A consultation has begun on the decision to conditionally recommend the digital enabled therapies which address depression and anxiety disorders, including PTSD and body dysmorphia. Each of the digital technologies includes the support and involvement of an NHS Talking Therapies clinician and use CBT techniques.
The eight therapies are conditionally recommended while further evidence is generated. They are the 6th and 7th early value assessments to have been undertaken using a new NICE rapid assessment process that seeks to identify promising medical technology for rapid deployment into the NHS.
Combined, the therapies have the potential to help more than 40,000 people.
One in six people report experiencing a common mental health problem such as anxiety and depression in any given week in England, according to NHS Digital and there is high demand for NHS talking therapies with some people currently waiting up to 6 weeks to access help.
These digitally enabled therapies, some of which are already in use, are conditionally recommended for use following a formal assessment with an NHS Talking Therapies therapist, as they may not be the right choice for everyone.
Mark Chapman, interim director of medical technology and digital evaluation, at NICE, said: “Our rapid assessment of these eight technologies has shown they have promise.
“Developed using tried and tested CBT methods, each one has demonstrated it has the potential to provide effective treatment to the many thousands of people who live with these conditions.
“We want these new treatment options to be available for people to use as quickly as possible and we also want to make sure they are clinically effective and represent good value for the NHS. The additional evidence collected during this period will help us do that.
“We also want to hear what people involved in this area think – both clinicians and the people who will be using these digital technologies. We know CBT can work well for many people and we know that digitally enabled technology can help the NHS get support to people faster.”
Digital therapies offer an alternative way for people to access help in a way that may be more suited to their personal needs by offering flexibility around both time and location of treatment.
The medical technology advisory committee heard from clinical and patient experts as part of their consideration of the evidence for the eight technologies. The evidence included the positive impact of CBT on these conditions and how these technologies can improve access.
Elizabeth Mullenger, lay specialist member on the NICE committees, said: “Digital technology could transform the experience of people living with mental illnesses. It can be incredibly isolating to be on a long waiting list for in-person treatment. You might know that help is coming, you just don’t know when.
“Having access to a digital therapy could help prevent this lonely feeling. Sometimes people need support most in the middle of the night, or after a busy day at work, and it’s hard to know where to turn. Having access to digital therapy, can give people the help they need, when they need it.
“These technologies will allow us to be in charge of our treatment, gaining a sense of autonomy as we navigate our own journey towards positive mental health.”
Professor Dame Til Wykes, specialist committee member and head of the School of Mental Health and Psychological Sciences at King’s College London, said: “Digital therapies may offer welcome additional help for people with a diagnosis of anxiety or depression. They may help enough to reduce the need for face-to-face contact be that in person or virtually. But we don’t know enough about who will improve and who will need extra help.
“I am pleased that these interventions will be offered with therapist supervision to identify any additional support early and importantly that patients will have a choice of whether to use them or not.”
Professor Stephen Pilling, specialist committee member and head of the clinical, educational and health psychology department at University College London, said: "I am pleased to welcome the committee's recommendation on the digital therapies for adults with an anxiety disorder or depression. These interventions can make a major contribution to increasing access to and choice of evidence-based psychological interventions as set out in NICE guidelines. Their implementation in the NHS Talking Therapies for Anxiety and Depression service, with its excellent routine outcome monitoring programme, means that it will be possible to further assess their benefits in routine practice before their clinical and cost effectiveness can be fully evaluated by NICE using this real-world evidence collected by the NHS."
Six technologies were conditionally recommended for helping adults with anxiety disorders.
For body dysmorphic disorder (BDD):
- Perspectives with support provided by a high intensity therapist trained in treating BDD.
For generalised anxiety symptoms or unspecified anxiety disorder:
- Beating the Blues and Space from Anxiety (SilverCloud) with support provided by a psychological wellbeing practitioner or high intensity therapist.
For post-traumatic stress disorder (PTSD):
- iCT-PTSD and Spring with support from a high intensity therapist trained in treating PTSD.
For social anxiety disorder:
- iCT-SAD with support provided by a high intensity therapist who is trained in treating social anxiety disorder.
For depression, the committee conditionally recommended the use of three online CBT programmes Beating the Blues, Deprexis, and Space from Depression (Silvercloud) as treatment options.
Digitally enabled therapies in NHS Talking Therapies services must be delivered with practitioner or therapist support including regular monitoring and management of patient safety and progress.
The committee believes the use of these technologies could lead to more people with mental health conditions being seen in NHS Talking Therapies services as digitally enabled therapies may need less practitioner or therapist time for delivery than other psychological interventions.
The technologies must achieve regulatory approval prior to their NHS use. This will include Digital Technology Assessment Criteria (DTAC) conformity approval from NHS England, CE or UKCA marking and compliance with the NHS Talking Therapies digitally enabled therapies (DET) assessment criteria
A consultation has now begun on both sets of recommendations. Comments can be submitted via nice.org.uk until Wednesday 15 March 2023.