NHS Talking Therapies services provide psychological interventions for adults in England who are struggling with anxiety disorders and/or depression. The services offer a range of NICE recommended talking therapies that are tailored to each individual’s needs. These therapies can be delivered face-to-face, remotely, individually or in groups and are free for patients to access.

Who are NHS Talking Therapies for anxiety and depression services for?

NHS Talking Therapies for anxiety and depression services provide treatment for adults with the following common mental health problems:

• agoraphobia
• body dysmorphic disorder (BDD)
• depression
• generalised anxiety disorder
• health anxiety (hypochondriasis)
• mixed depression and anxiety (the term for sub-syndromal depression and anxiety, rather than both depression and anxiety)
• obsessive-compulsive disorder (OCD)
• panic disorder
• post-traumatic stress disorder (PTSD)
• social anxiety disorder
• specific phobias (such as heights, flying, spiders etc.)

Therapies can also be helpful where these difficulties are linked to a long-term physical health condition, chronic fatigue syndrome (CFS) or irritable bowel syndrome (IBS).

In addition to evidence-based talking therapies for the mental health problems listed above, NHS Talking Therapies for anxiety and depression services also provide employment advice in many areas of England, to support people to reach their employment goals.

What does NHS Talking Therapies for anxiety and depression involve?

All talking therapies involve the patient and therapist, or practitioner, working as a team to understand problems, overcome current difficulties and achieve identified goals. Therapy involves talking, but usually also involves doing practical exercises and tasks both in and outside of sessions. It is an active process, and the therapist or practitioner will regularly check in with the patient to ensure progress.

Talking therapies are provided in different ways, including:

• using a self-help workbook or website with the support of a therapist
• one-to-one in person, over the phone or through video consultation
• in a group

If a patient’s first language is not English, or they use British Sign Language (BSL), they can take part in talking therapies in their chosen language through multi-lingual therapists or confidential translators.

How can people access NHS Talking Therapies for anxiety and depression services?

Details of local NHS Talking Therapies for anxiety and depression services are available on the nhs.uk website: Find an NHS psychological therapies service.

People can refer themselves to NHS Talking Therapies for anxiety and depression services or be referred by a healthcare professional. Services can be accessed through:

• self-referral into every service (find an NHS psychological therapies service – www.nhs.uk)
• referral by a community NHS worker or a voluntary organisation
• referral by a GP or other primary care professional
• referral by an NHS professional in a hospital or specialised clinic (including both mental health and physical health secondary care services)

How are NHS Talking Therapies for anxiety and depression services provided?

Services should offer a choice of in-person or remotely delivered therapies.

Most in-person therapy is provided in local settings that are easy for people to access such as GP practices, physical health clinics, community settings and voluntary organisations.

People can also opt to have therapy remotely via video platform, telephone or online.

Alongside these options, services are also offering digital treatment (digitally enabled therapies) via the internet.  Such platforms encourage learning through patient self-study, reinforced and supported by a suitably trained therapist.  Digital treatment can be accessed flexibly, which many people find more convenient.

Information about the full range of appropriate, evidence-based treatment options available will be provided by the clinician to ensure that individuals can make informed choices about the therapy they receive.

What types of therapy are offered in NHS Talking Therapies for anxiety and depression services?

The following are the NICE recommended talking therapy options for depression, anxiety and post-traumatic stress conditions. You can find out more about these options on the NHS website’s Types of talking therapy page.

Depression

• guided self-help based on cognitive behavioural therapy principles
• cognitive behavioural therapy (CBT)
• interpersonal therapy (IPT)
• couple therapy for depression (CTfD) or behavioural couple therapy (BCT)
• dynamic interpersonal therapy (DIT)
• counselling for depression (PCE-CfD).
• mindfulness-based cognitive therapy (MBCT)

Anxiety which can include disorders such as panic disorder, phobias, obsessive compulsive disorder, and generalised anxiety disorder:

• guided self-help based on cognitive behavioural therapy principles. This is not recommended for social anxiety disorder or post-traumatic stress disorder
• cognitive behavioural therapy (CBT)

Post-traumatic stress disorder

• trauma-focused cognitive behavioural therapy (TfCBT)
• eye movement desensitisation and reprocessing (EDMR)

Social anxiety disorder

• cognitive behavioural therapy (CBT)

What is the history of NHS Talking Therapies for anxiety and depression services?

The NHS Talking Therapies for anxiety and depression programme (formerly known as Improving Access to Psychological Therapies, IAPT) was developed to improve the delivery of, and access to, evidence-based, NICE recommended, psychological therapies for depression and anxiety disorders within the NHS.

From small beginnings in 2008, the programme has steadily grown so that 670,000 people received a course of treatment in 2023/24. This expansion was the result of training and deploying thousands of new psychological therapists and practitioners, as well as providing additional training for existing therapists. In 2023, five years of additional government investment was committed to deliver an additional 384,000 courses of treatment by 2029 whilst increasing recovery rates. This will be achieved by employing more therapists.

What are the principles of NHS Talking Therapies for anxiety and depression?

NHS Talking Therapies for anxiety and depression services provide NICE-recommended psychological interventions for adults and older adults with anxiety disorders and/or depression. This can be standalone or in the context of a long term physical health condition where this can be managed effectively in a uni-professional service. Evidence-based therapies are delivered by trained practitioners, with or without concurrent pharmacological treatment.

NHS Talking Therapies for anxiety and depression services are characterised by three key principles:

1. all psychological therapies offered are evidence-based and delivered at the appropriate dose: where NICE-recommended therapies are matched to the mental health problem, and the intensity and duration of delivery is designed to optimise clinical outcomes
2. all within the clinical workforce are appropriately trained and supervised: high-quality care is provided by clinicians who are trained to an agreed level of competence and accredited in the specific therapies they deliver, and they receive weekly outcomes focused supervision from senior clinical practitioners with the relevant competences to support continual improvement
3. routine outcome monitoring via standardised measures is used on a session-by-session basis, so that the person having therapy and the clinician offering it have up-to-date information on the person’s progress. The outcomes of all NHS Talking Therapies for anxiety and depression services are published so that the sector can learn from variation in outcomes and public transparency about the benefits and limitations of the services is maintained. This helps guide the course of each person’s treatment and provides a resource for service improvement and public accountability

Services are delivered using a stepped-care model, which works according to the principle that people should be offered the least intrusive intervention appropriate for their needs first.

For more information on how the services work, please see the NHS Talking Therapies, for anxiety and depression manual.

How are NHS Talking Therapies for anxiety and depression services commissioned?

Services are commissioned by local integrated care boards (ICBs) and are overseen by NHS England and the Department of Health and Social Care on a regional and national basis. NHS Talking Therapies for anxiety and depression services also work closely with community mental health services for people with severe mental health problems (also referred to as severe mental illness) to ensure people are able to receive support from the right service for their needs.

NHS Talking Therapies for anxiety and depression services need to develop strong relationships with professionals across a broad range of mental and physical health care pathways, as well as social care. This can ensure that people with needs that are not best served by NHS Talking Therapies for anxiety and depression receive the care and treatment in the right place.

Patient and public participation is an essential part of the NHS Talking Therapies for anxiety and depression programme. The knowledge and expertise of those using services is key to driving all aspects of the development of the service.

How is NHS Talking Therapies for anxiety and depression ensuring it meets the needs of the whole population?

Referral pathways have been specifically developed to promote access and equality.

Aligned with the Advancing mental health equalities strategy and the patient and carer race equality framework, NHS Talking Therapies for anxiety and depression services are working to reduce health inequalities, ensuring services meet the needs of all in the population that they serve.  Our work on advancing equalities focuses on improving access, outcomes and experiences for specific populations and under-represented groups.

As well as maximising the geographic reach of the NHS Talking Therapies for anxiety and depression programme, delivering treatment via digital platforms means that treatment can be accessed at a time and place that suits the service user. It can also help promote access to treatment for people who may be less likely to engage with more traditional face-to-face therapy appointments. Other people prefer in person therapy and can choose this. It is a matter of choice.

Psychological therapies for adults and older adults with other conditions

Psychological therapies for people with severe mental health problems (also referred to as severe mental illness) are a key part of the new integrated offer for adults and older adults, as set out in the NHS Long Term Plan.  Severe mental health problems include psychosis, bipolar disorder, ‘personality disorder’ and eating disorders. All areas of the country are seeking to increase availability of these therapies as part of a wider transformation of adult and older adult community mental health services. For more information on community mental health services please see our community mental health services page.

Evidence base for NHS Talking Therapies for anxiety and depression

• The first NHS Talking Therapies services (then called Improving Access to Psychological Therapies, IAPT) were piloted in Doncaster and Newham in 2008. These pilot services demonstrated accessibility and effectiveness of services and supported a national rollout. Improving access to psychological therapy: Initial evaluation of two UK demonstration sites – PMC
• Since 2017 NHS Talking Therapies services nationally have supported half of those receiving a course of treatment to recover and two thirds to improve significantly, thus achieving the objective set for the service at its inception. NHS Talking Therapies services providers collect and return comprehensive data on patient outcomes which provides transparency and enables monitoring of a wide range of metrics including activity, waiting times and patient outcomes. NHS Talking Therapies data set reports – NHS England Digital
• Long term physical health conditions are often associated with depression or anxiety disorders. Being depressed or anxious can be both a consequence of living with a long-term condition and can exacerbate the condition or interfere with the ability to manage it. Psychological therapies for anxiety and depression can therefore help people with long term health conditions significantly, and also reduce the need for other treatments. Thrive: The Power of Psychological Therapy (Layard and Clark, 2014).
• Psychological therapies services have been shown to deliver significant benefits not just to individual wellbeing but also to the economy. A service in Norway modelled on NHS Talking Therapies showed that the benefit to the economy was five times the cost of the service, over a three-year period. This was because those who had received treatment from the service were more likely to be in work and not require welfare benefits afterwards, compared to those receiving standard care. Completing therapy with NHS Talking Therapies in England and similar services in Spain has also been found to be associated with increased earnings (and therefore tax contribution) after therapy finished. As a result of findings such as this, further significant expansion of Talking Therapies services was agreed for 2024-2029.
  • Cost-benefit of IAPT Norway (Smith et al., 2025)
  • The effect of psychological therapies on employment and earnings: Evidence from England (Rzepnicka et al., 2025)
  • Investing in mental health: a path to economic growth through psychological therapies (Munoz-Navarro, et al., 2024)

• Psychological therapies for addictions, ‘personality disorder’, psychosis and bipolar disorder, according to economic analysis from the London School of Economics, would be expected to pay for themselves within two years as a result of their impact on employment, reduced use of other NHS services and the criminal justice system. Value for money: How to improve wellbeing and reduce misery Frayman et al., 2024).