Newly recommended CBT therapies could help children and young people manage anxiety
NICE conditionally recommends digital cognitive behaviour therapies (CBT) for use in the NHS to help children and young people with symptoms of mild to moderate anxiety
Draft guidance released for consultation today (Friday 4th Nov) states the technologies can be used with support from a mental health professional, while further evidence is generated to check if the benefits they offer are realised in practice.
The five self-guided products offer games, videos and quizzes, based on CBT principles, help children and young people learn techniques to better understand and manage their symptoms of anxiety and low mood with the support of a mental health practitioner.
If the recommendations are confirmed after consultation, the technologies could be offered to some children and young people, identified as having mild to moderate symptoms of anxiety or low mood by a mental health practitioner. Users may be offered other support such as face to face CBT alongside digital therapies, where appropriate.
Digital CBT is delivered via mobile phones, tablets, or computers and can be accessed remotely and offers flexible access, greater privacy, increased convenience, and increased capacity and support for face to face CBT. It may be particularly appealing to children and young people who are typically regular users of digital technologies such as smartphones and tablets.
The independent NICE committee found there is some evidence to suggest that guided self-help digital CBT technologies may improve symptoms of anxiety but more evidence is needed to inform a full NICE assessment before considering these for routine use in the NHS.
There is an increased need for child and young people’s mental health services that has become even greater due to the COVID-19 pandemic. Technologies like these, could help children and young people get wider access to support.
We understand that for some children and young people, technologies will not replace face-to-face interventions. What is promising about all the technologies we have conditionally recommended today is the way they bring together digital interventions with clinical support.
By driving innovations like these into the hands of clinicians we can improve care for patients and help the service recover following the pandemic.
The Health Foundation estimates that among those aged six to 16 in England, one in six had a probable mental health condition in 2021, up from one in nine in 2017.
I am aware of how children and young people can be affected by mental health difficulties: including my own children and those in my work in schools.
Some children and young people find it challenging to socially communicate and interact, which can affect their mood and cause anxiety. Having more digital support may well be more attractive and accessible. Also, if digital support can be offered earlier than face to face treatment, this can give support and importantly validation to their feelings sooner.
NICE’s independent medical technologies advisory committee has conditionally recommended five technologies as first line treatment options (or alongside other treatments), while further evidence is generated. They are:
Lumi Nova (BfB Labs)
Lumi Nova: tales of courage, is a digital therapeutic intervention in the form of a game available on Android and iOS for children and young people aged between seven and 12 with symptoms of mild to moderate anxiety.
It combines evidence-based therapeutic content (exposure therapy, a form of CBT) and psychoeducational content within an intergalactic role-playing game.
Practitioners track and monitor player progress with the game and check in with users and carers provide support to their child (app user) when needed and can receive SMS notifications when their child uses the app.
Space from anxiety for teens, Space from low mood for teens, Space from low mood & anxiety for teens (SilverCloud)
Internet-based (computer, tablet or smart phone) intervention for 15- to 18-year-olds with symptoms of anxiety, low mood, or both.
It can be used in younger children according to Child and Adolescent Mental Health Services (CAMHS) protocols and clinical judgement. It is structured around the principles of traditional CBT, with sections on: understanding anxiety or low mood, noticing feelings, facing your fears, spotting thoughts, challenging thoughts, managing worry and reflections on learnings.
There is online support from psychologists and online cognitive behavioural therapy co-ordinators. After each module, they check in to help progress through the CBT content and send motivational messages.
Online support and intervention for child anxiety (OSI)
OSI is an internet based (computer, tablet and smart phone), parent-led and therapist supported psychological intervention for children aged 5 to 12 years old with symptoms of anxiety.
It has three components, a parent’s website, a clinician case management website and an optional game app for children (Monster’s Journey: Facing Fears). It includes interactive worksheets, videos and quizzes.
Parents or carers have weekly telephone appointments with a therapist to review, after which the next week’s weekly module is released.
OSCA (Online Social anxiety Cognitive therapy for Adolescents)
OSCA is an internet programme of cognitive therapy for social anxiety in adolescents aged 14 to 18 years old.
All users receive a core set of modules to work through which is then individualised for each user. The therapist has a 15-minute phone call with the user each week and releases modules that will be most helpful. They will receive encouragement and support via secure messaging within the online programme and SMS texts. Parents receive regular emails on their child’s progress. This is explained to children aged 14 to 15 and consent is asked from young people aged 16 to 18 years old.
ThinkNinja CBT Bytesize (Healios)
ThinkNinja CBT-Bytesize is intended for children and young people aged 11 years and older with anxiety or low mood, and related problems.
It is an app that contains psychoeducational, and CBT based content with wrap around clinician support in the form of text messaging in the app and video calls via a secure platform on the computer or tablet.
The protocol specifies at least three short clinical contacts per week (text or video calls), but children and young people are encouraged to get in touch via text at any time.
The online and mobile technologies are part of a NICE pilot for early value assessment (EVA) of medical technologies.
The objective of EVA is to identify the most promising technologies in health and social care where there is an unmet need and to enable earlier conditional use of the technologies in the NHS, while further evidence is generated.
The evidence developed will demonstrate if the expected benefits of the technologies are realised and inform a final NICE evaluation and decision on the routine use of the technology in the NHS.