NICE-recommended digital therapies in NHS Talking Therapies

1. Introduction

Version followed: NICE HealthTech guidance HTG675 (formerly early value assessment HTE8, Digitally enabled therapies for adults with depression, published 16 May 2023, page last reviewed 14 January 2025) and HTG676 (formerly HTE9, Digitally enabled therapies for adults with anxiety disorders, page last reviewed 12 February 2024), read with the NHS Talking Therapies for anxiety and depression Manual, version 7 (first published June 2018, updated March 2024). Product status checked as of October 2026. Where trial protocols describe support schedules (iCT-PTSD: STOP-PTSD trial, Ehlers et al. 2023; Spring: RAPID trial, Bisson et al.), those are named as such.

This entry is not a single therapy. It is a service model: NICE-assessed, CBT-based online programmes that a client works through on a computer or phone, offered inside NHS Talking Therapies (England) after an assessment, and always with support from a trained psychological wellbeing practitioner (PWP) or high-intensity therapist [source: NICE HTG675 rec 1.1; NICE HTG676 rec 1.1; NICE news article on the 8 technologies]. The programme carries the treatment content; the practitioner carries assessment, choice, encouragement, progress review, safety monitoring and the decision to step up or end [source: NICE HTE8 section 2; HTE9 sections 2.1, 3.3].

The theory of change is that of each programme's underlying CBT model, not of "digital" as such:

• iCT-PTSD is built on Ehlers and Clark's cognitive model of PTSD: it targets threatening appraisals of the trauma and its aftermath, updates trauma memories, trains discrimination of re-experiencing triggers and changes behaviours that keep symptoms going [source: Ehlers et al. 2023, STOP-PTSD; NICE HTE9 PDF].
• iCT-SAD is built on Clark and Wells' cognitive model of social anxiety: psychoeducation, monitoring, video feedback, attention training, behavioural experiments and memory-focused work [source: NICE HTE9 PDF].
• Spring is an 8-step guided self-help programme of core trauma-focused CBT components, described by NICE for PTSD from a single event [source: NICE HTE9 PDF; NCMH Cardiff RAPID page].
• Space from Depression / Space from Anxiety (SilverCloud) combine CBT with, for Space from Anxiety, mindfulness, positive psychology and motivational interviewing elements, delivered as modules with videos, interactive activities and homework [source: NICE HTE9 PDF; NICE HTE8 section 2].
• Perspectives (Koa Health) is a 12-week CBT programme for body dysmorphic disorder with psychoeducation, interactive exercises, CBT skills and symptom tracking, and it signposts emergency services and suicide helplines [source: NICE HTE9 PDF].

For general guided internet CBT practice (programme-agnostic supporter skills, message writing, engagement) see 086 Internet-delivered CBT. The internet trauma-focused CBT part of Domain VI 037 (guided internet trauma-focused CBT) is covered here (iCT-PTSD, Spring); for its virtual-reality exposure part, see 092 Virtual-reality exposure therapy in this doc.

NICE status by product (as of October 2026)

Whether each conditionally recommended product currently holds its DTAC, DET and (for Spring and Perspectives) UKCA/CE approvals, and which services commission it, is not shown on the NICE pages [uncertain: not verified]; check with your service's digital lead before offering. NICE states the guidance will be reviewed if new evidence is likely to change the recommendations [source: NICE HTG675, HTG676 overview pages].

Who delivers and where. Scope is adults, within NHS Talking Therapies; use elsewhere in the care pathway is outside the guidance [source: NICE HTE8 recommendations]. Low-intensity use is supported by a PWP, high-intensity use by a high-intensity therapist [source: NICE HTG676 rec 1.1; HTE9 2.2]. Status outside England (other UK nations, other countries) is not addressed by these pages [uncertain: not verified]. Under-18s: outside scope of the guidance; no NICE position for young people in these documents.

Evidence limits (brief). NICE's anxiety assessment rested on 19 published studies (4 RCTs, 1 comparative observational cohort, 12 single-arm studies, 2 secondary RCT analyses); waiting-list comparators are not standard care; only 2 technologies had comparative data against standard care; few studies reported adverse events; UK and NHS Talking Therapies data, long-term recovery and relapse data, and reasons for stopping are gaps [source: NICE HTE9 PDF, sections 3.11, 3.14, 3.15]. NICE asks services to generate evidence on recovery, reliable improvement and deterioration, drop-out and its reasons, relapse, adverse effects, stepping up, patient experience, quality of life and resource use, including level of guidance by staff grade and time [source: NICE HTE8 rec 1.2; HTG676 rec 1.2]. Stronger trials exist for some products: in STOP-PTSD (217 adults randomised 3:3:1), iCT-PTSD outperformed an internet stress-management programme and a waiting list at 13 weeks, with gains maintained at 65 weeks and drop-out under 10% [source: Ehlers et al. 2023]; in RAPID (196 participants), Spring was non-inferior to face-to-face trauma-focused CBT [source: NCMH Cardiff RAPID page]. Results should not be generalised across products or conditions [source: NICE HTE9 3.11].

2. Framework

The framework below follows the NICE delivery conditions and the Talking Therapies stepped-care model; phase labels are an organising [synthesis] of those sources.

Talking Therapies routine outcome monitoring is session by session, so client and clinician have up-to-date information on progress [source: Talking Therapies Manual v7, section 1.2]. Some programmes administer outcome measures themselves (iCT-PTSD and iCT-SAD administer the Talking Therapies measures and export them to local IT systems) [source: NICE HTE9 PDF].

3. Guiding principles

• Never stand-alone. Every NICE recommendation requires practitioner or therapist support; in practice you do not hand over a log-in and close the case [source: NICE HTG675/HTG676 rec 1.1].
• Assess first, match the product to the problem. Offer only after a formal assessment and an ICD-10 problem descriptor; a PTSD product is not used for depression because it is "available" [source: HTG676 rec 1.1].
• Risk assessment precedes the offer and continues throughout. Safety and progress are monitored for the whole course so that worsening is spotted quickly [source: NICE HTE8 recommendations; HTG676].
• Choice is real. The client can decline; face-to-face therapy remains an option and declining is recorded without penalty [source: NICE HTE8; HTG676; NICE news article].
• Use only what is recommended and approved. Within Talking Therapies, use conditionally recommended products that hold the required approvals; research-only products are used only inside an ethics-approved study [source: HTG675/HTG676 rec 1.3].
• Date-stamp status. Products leave the market (Beating the Blues, Deprexis); recheck NICE and local commissioning before each new offer [source: HTG675, HTG676 update information].
• Digital inclusion. People with limited devices, internet, digital confidence, reading ability, English, vision, hearing or dexterity are less likely to benefit; adapt or offer another route [source: NICE HTE9 3.8–3.9].
• Privacy is part of consent. NICE notes users need reassurance on privacy and security; explain it before sign-up [source: NICE HTE9 3.7].
• Fidelity to the underlying model. Support the programme's own CBT model (e.g. memory updating in iCT-PTSD, dropping safety behaviours in iCT-SAD) rather than substituting unrelated advice [synthesis].
• Guidance is lighter, not absent. Committees judged these therapies may need less practitioner time; the saving comes from shorter contacts, not from skipping reviews [source: NICE HTE9 3.4; NICE news article].
• Measure every contact. Session-by-session outcome data guide decisions and feed the national evidence generation NICE requires [source: Talking Therapies Manual v7, 1.2; HTG676 rec 1.2].
• Adults, Talking Therapies only. These recommendations do not cover under-18s or other parts of the pathway [source: NICE HTE8 recommendations].

4. Intervention inventory

Part A describes how the programmes are delivered, as NICE and the trial reports describe them. Part B gives the practitioner's own interventions. Programme content belongs to the developers and is not reproduced; modules are named only at the level NICE describes them. Example language is illustrative wording, not taken from any programme.

A1. How the programmes are delivered (descriptive)

• Purpose: Know what the client will meet on screen so you can support it accurately.
• Steps (what each product contains, per sources):
  • Space from Depression: online CBT programme, 5 modules (NICE HTE8 section 2).
  • Space from Anxiety: CBT with mindfulness, positive psychology and motivational interviewing elements; informational content, videos, interactive activities and homework (NICE HTE9 PDF).
  • iCT-PTSD: psychoeducation, case examples, monitoring sheets, videos, behavioural experiments and assignments; memory- and meaning-focused techniques; administers Talking Therapies PTSD outcome measures (NICE HTE9 PDF). In STOP-PTSD, support was by in-programme messages, SMS and short weekly calls (about 20 minutes) over 12 weeks, then three monthly booster calls (Ehlers et al. 2023).
  • iCT-SAD: psychoeducation, case examples, monitoring, video feedback, attention training, behavioural experiments, memory-focused techniques; translated into other languages; administers outcome measures (NICE HTE9 PDF).
  • Spring: 8 interactive steps; the user's input shapes the feedback on activities (NICE HTE9 PDF). In RAPID, therapist contact included check-in sessions and phone calls (NCMH Cardiff). Exact number and length of contacts [uncertain: not verified].
  • Perspectives: 12-week CBT programme for BDD with psychoeducation, interactive exercises, CBT skills, symptom tracking and information on local emergency services and suicide helplines (NICE HTE9 PDF).
  • All: some technologies alert the practitioner to concerns; reviews are by messaging and sometimes telephone (NICE HTE9 3.3–3.4).
• Example language (illustrative): "The programme gives you the exercises; I check in each week, read what you've done and help you get the most from it."
• Watch for: Local versions differ from trial versions (contact schedule, booster phase, alerts). Follow your service's DET operating procedure and record which version you use [synthesis].

B1. Assessment and problem-descriptor matching

• Purpose: Ensure the product fits the presenting problem, as NICE requires.
• Steps:
  1. Complete the standard Talking Therapies assessment, including problem descriptor in line with ICD-10 [source: HTG676 rec 1.1].
  2. Identify the main problem (e.g. PTSD from a single event, social anxiety disorder, BDD, depression, generalised or unspecified anxiety).
  3. Check the product's NICE indication: Space from Depression for depression; Space from Anxiety for generalised or unspecified anxiety; iCT-PTSD or Spring for PTSD; iCT-SAD for social anxiety disorder; Perspectives for BDD.
  4. Take baseline measures (see B7) and record severity and functional impairment.
  5. Note comorbidity; NICE flags that people with severe functional impairment or needing more support may need more intensive care [source: HTE9 3.6].
• Example language (illustrative): "From what you've described, the main difficulty looks like social anxiety, so the option that fits is the online cognitive therapy built for that."
• Watch for: Mixed presentations where the "main" problem is unclear; trauma histories with multiple events offered Spring (NICE describes it for a single event); STOP-PTSD excluded psychosis, current substance dependence, current borderline personality disorder and acute serious suicide risk, so evidence for those groups is thin [source: Ehlers et al. 2023].

B2. Risk assessment before the offer

• Purpose: NICE requires risk assessment before offering a digital therapy [source: NICE HTE8 recommendations].
• Steps:
  1. Assess suicidal ideation, intent, plans, self-harm, risk to others and safeguarding, using your service's risk procedure.
  2. Decide whether a supported self-help format is safe given the level of contact it involves.
  3. If risk is raised, agree a safety plan and decide whether digital therapy should wait, run alongside closer contact, or be replaced by another route [synthesis].
  4. Record the decision and the review frequency.
• Example language (illustrative): "Because we'll be in touch less often than in weekly face-to-face sessions, I need to be sure we have a plan for times you feel at your worst."
• Watch for: Clients minimising risk to get quicker access; for BDD, the clinical literature associates the disorder with raised suicide risk [uncertain: not verified in sources consulted], so ask directly.

B3. Suitability and digital-access screen

• Purpose: Avoid offering a format the person cannot use; NICE warns of lower benefit with limited access or skills [source: HTE9 3.8].
• Steps:
  1. Ask about device, data or broadband, private space to use it, and confidence online.
  2. Check reading ability and English; ask about vision, hearing and dexterity needs [source: HTE9 3.9].
  3. Ask whether a shared device or a partner's account could compromise privacy (see B4).
  4. Agree any adaptations (larger text, audio content, more frequent calls) or offer another option [synthesis].
• Example language (illustrative): "Where would you use it, and is that somewhere you can be private for half an hour?"
• Watch for: Reluctant agreement because the waiting list for face-to-face therapy is long; record that the client knows the alternatives [synthesis].

B4. Informed choice, consent and the privacy conversation

• Purpose: NICE states the client may choose and that privacy reassurance is needed [source: HTE8 recommendations; HTE9 3.7].
• Steps:
  1. Describe the option, its support model, how long it runs and what it asks of the client.
  2. Name the alternatives, including face-to-face therapy, and that declining is fine.
  3. Explain who will see what: the supporter reads entries and measures; data are held by the developer under service agreements; check your service's information on storage, retention, research use and access requests [synthesis; the product-specific privacy terms are uncertain: not verified].
  4. Note that products used must hold NHS England DTAC approval, NHS England's digital technology assessment criteria [source: NICE news article; HTG675/676 rec 1.1]. The detailed content of DTAC [uncertain: not verified].
  5. Practical privacy: lock-screen notifications, email or SMS reminders seen by others, shared devices, saving passwords on shared computers [synthesis].
  6. Record consent and the client's choice.
• Example language (illustrative): "Anything you type in the programme I can read, and so can the service; it isn't shared with your employer. Reminders can be switched to show no details."
• Watch for: Clients in controlling or abusive relationships, where a device may be monitored; offer another route or safety-plan around device use [synthesis].

B5. Onboarding and orientation contact

• Purpose: Get the client started and set expectations for the support relationship.
• Steps: [synthesis, aligned with NICE's description of the supporter role]
  1. Help the client register and open the first module, or confirm they have done so.
  2. Explain the programme's structure (number of modules, steps or weeks; see A1).
  3. Agree a weekly use target in the client's own terms (days and times).
  4. Agree the review schedule and channel (messages, calls), how quickly you reply and what to do between reviews.
  5. Give out-of-hours and crisis contacts (see B10).
  6. Name the endpoint and what happens if progress stalls.
• Example language (illustrative): "Let's pick two times a week you'll log in. I'll review on Thursdays and call you every other week."
• Watch for: Clients who never log in after onboarding; an early non-use flag should trigger contact (B8).

B6. Scheduled supporter reviews

• Purpose: The core practitioner task NICE describes: facilitating the intervention, encouraging completion, recommending complementary material, reviewing progress and outcomes [source: NICE HTE8 section 2].
• Steps:
  1. Before contact, look at module completion, entries, homework and the latest measures.
  2. Open with a summary of what the client has done and one specific thing you noticed.
  3. Ask what was useful and what was hard; clarify misunderstandings of the CBT model.
  4. Review measures and risk (B7, B10).
  5. Agree the next module or exercise and one obstacle-plan.
  6. Recommend complementary material within the programme where relevant.
  7. Write a brief message or note confirming the plan.
• Example language (illustrative): "I read your thought record from Tuesday; noticing the 'they think I'm boring' thought was a big step."
• Watch for: Generic messages that do not reference the client's work (associated with drift) [synthesis]; reviews that turn into unstructured counselling and replace the programme; for high-intensity products (iCT-PTSD, iCT-SAD), keep the review anchored to the cognitive model. See 086 for message-writing practice.

B7. Session-by-session outcome monitoring

• Purpose: Talking Therapies monitors outcomes at every session so decisions rest on current data [source: Talking Therapies Manual v7, 1.2].
• Steps:
  1. At each review, collect the service's standard measures: in Talking Therapies these are the PHQ-9 (depression) and GAD-7 (anxiety) plus an anxiety-disorder-specific measure where relevant [synthesis based on standard Talking Therapies practice; the Manual's measures table was not part of the material consulted: uncertain].
  2. For PTSD products, use the PTSD-specific measure your service collects; STOP-PTSD used the PCL-5 [source: Ehlers et al. 2023]. iCT-PTSD and iCT-SAD administer and export Talking Therapies measures themselves [source: NICE HTE9 PDF].
  3. Compare with baseline and last score; look for reliable improvement or deterioration using your service's thresholds.
  4. Look at the depression item on self-harm thoughts in the PHQ-9 and follow up any positive response the same day per service policy [synthesis].
  5. Share the trend with the client.
• Example language (illustrative): "Your anxiety score has come down four weeks running; which parts of the programme do you think are doing that?"
• Watch for: Missing measures at the last contact (which loses outcome data); scores improving while the client avoids the hardest modules; scores rising after starting trauma memory work (expected short-term distress versus deterioration: discuss with supervisor).

B8. Re-engaging after disengagement

• Purpose: NICE notes practitioners may contact clients who stop using the programme [source: HTE9 3.3]; reasons for stopping are a named evidence gap [source: HTG676 rec 1.2].
• Steps:
  1. Set a trigger (e.g. no log-in since last review) [synthesis].
  2. Contact by the agreed channel; ask non-judgementally what got in the way.
  3. Classify the reason: practical (time, device), content (too hard, irrelevant), symptom (low mood, avoidance), preference (wants a person).
  4. Problem-solve, reduce the next task, or offer a change of route.
  5. Record the reason for stopping if the client ends.
• Example language (illustrative): "I noticed you haven't logged in for ten days. That's common; what's been getting in the way?"
• Watch for: Avoidance as a symptom (PTSD, social anxiety, BDD); repeated non-use despite plans, which suggests stepping up or a different format.

B9. Responding to deterioration and stepping up

• Purpose: NICE requires decline to be identified and care stepped up when needed [source: HTE9 3.3]; stepping up is an evidence-generation outcome [source: HTG676 rec 1.2].
• Steps:
  1. Define in advance what counts as deterioration (reliable worsening on measures, new risk, loss of function).
  2. On a trigger, contact the client promptly, reassess risk and discuss the picture.
  3. Take to supervision; decide on more frequent support, a switch to step 3, a different treatment, or referral to secondary care.
  4. Explain the change to the client as a matter of fit, not failure.
  5. Record reason for stepping up.
• Example language (illustrative): "The scores tell me this format isn't giving you enough at the moment. I'd like to move you to working with a therapist directly."
• Watch for: Holding a client in a digital programme to protect waiting-list numbers; delays between flag and contact.

B10. Crisis pathway and safety monitoring during digital treatment

• Purpose: Practitioner support must include monitoring and managing safety [source: NICE HTE8 recommendations]; some products alert practitioners to concerns [source: HTE9 3.3]; Perspectives signposts emergency services and suicide helplines [source: NICE HTE9 PDF].
• Steps:
  1. Know how your product raises alerts (risk items, free-text flags) and who receives them in and out of hours [synthesis; product-specific alert rules uncertain: not verified].
  2. Give the client written crisis contacts at onboarding: service duty line, GP, NHS 111 mental health option, emergency services, and helplines the service uses [synthesis].
  3. Make clear the programme and messages are not monitored in real time.
  4. On an alert, follow your service's same-day risk procedure: contact, assess, safety-plan, escalate.
  5. Review the safety plan at intervals and after any alert.
• Example language (illustrative): "Messages here aren't read at night or weekends. If you feel unsafe, call the numbers on this card rather than writing to me."
• Watch for: Clients disclosing risk in free text and assuming someone has read it; alert fatigue among supporters; lethal-means counselling (safe storage, removal) where risk is present, per standard practice.

B11. Supporting trauma-focused work in iCT-PTSD and Spring

• Purpose: Help the client do memory- and meaning-focused trauma work online safely and fully (covers the internet trauma-focused CBT element referred from Domain VI 037).
• Steps:
  1. Confirm the PTSD diagnosis and the index trauma; for Spring, confirm NICE's single-event description fits [source: HTE9 PDF].
  2. Explain the rationale in the programme's terms: in iCT-PTSD, changing threatening meanings of the trauma, updating the memory with what is known now, spotting and discriminating triggers, and dropping behaviours that keep symptoms going [source: Ehlers et al. 2023].
  3. Before memory work, check grounding and coping, and plan when and where the client will do it (not before driving, not with children present) [synthesis].
  4. In reviews, ask what the client wrote or noticed, which meanings shifted, and which triggers they practised discriminating.
  5. Encourage behavioural experiments and assignments the programme sets; troubleshoot avoidance.
  6. Monitor the PTSD measure each contact; distinguish temporary distress after memory work from sustained deterioration (B9).
  7. In iCT-PTSD, plan the booster phase (three monthly calls in STOP-PTSD) [source: Ehlers et al. 2023].
• Example language (illustrative): "When you read your account back, which moment felt worst? What do you know now about that moment that you didn't then?"
• Watch for: Skipping memory modules; dissociation during work; new safety concerns (e.g. an ongoing threat, which would change the plan). Exposure-type work needs consent and contraindication checks per service protocol. Virtual-reality exposure is outside this entry (see 092 Virtual-reality exposure therapy in this doc).

B12. Supporting iCT-SAD

• Purpose: Support the Clark and Wells components the programme delivers [source: NICE HTE9 PDF].
• Steps:
  1. Help the client grasp the model: self-focused attention and safety behaviours keep social fears going (as described in the programme) [synthesis summarising the model named by NICE].
  2. Encourage video feedback and attention-training tasks and debrief what they showed.
  3. Plan behavioural experiments: prediction, test (e.g. dropping a safety behaviour), outcome, learning.
  4. Review memory-focused work on early socially painful memories as the programme sets it.
  5. Track the social anxiety measure the service uses.
• Example language (illustrative): "What did you predict would happen if you stopped rehearsing sentences? What actually happened?"
• Watch for: The client avoiding the programme's own social tasks (including calls with you); "safe" experiments that keep safety behaviours in place.

B13. Supporting Perspectives for body dysmorphic disorder

• Purpose: Support the 12-week CBT programme for BDD [source: NICE HTE9 PDF]. NICE's comparator for it was individual or group CBT with exposure and response prevention [source: HTE9 2.3].
• Steps:
  1. Confirm the BDD diagnosis and assess risk carefully at baseline and at each review (B2, B10).
  2. Review symptom-tracking data with the client.
  3. Encourage interactive exercises and CBT skills practice; ask about checking, comparing, camouflaging and reassurance seeking as they appear in the client's entries [synthesis].
  4. Ask about cosmetic procedure plans; discuss with supervisor and GP rather than advising [synthesis].
  5. Step up if insight is very poor, functioning is severely impaired or risk rises.
• Example language (illustrative): "Your tracker shows mirror-checking dropped this week; how did you manage that?"
• Watch for: Hidden escalation of checking; requests for reassurance in messages (respond to the process, not the appearance question) [synthesis]; suicidality.

B14. Supporting Space from Depression and Space from Anxiety

• Purpose: Support module completion and skills use for depression, or generalised or unspecified anxiety [source: NICE HTE8 section 2; HTE9 PDF].
• Steps:
  1. Agree which modules come first and why.
  2. At each review, comment on specific entries (activity plans, thought work, worry exercises) and recommend complementary content.
  3. Link homework to the client's goals.
  4. Review PHQ-9 and GAD-7 trends (B7).
• Example language (illustrative): "You did two of the three planned activities; which one shifted your mood most?"
• Watch for: Passive reading without homework; rising PHQ-9 scores or self-harm thoughts.

B15. Collaboration with GP, prescriber and other services

• Purpose: Keep digital treatment joined up with medical care.
• Steps:
  1. Note current psychotropic medication and prescriber (STOP-PTSD required stable medication for at least 1 month [source: Ehlers et al. 2023]).
  2. Pass on side effects, worsening or risk changes to the GP or prescriber; never advise starting, stopping or changing medication [synthesis].
  3. Inform the GP of start, stepping up and discharge per service policy.
• Example language (illustrative): "That's worth talking to your GP about; would you like me to let them know too?"
• Watch for: Clients asking whether to stop medication now they are "doing therapy"; route to the prescriber.

B16. Conversations about non-recommended apps and AI chatbots

• Purpose: Many clients use other apps. NICE lists some (including the AI-based Wysa) for research use only within Talking Therapies [source: HTG675, HTG676 rec 1.3].
• Steps:
  1. Ask neutrally what else the client uses.
  2. Explain that within the service only recommended, approved products are offered, and why.
  3. Discuss any privacy or safety concerns; check the client is not relying on an app for crisis support.
  4. Do not present general-purpose AI as a replacement for therapy [synthesis].
• Example language (illustrative): "Lots of people use apps alongside therapy. Which ones help, and is any one where you'd go if things got really bad?"
• Watch for: Conflicting advice between apps and the programme; crisis disclosures to apps that are never seen by a clinician.

B17. Ending, relapse prevention and boosters

• Purpose: Close well and protect gains; relapse is an evidence-generation outcome [source: HTG676 rec 1.2].
• Steps:
  1. Collect final measures at the last contact.
  2. Review what changed and which skills did it, using the client's own entries.
  3. Write a brief setback plan: early signs, skills to restart, whom to contact, how to re-refer.
  4. Confirm how long the client keeps programme access [uncertain: product-specific, not verified].
  5. Arrange boosters where the programme includes them (iCT-PTSD booster phase in STOP-PTSD).
  6. Discharge letter to GP per service policy.
• Example language (illustrative): "If the nightmares come back, what's the first thing from the programme you'd go back to?"
• Watch for: Ending without final measures; residual symptoms that need a further step.

B18. Recording and contributing to evidence generation

• Purpose: NICE's conditional recommendations depend on routine NHS Talking Therapies data [source: NICE news article; HTG676 rec 1.2].
• Steps:
  1. Record the product, start and end, number of reviews and your time per contact (level of guidance by staff grade and time is a named gap).
  2. Record reasons for stopping, adverse effects, stepping up and relapse.
  3. Ensure measures are exported or entered into the service system.
• Example language (illustrative): "Could you tell me briefly why you've decided to stop? It helps us improve the service."
• Watch for: Unrecorded supporter time; missing ending reasons.

5. Handling problems

NICE names the risks (worsening, stopping, need for more support, access barriers, privacy) but gives few concrete responses; responses below are [synthesis] unless a source is given.

• Stuck client (modules done, scores flat). Review whether the client is doing the active tasks or only reading; pick one core exercise and do it together on a call; if flat after an agreed number of reviews, step up (B9) [synthesis; stepping up per HTE9 3.3].
• Non-adherence and drop-out. Contact on non-use (HTE9 3.3); name avoidance as part of the problem in PTSD, social anxiety and BDD; shrink the next task; agree a fixed time; if still not using, offer another format and record the reason for stopping (HTG676 rec 1.2).
• "I want a real person." Respect the choice; NICE says face-to-face remains available and patients can decline [source: HTE8 recommendations; HTG676]. Offer a switch without making the client "earn" it.
• Overwhelm during trauma memory work. Pause the memory module, revisit grounding and the rationale, break the task into shorter pieces, add a call before the next attempt; if distress persists or dissociation is marked, step up to therapist-delivered trauma-focused therapy.
• Rupture with an unseen supporter. Brief messages can read as cold or critical; repair by acknowledging the impact, switch to a call, and personalise messages (see 086).
• Rising risk. Same-day contact and risk assessment, safety plan, escalate per service policy (B10); do not rely on the programme to manage risk; step up or refer.
• Product becomes unavailable mid-course. As happened when Beating the Blues and Deprexis left the NHS/UK market [source: HTG675, HTG676 update information]: tell clients early, export or record progress, and move them to an equivalent recommended option or practitioner-led treatment without restarting the waiting list where possible.
• Wrong product for the problem. If reassessment shows a different main problem (e.g. depression secondary to PTSD), switch to the matched product or treatment rather than continuing.
• Digital barriers emerge. Offer telephone-supported use, accessibility settings, help from a trusted person, or another route (HTE9 3.8–3.9).
• Privacy worry or breach. Stop and explain again who sees what; report any suspected data incident to your information governance lead; offer a non-digital route.
• Misused messaging (crisis disclosures, out-of-hours expectations). Restate response times and crisis contacts; follow up disclosures by phone.
• Client wants to continue privately with a non-recommended app or AI chatbot instead. Explore reasons, share the status and privacy points neutrally (B16), keep the door open.
• Supporter drift. Supervision should sample messages and check reviews follow the model; for iCT-PTSD and iCT-SAD, supporters need training in the underlying cognitive therapy [synthesis; training requirements uncertain: not verified].
• Evidence gaps affecting decisions. For groups excluded from trials (psychosis, substance dependence, borderline personality disorder, acute suicide risk in STOP-PTSD), decide case by case in supervision and monitor more closely [source for exclusions: Ehlers et al. 2023].

Sources

• NICE HTE8: Recommendations (digitally enabled therapies for adults with depression)
• NICE HTE8: History
• NICE HTE8: 2 The technology
• NICE HTE8: public information PDF
• NICE HTG675: Digitally enabled therapies for adults with depression (overview and update information)
• NICE HTG675: History
• NICE HTG676: Recommendations (digitally enabled therapies for adults with anxiety disorders)
• NICE HTG676: overview and update information
• NICE HTE9: early value assessment PDF (anxiety disorders)
• NICE news: NICE recommends 8 digitally enabled therapies to treat depression and anxiety
• NHS England: NHS Talking Therapies for anxiety and depression Manual, v7 (updated March 2024)
• Ehlers A, Wild J, Warnock-Parkes E, et al., Clark DM (2023). Therapist-assisted online psychological therapies differing in trauma focus for PTSD (STOP-PTSD): a UK-based, single-blind, randomised controlled trial. Lancet Psychiatry 10:608–22 (repository copy)
• National Centre for Mental Health (Cardiff): Online self-help therapy as effective as face-to-face: four-year PTSD trial results (RAPID)
• Bisson JI et al. (2022). RAPID trial of guided internet-based self-help (Spring) versus face-to-face trauma-focused CBT, BMJ 377 [uncertain: full paper not verified; details taken from the NCMH page].
• iCT-SAD trial reports (Clark and colleagues) [uncertain: not verified].