NHS Talking Therapies, for anxiety and depression, Annual reports, 2023-24

The National Institute of Health and Care Excellence (NICE) recommends different psychological therapies for specific types of anxiety and depression. The table below is a summary of the recommendations, taken from the NHS Talking Therapies Manual published at The NHS Talking Therapies Therapies Manual. 

When a patient is referred to an NHS Talking Therapies service, they are first assessed for suitability and to identify suitable treatment(s). For many patients with mild to moderate symptoms of anxiety or depression, a low intensity intervention is first recommended, with other, higher intensity therapies offered if necessary. This is known as a stepped care model. Appendix A describes what therapies are recommended for particular conditions.

Figure 1 shows an example patient journey through an NHS Talking Therapies service. In this example, the patient has received six appointments in total; three where Guided Self Help (Book) was administered as a treatment and three where Cognitive Behavioural Therapy was administered. This patient would be considered to have finished a single course of treatment according to the standard definition in the Official Statistics; but has received two distinct courses of therapy.

A patient has received a course of therapy if the following criteria are met:

• The referral has finished a course of treatment in 2023-24;
• There are at least two appointments where the therapy type (e.g. ‘Cognitive Behavioural Therapy’) is recorded and where the appointment also conforms to the following:
  • It is attended;
  • It is a treatment appointment;
  • It occurs between the referral received date and the referral end date.

The start of the course of therapy is taken to be the first treatment appointment chronologically where that therapy is recorded and the end of the course of therapy is the last such appointment. This is regardless of whether other therapy types were also recorded in the same appointment or in other appointments between the start and end of the referral.

A referral can have one or more courses of therapy – any referrals finishing treatment in the year but having one or no appointments with recorded therapies are not included in this analysis. For a full technical definition of a course of therapy, see the ‘Constructions’ tab of the accompanying data tables, which can be downloaded from the overview page. 

Outcomes in NHS Talking Therapies are measured in terms of three measures: reliable improvement, recovery, and reliable recovery. For an explanation of these terms, see pages 24-29 (section 6.3) of the ‘IAPT v2.1 Guidance document', available from NHS Talking Therapies data set reports - NHS Digital.

Importantly, outcomes are only calculated for referrals that meet the definition of having finished a course of NHS Talking Therapies treatment (see page 32 of the above document) and have therefore been discharged by the NHS Talking Therapies service.

This makes the calculation of outcomes by therapy type in this report different from the patient outcomes measures described above, and for this reason comparisons should not be made between these two types of outcome measure. Though the same cohort of patients is used (referrals finishing a course of treatment in 2022-23), an important distinction is that not all courses of therapy in this analysis will be immediately followed by the patient being discharged from the service. To illustrate this, consider the example pathway in Figure 1 above. The first course of therapy in this pathway is ‘Guided Self-Help (Book)’ but at the point at which this course of therapy ends, a second begins, and subsequently any outcome measures calculated for the first course of therapy only will not consider any subsequent change (positively or negatively) in the patient’s condition as a result of the second course of therapy.

Therapy-based outcomes in this analysis are only calculated where there are two or more PHQ-9 scores and two or more ADSM scores that occur between the start and end of the course of therapy (see Appendix B). Other scores in the referral pathway that were recorded before the course of therapy started or after it ended are not considered.

Patients can attend NHS Talking Therapies services with a range of conditions, both mental and physical. However, the NHS Talking Therapies dataset has the provision to record a single ‘problem descriptor’; this is the primary, or main, condition from which the patient is suffering, and should reflect what the NHS Talking Therapies service is treating the patient for – that is, a problem for which the NHS Talking Therapies service is able to treat them.

Problem descriptors are also used to inform which Anxiety Disorder-Specific Measure (ADSM) is used to assess outcomes. In standard outcomes reporting, the last recorded problem descriptor is used for this purpose. However, in consultation with key stakeholders it has been agreed to use the first problem descriptor recorded during the course of therapy for this analysis, as this reflects the rationale behind a particular therapy being given (in accordance with NICE guidelines). For clarity, this means that the problem descriptor recorded in the same submission as the appointment marking the start of the course of therapy is used, and the ADSM used in the calculation of therapy-based outcomes is then chosen on the same basis as in standard outcomes from this point (see page 39 of the ‘IAPT v2.1 Guidance document' for further details).

The NHS Talking Therapies annual data was used to produce the Therapy-based Outcomes statistics. It should be noted that in April 2022, the IAPT dataset underwent a formal version change from version 2.0 to version 2.1. Data from both the 2022-23 and 2023-24 IAPT annual reports are based on a full year of IAPT version 2.1. The 2021-22 report includes data from version 2.0. The change has had no significant impact on the report findings.