NHS Talking Therapies, for anxiety and depression

The NHS Talking Therapies, for anxiety and depression programme (formally 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 nearly 1.2 million people were able to access services in 2021/22. This expansion was the result of training and deploying thousands of new psychological therapists and practitioners, as well as providing additional training modules for existing therapists. Taken together The Five Year Forward View for Mental Health and The NHS Long Term Plan commit the NHS to further expand the NHS Talking Therapies, for anxiety and depression programme so that 1.9 million people per year will be able to access services by the end of 2023/4.

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

What are NHS Talking Therapies, for anxiety and depression services?

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, transparency, 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.

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

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 clinicians, with or without concurrent pharmacological treatment.

NHS Talking Therapies, for anxiety and depression services provide treatment for people 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.).

In addition to evidence-based talking therapies for the common 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.

Aligned with the Long Term Plan and the Advancing mental health equalities strategy, 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.

How are NHS Talking Therapies, for anxiety and depression services accessed?

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

  1. self-referral into every service (find an NHS psychological therapies service – www.nhs.uk)
  2. community or voluntary service referral
  3. primary care referral
  4. secondary care referral (including both mental health and physical health care services).

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 patients first language is not English, talking therapies can be delivered in their chosen language through multi-lingual therapists or confidential translators. NHS Talking Therapies, for anxiety and depression are also available in British Sign Language (BSL) through SignHealth.

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:

Depression:

  • Guided self-help based on cognitive behavioural therapy principles

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

  • Guided self-help based on cognitive behavioural therapy principles. This is not advised for social anxiety disorder or post-traumatic stress disorder

Post-traumatic stress disorder:

  • Trauma focused Cognitive behavioural therapy (Tf CBT)

Social anxiety disorder:

  • Cognitive behavioural therapy (CBT)

How are NHS Talking Therapies, for anxiety and depression services delivered?

Services should offer a choice of in-person or remotely delivered therapies. Most of the in-person therapy is provided in local settings that are as easy for people to access such as GP practices, physical health clinics, community settings and voluntary organisations. In recent years, expedited by the pandemic, more people are opting to have therapy remotely (via video platform, telephone or text talk).  Alongside these options, services are also offering digital treatment (digitally enabled therapies, DET), provided via the internet.  Such platforms encourage learning through patient self-study, reinforced and supported by a suitably trained therapist.  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 anywhere and at any time. 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.

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 on a regional and national basis.NHS Talking Therapies, for anxiety and depression services will 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 Therapy 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, to ensure that people with needs that are either not appropriate or are too complex for NHS Talking Therapy for Anxiety and Depression services receive the necessary care 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 our programmes development.

Psychological therapies for severe mental health problems (adults and older adults) 

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.