice of therapy “must be the right one for the individual,” he added.

Dr David Rigby, who jointly chairs the Royal College of Psychiatrists’ digital group, said digital therapies could make it easier for some vulnerable patients to access vital mental-health support but were not a long-term solution.

“Mental health services are struggling with chronic staff shortages which are making it difficult for them to provide patients with quick and effective treatment,” he said.

“The government must tackle the workforce crisis by honouring its commitment to publish a comprehensive NHS workforce plan this year.”

Marjorie Wallace, who founded the mental health charity SANE, said that digital therapy “may be very useful for some” but was “no substitute for a one-to-one relationship with someone who knows their story”.

“Our experience with those who contact us is that self-diagnosis and techniques of self-management do not always reach the layers of their inner mental pain and can leave them feeling even more unsafe and alone,” she said.

While some of the digital therapies are already in use, others require further approvals before they can be rolled out. NICE will evaluate the evidence from their use over the next few years to work out how cost-effective they are.