Engagement and acceptability of a digital programme for anxiety
Research type
Research Study
Full title
Evaluating engagement and acceptability of ieso’s 6-week digital programme for adults experiencing symptoms of anxiety
IRAS ID
327897
Contact name
C Palmer
Contact email
Sponsor organisation
Ieso Digital Health
ISRCTN Number
ISRCTN52546704
Duration of Study in the UK
0 years, 8 months, 2 days
Research summary
Summary of Research
ieso is an NHS service provider available in over half of the integrated care systems (ICSs) in England, and nationwide across Scotland. We provide online, typed, therapist-delivered cognitive behavioural therapy (CBT) via our online platform. With more than 600 fully qualified therapists, we have treated over 100,000 adults in the NHS over the past decade with excellent patient outcomes and experience.
To increase access to mental health support for patients with anxiety, we have developed a 6-week self-guided digital programme, IDH-DP2-001 (‘DP2’), delivered via a smartphone app, intended to alleviate anxiety symptoms. The programme uses a digital guide (similar to a chatbot) to deliver educational content about anxiety and techniques to help alleviate symptoms in an engaging way through typed conversation and interactive features, such as video and audio. The script our digital guide follows was written by our team of accredited clinicians and uses evidence-based cognitive and behavioural therapy principles. The programme also includes a human clinical oversight and user support wrap-around service designed to enhance engagement, safety and potential clinical benefit.
This study is designed to understand whether patients experiencing symptoms of generalised anxiety find ieso’s digital programme engaging and acceptable. We aim to understand: 1) how participants engage with the programme; 2) whether participants use the programme as intended; and 3) whether the programme meets their needs. We also aim to understand the study feasibility for future clinical trial design and generate preliminary safety and efficacy data.
We will invite patients with anxiety who are referred to ieso’s therapy service either through an NHS trust or self-referral to participate. We will also recruit through online advertisements or email. A clinician will assess eligibility, obtain informed consent, and monitor participant progress. Participants will be asked to download the app on their own smartphone to complete the programme.
Summary of Results
We carried out a study to investigate the ieso digital mental health program, which combines an AI-driven digital experience with human support. The aim was to see whether this type of support could help people experiencing symptoms of generalized anxiety in a way that feels acceptable, safe, and effective.
Participants used the digital program for up to nine weeks. Most people (around 78%) used the program for at least an average of two hours across 14 days, with the typical user spending six hours in total. People reported that they found the program easy to use, engaging, and helpful. In interviews with a small group, participants highlighted four main reasons why they found the program acceptable: 1) it offered easy access to useful tools that led to real improvements; 2) it felt personal and tailored to them; 3) it gave them a clear structure but also let them go at their own pace; and 4) the human support made them feel guided and cared for. However, some users did wish for more personalization and were frustrated when the chatbot misunderstood them.
To understand how well the program worked, we looked at changes in anxiety symptoms using standard clinical measures. We analysed results in two ways: one that included everyone who took part, regardless of how much they used the program (intention-to-treat), and one that focused only on those who used the program as intended (per-protocol). The intention-to-treat analysis is designed to estimate population level changes in the real-world when not everyone will use the program as intended. Both analyses showed a significant and meaningful reduction in anxiety symptoms. For those who engaged fully, anxiety scores dropped by an average of 7.4 points, which is considered a large and clinically important improvement, and across the whole sample, scores dropped by 5.4 points on average, which is also a meaningful change.
We then compared these results with data from NHS Talking Therapies patients either waiting for treatment or who received cognitive behavioural therapy (CBT) face-to-face or via a remote-typed service. The outcomes from the digital program were better than for people waiting for treatment, and similar to those receiving therapy either in person or remotely.
Importantly, the program achieved these results with far less clinician time. On average, clinicians spent about 1.6 hours per participant, which is up to eight times less than the typical amount of therapist time in traditional care (using global estimates). This suggests that combining AI with human support could be a practical and scalable way to deliver effective mental health care to more people.
The findings are publicly available in the following papers:
- Peer-reviewed article: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fwww.jmir.org%252F2025%252F1%252Fe69351%2FNBTI%2Ft4a9AQ%2FAQ%2Fda2a4734-cb1c-4561-8747-73c4524dbce8%2F2%2FvXHQwqK-QO&data=05%7C02%7Capprovals%40hra.nhs.uk%7Cc7f780c6db2f433ec07208dd99dbdbaf%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638835891745079448%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=YlMwKer6sxK7Dh3NK9cYqcuMu4P5In%2FlHVBlyvTCMlE%3D&reserved=0
- Preprint: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fosf.io%252Fpreprints%252Fpsyarxiv%252Fg3dhy_v1%2FNBTI%2Ft4a9AQ%2FAQ%2Fda2a4734-cb1c-4561-8747-73c4524dbce8%2F3%2FL6kKourPWE&data=05%7C02%7Capprovals%40hra.nhs.uk%7Cc7f780c6db2f433ec07208dd99dbdbaf%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638835891745093515%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=YHpXkXIZtrrrJyp3rDIkEkco0yHNG1xbVuCjKanP8sw%3D&reserved=0REC name
West of Scotland REC 4
REC reference
23/WS/0081
Date of REC Opinion
14 Jul 2023
REC opinion
Further Information Favourable Opinion