On-line ACT-based psychological interventions for low mood, anxiety and stress (#1922)

Idea Description
Supplementary Information
Detailed Submission Data
Innovation 'Elevator Pitch':
Headsted's on-line interventions are an evidence-based, flexible and cost-effective alternative to face-to-face psychotherapy for low mood, anxiety and stress, which can help people in distress without delay, and reduce budget pressure for the NHS.
Overview of Innovation:
Headsted's offerings are an innovative implementation of Acceptance and Commitment Therapy (ACT). Over a period of 5-7 weeks (varies by the solution) users learn to combat low mood, anxiety or stress through interactive exercises (including audio and video), and develop prevention strategies to protect themselves in the future.

ACT belongs to the family of third-wave cognitive behavioural therapies, and its roots are in research on human language and cognition. The aim of ACT is to learn to resist experiential avoidance: the unwillingness to experience negative emotions, feelings and thoughts. This skill, which allows a person to accept discomfort and commit valued actions, is called psychological flexibility.

ACT is a form of cognitive behavioural therapy (CBT) but it has three distinctive characteristics.

1.     ACT does not attempt to change the content of thoughts and beliefs, because the role of the context of a behaviour is more important in determining how to influence it.
2.     ACT's model of psychopathology emphasizes the importance of cognitive defusion skills, that is, the ability to distance oneself from thoughts that are not beneficial.
3.     ACT focuses on the person's relationship to experiences instead of the content of the experiences. This allows people to free themselves from the grip of their painful memories and assumptions.

ACT uses metaphors and experiential exercises to aid you in gaining distance from persistent thoughts and emotions, and in experiencing awareness of the present moment. ACT involves mindfulness exercises and emphasizes values clarification and living life according to one’s values.

"Passengers on a Bus" is one of the metaphors used in ACT. Negative thoughts are often a significant cause of low mood, anxiety, and similar issues. They may manifest themselves like annoying passengers on a bus.  (See below for video).

ACT lends itself well to implementation on online and mobile platforms thanks to its structured approach and reliance on experiential exercises.

Company website: https://headsted.co.uk

Association for Contextual Behavioural Science, Analysis of studies comparing ACT and CBT  - https://contextualscience.org/are_there_advantages_of_act_as_compared_to_traditional_cbt

Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
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Innovation 'Elevator Pitch':
TPT is a new delivery platform for CBT offering easily accessible pre-recorded therapy sessions using a customised interactive phone system. Patients call TPT free - anytime, anywhere. Healthcare providers reduce treatment costs & cut waiting lists
Overview of Innovation:
TPT is a personalised, guided self-help psychological therapy delivered over the telephone in a range of pre-recorded modules for the treatment of mild to moderate anxiety-based mental health problems. It uses modern telephone technology to achieve vastly reduced costs with no waiting lists and is designed for use in NHS primary or secondary care settings.

Easy to prescribe, easy to use
TPT is available 'on prescription' to patients from their GP or other healthcare provider. The therapy can then be regularly accessed by the service-user making a simple free telephone call. An interactive, intelligent computer controlled telephone system using voice recordings of therapeutic scripts and questionnaires will then guide the service-user through a psycho-education, treatment and recovery programme that is responsive to the patient's individual presentation and circumstances. Patients will typically complete the programme in 8 to 12 weeks.
Instant access
Psycho-education, guidance and structured self-help for managing their condition are available to service-users wherever they are and at all times of the day and night. This immediacy of access is of particular benefit to patients with conditions that require help managing situational responses to emotional and environmental triggers or developing and maintaining impulse control strategies.
Choice of treatment modules for different presentations
A range of TPT modules is available for the treatment of different mild to moderate anxiety-based mental health problems such as generalised anxiety disorder, OCD and agoraphobia. Although each module is written with the specific presentation in mind there is a broad commonality of structure. A typical TPT module will have some of the following elements delivered by spoken scripts and using targeted questionnaires:
  • Introduction to anxiety and its effects
  • Description of the symptoms and causes
  • Psycho educational quizzes and self assessment measures
  • A range of anxiety management strategies
  • Instant-access session for managing acute symptoms
  • Cognitive techniques for overcoming negative thinking
  • Text messages which are sent to service-users to give feedback, reinforcement and reminders
  • Tailored sessions to inform and support friends and family
For a quick introduction to TPT, its operation and its benefits visit our 3 minute video at: https://vimeo.com/145905041
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Lower costs
  • TPT costs are 80% less than the cost of a course of therapy by a psychological wellbeing practitioner
  • No need for staff training or regular patient supervision by a therapist
  • No extra capital investment
  • Secondary prevention reduces need for further treatment
  • Reduction in demand for consultations by 'revolving door' patients
Instant access
  • Presenting service-users can leave the consulting room with a prescription giving immediate access to a suitable treatment offered in the 'language of their thoughts'.
  • Ease of use – familiar telephone dial in system for patients to access the session they require.
  • Help is available 24/7 whenever the patient needs support
Cuts waiting lists
  • High-level IAPT and secondary care services are freed up for more seriously ill service-users
Reduced dependency
  • Opportunity to reduce risk and cost of service-user dependency on prescription drugs
Reduced benefits bill
  • Patients can get back to work without deteriorating on a waiting list for other treatments
Fully translatable for the BAME community:
  • TPT modules can be translated once and used by many, reducing the cost for conventional translators
Meeting the Government agenda
In the face of growing numbers of people with common mental health problems and in an environment of increasing costs and reduced budgets the Government is directing commissioners to look for new ways of improving accessibility to treatment. TPT falls in line with many of these objectives, such as:
  • Cost reductions in the NHS
  • Increased patient choice
  • Flexible delivery of services
  • Access by minority groups
  • Use of new technology
  • Innovation programmes
Quality Assurance
The Cognitive Behavioural Therapy delivered by TPT is well researched, evidence-based, and commonly practiced in the NHS. The therapy scripts have been peer reviewed. The technology of the delivery platform has been exhaustively tested to ensure reliable operation in the face of intensive and unpredictable use.

Performance metrics
Standard reports showing patient outcome and experience measures are available from the database which manages TPT. Healthcare providers can monitor their consumption of TPT licences. Cornard Healthcare is happy to work with clients on their reporting requirements in the light of user experience.
Initial Review Rating
4.20 (1 ratings)
Benefit to WM population:
Prevention of Mental Health Problems
We believe that TPT can address the needs identified under the ‘Prevention of Mental Health Problems’ campaign. It is a simple, easy-to-use delivery platform which gives patients with mild to moderate mental health problems instant access to CBT and gives healthcare providers a cost-effective and flexible treatment option.
TPT is designed to teach people coping strategies for mild to moderate mental health problems. This, in turn, will improve the lives of the friends and family who are supporting them.
Using TPT in a primary care setting such as the Sandwell Model will reduce the burden on GPs and, by improving access to cost-effective treatment, will improve the mental health of the population. With only a few mouse-clicks during a consultation, GPs and other healthcare professionals log in online, prescribe a unit of TPT and print a simple two-page user-guide for the patient to take away.
The modular nature of TPT means it can be tailored to the needs of the population across the West Midlands, thus reducing the number of people directly and indirectly affected by mental health problems. Cornard Healthcare can work with healthcare providers and with commissioners to develop modules to best address the specific needs of the region.
The confidentiality of the TPT delivery platform for CBT and its ready translatability make it specially well suited to the diverse multi-ethnic and multi-cultural population groups in the West Midlands where language barriers and the stigma associated with mental health problems can prevent  patients from accessing the services they need.
Patient data protection
There is no personal data stored within the system as all patients are only referenced via their unique ID number.
Delivery Costs
The cost to the prescribing healthcare organisation is in two parts:
  • The prescribing licence for the organisation
  • A service-user licence for each 12 week course of treatment. These are pre-purchased in blocks by healthcare organisations.
Cornard Healthcare is happy to discuss favourable terms for early-adoption sites.
Patient Cost - None
TPT is free at the point of use. There is no cost to the patient as this covered by the service-user licence, so those on low income or benefits do not need to use valuable mobile credit or incur large telephone bills.
Current and planned activity: 
Cornard Healthcare is currently working with MIND in Suffolk who are using the TPT system to help their clients. The pilot study has already shown the system to be easily accepted and used by patients, popular with clinicians and reliable in use.

Required activity:
  • Procurement / Adoption of TPT across the West Midlands Trusts within both primary and secondary care settings
  • Feedback from clinicians and patients on how to develop the service to best suit the needs of patients and providers

What is the intellectual property status of your innovation?:
IP held and owned by Cornard Healthcare Limited.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
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Innovation 'Elevator Pitch':
The FearFighter Treatment is the only product endorsed by National Institute for Health and Clinical Excellence (NICE) in the UK (TA097) – for an Anxiety Treatment
Evidence-based online program - Available 24/7/365 from any computer or mobile device
Overview of Innovation:
FearFighter is an online programme for the treatment of generalised anxiety, panic and phobia. The programme teaches users how to confront and change their thoughts and challenge avoidance behaviour that characterise panic and phobia. Users can print out worksheets for activities, monitor progress and receive emails with further tips at the end of each step. Most sessions last about 50 minutes. One session a week is the current recommended treatment regime.
FearFighter is an online program for the treatment of panic and phobia. It is based on the evidence based approach known as Cognitive Behavioural Therapy, or CBT for short. Thousands of people have used this programme to help them overcome their fears and lead a more normal life.
The programme teaches patients how to tackle their thoughts and challenge avoidance behaviours that characterise panic and phobia. They can print out worksheets for activities, monitor their own progress and receive emails with further tips at the end of each step. Most sessions last about 50 minutes.  It is recommended that patients do one session a week.
Between certain steps, FearFighter sets activities to complete. These help them build on topics covered in sessions & are essential to make progress. FearFighter consists of 9 steps that need to be worked through one by one in order to obtain the greatest benefits. It guides users through CBT as much as a therapist does.
FearFighter has undergone extensive testing & trial pilots involving 700 patients and has received an endorsement by the NICE as being proven to be clinically & cost effective.  In the NICE Final Appraisal Determination (FAD), FearFighter has been recommended as an option for delivering CBT in the management of panic & phobia. FearFighter has since been implemented in many NHS regions as well as being adopted in other countries as a recognised standard form of treatment.
The FearFighter Program
  • FearFighter is NICE approved
  • UK National Health Service (NHS) and other nations recognise FearFighter as a standard form of treatment for anxiety and phobia disorders
  • Evidence-based & extensively tested
  • Online programme available to patients 24/7/365 from any computer or mobile device
  • Allows patients to learn how to confront and change their thoughts
  • Challenges avoidance behaviours that characterize panic and phobia
  • Print worksheets for activities, monitor progress & receive emails with further tips at the end of each step
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
  • Our latest data shows recovery rates of 48.2% this compares to the national recovery rate in 2015 of 38.4%
  • Research from trials shows dropout rates are not significantly different to face to face therapy.
  • Trials showed that clinician time per patient was reduced by 73%
  • The NICE Endorsement was for clinical and cost effectiveness with financial savings up to 70% compared to conventional therapy
  • The programme is available on desktop and mobile compliant devices and are available 24/7 thereby making access easier for a patient.
  • Reporting analytics are compatible with NHS requirements and the back office is simple to use

Quote from Mary ‘To date I’ve travelled on the underground train without a twinge of anxiety – I still can’t believe it! FearFighter has surpassed all my expectations’.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
NHS Benefits
Reduction in the demand on therapist time means more patients can be treated with improved recovery rates and reduced waiting lists
  • It provides greater choice of treatment to both the clinician and patient.
  • Evidence proves that the treatments work.
  • The product should provide direct financial savings.

Patients Benefits
Patients are able to self-manage their condition and thus not have to rely on or need psychological interventions and can also reduce or remove the dependence on medication.
The programmes help people to understand themselves better and to recognise and change unhelpful habits and thinking patterns.
The tracking system helps users review their progress throughout the programme using simple, scientifically validated questionnaires.

A wider adoption of our CCBT technology and FearFighter would allow our West Midlands based company to expand its activities within the UK and overseas and thus take on additional staff to support clinicians and users / patients.
It would also facilitate us to develop a broad portfolio of treatments we have in the pipeline.
Current and planned activity: 
Birmingham and Solihull Mental Health NHS FT has been our client since May 2013 to date during which time that have used our FearFighter, MoodCalmer and OCFighter programmes and they are currently piloting both our Shade (Drug & Alcohol addiction) and Restore (Insomnia & Sleep disorders) programmes
Dudley and Walsall Mental Health Partnership NHS Trust currently in discussion with the trust to adopt our platform for are evidence based programmes for people with anxiety (FearFighter™), depression (MoodCalmer™), OCD (OCFighter™), addiction (SHADE™), sleep disorders (RESTORE™)

  • Procurement / Adoption of: -  Require increased sales and access to market our products to CCGs and Trusts Mental Health teams.
  • Awareness / Profile Raising Greater awareness of our products and the conditions it can address
  • Project Assistance required - We are interested in locating possible clinical / academic collaborators and pilot sites for new Online mental health tools.
What is the intellectual property status of your innovation?:
All IP is owned by CCBT Ltd.

All our products are NHS information Governance Toolkit (IGT) and Interoperability Toolkit (ITK) compliant and our secure socket layer (SSL) and database encryption technologies have been enhanced to keep up with the ever changing requirements for web security and NHS informational governance standards and is integrated with IAPTUS and PCMIS. IE11, Chrome or Firefox are recommended
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
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