1 Recommendations


Five digitally enabled therapies can be used as treatment options for adults with anxiety disorders while further evidence is generated on their clinical and cost effectiveness, once they have appropriate approval.

The following technologies can only be used once they have Digital Technology Assessment Criteria (DTAC) approval and an NHS Talking Therapies for anxiety and depression digitally enabled therapies assessment from NHS England:

  • iCT‑PTSD (OxCADAT) for post-traumatic stress disorder (PTSD)

  • iCT‑SAD (OxCADAT) for social anxiety disorder

  • Space from Anxiety (SilverCloud) for generalised anxiety symptoms or unspecified anxiety disorder.

    The following technologies can only be used once they have CE or UK Conformity Assessed (UKCA) mark approval, DTAC approval and an NHS Talking Therapies for anxiety and depression digitally enabled therapies assessment:

  • Perspectives (Koa Health) for body dysmorphic disorder (BDD)

  • Spring (Cardiff University) for PTSD.

    Low intensity interventions should be supported by a psychological wellbeing practitioner and high intensity interventions by a high intensity therapist in NHS Talking Therapies for anxiety and depression services.


Further evidence should be generated on:

  • rates of recovery

  • rates of reliable recovery

  • rates of reliable improvement

  • rates of reliable deterioration

  • rates and reasons for stopping treatment

  • rates of relapse

  • adverse effects and stepping up of care

  • patient experience

  • health-related quality of life

  • resource use during and after treatment, including the average number of treatment sessions and level of guidance provided (defined by healthcare professional grade and time)

  • baseline data including the demographics and symptom severity of the people using the technology and their risk classification.

    Find out more in the evidence generation section of this guidance.


The following technologies should only be used as part of a research study that has been approved by an ethics committee, once they have appropriate regulatory approval:

  • Cerina (NoSuffering), Iona Mind (Iona Mind), Minddistrict (Minddistrict), Resony (RCube Health) and Wysa (Wysa) for generalised anxiety disorder (GAD) or generalised anxiety symptoms

  • Cerina, Minddistrict and Space from OCD (SilverCloud) for obsessive compulsive disorder (OCD)

  • Minddistrict and SilverCloud programmes for health anxiety, panic disorder with or without agoraphobia, social anxiety disorder and phobias.

    Find out more in the research only recommendations section of this guidance.

Potential benefits of early value assessment

  • Access: Digitally enabled therapies offer another treatment option for adults with anxiety disorders. They will particularly benefit anyone who needs more flexible access to treatment or who prefers digitally enabled therapy over face-to-face therapy.

  • Clinical benefit: The clinical evidence suggests that digitally enabled therapies may reduce symptoms of anxiety in the anxiety disorders they were designed to treat. They may help people to better manage their anxiety, and their treatment choices, which could increase their autonomy and empowerment.

  • Resources: Digitally enabled therapies may need less practitioner or therapist time for delivery than other psychological interventions in NHS Talking Therapies for anxiety and depression (formerly Improving Access to Psychological Therapies or IAPT) services. This could free up resources that could be allocated elsewhere in the services to increase access or reduce waiting times. There is preliminary evidence that suggests digitally enabled therapies may be cost effective compared with standard care.

Managing the risk of early value assessment

  • Clinical assessment: In NHS Talking Therapies for anxiety and depression services, digitally enabled therapies would be offered after assessing and identifying the appropriate problem descriptor in line with ICD-10. Healthcare professionals would also assess the safety of patients and the suitability of these interventions.

  • Clinical support: Digitally enabled therapies in NHS Talking Therapies for anxiety and depression services must be delivered with practitioner or therapist support including monitoring and managing the safety of patients and their progress. This means that if the treatment is not working and symptoms worsen, it can be identified quickly.

  • Individual choice: Digitally enabled therapies can be offered as a treatment option for adults with anxiety disorders. Some people may choose not to use digitally enabled therapies and may prefer another treatment option such as face-to-face therapy. Everyone has the right to make informed decisions about their care.

  • Equality: Digitally enabled therapies may not be accessible to everyone. Adults with limited access to equipment or an internet connection, or who are less comfortable or skilled at using digital technologies are less likely to benefit and may prefer another treatment option.

  • Costs: Results from the early economic analysis suggest that the technologies could be cost effective based on current prices and evidence. This guidance will be reviewed within 4 years and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.

  • Care pathway: This guidance focuses on using digitally enabled therapies for treating anxiety disorders in adults using NHS Talking Therapies for anxiety and depression services. Digital therapies may be used elsewhere in the NHS care pathway, but this is outside the scope of this assessment.

The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.