NICE says yes to digital CBT for children with anxiety

Child with tablet
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UK cost-effectiveness agency NICE has said that guided, self-help digital cognitive behavioural therapy (CBT) apps can be used by the NHS for initial treatment of children and young people with anxiety – at least while more information is gathered.

New guidance from the health technology assessment (HTA) organisation covers four digital technologies that it says can help the five to 18 age group with mild to moderate symptoms of anxiety or low mood, once they are approved for use by NHS England under its Digital Technology Assessment Criteria (DTAC) framework.

This is the first example of a green light being given under NICE's early value assessment (EVA) pathway for medtech innovations, which was piloted with five apps for mild anxiety last year and aims to provide quicker access to digital health products, diagnostics, and devices that could relieve pressure on the NHS.

The process aims to take around six months, quicker than the current timescale for NICE medical technologies guidance. It comes amid recognition that the digital technologies route first piloted in 2019 has only seen one positive recommendation by NICE since it went live.

The four apps that are covered by the guidance are as follows:

  • BfB Labs' Lumi Nova: Tales of Courage, a digital therapeutic (DTx) in the form of a game for children aged seven to 12, which combined exposure therapy and psychoeducational content within an intergalactic role-playing game;
  • Online Social anxiety Cognitive therapy for Adolescents (OSCA), an internet programme of cognitive therapy for social anxiety in adolescents aged 14 to 18 years old; 
  • Online support and intervention for child anxiety (OSI), an internet-based, parent-led, and therapist-supported psychological intervention for children aged five to 12 years old with symptoms of anxiety;
  • SilverCloud's 'Space from' series, a CBT range which targets 15 to 18-year-olds with symptoms of anxiety, low mood, or both, with online support from therapists;

Another app reviewed in the pilot – Healios' ThinkNinja CBT Bytesize – is awaiting CE mark approval, so cannot be used yet.

"The availability of effective mental health treatments is limited, with a shortage of qualified staff and long waiting times," according to the guidance. "Many children and young people are not getting access to treatment when they need it [and these] technologies are a way to increase access to treatment with support from a healthcare professional."

An initial assessment with a healthcare professional is needed before using these technologies to make sure they are suitable, and children and young people are then checked on a regular basis.

NICE said it will be up to the local NHS to determine how they wish to commission these new treatment options once they are DTAC approved.