cCBT Referrer Information

cCBT offers a range of treatment programmes that use cognitive behavioural therapy (CBT) to help people experiencing mild to moderate depression and/or anxiety, either as a primary problem or in response to a variety of long term conditions. NHS GGC uses programmes from Silvercloud.

Silvercloud offers a range of programmes with reviews during the programme to provide encouragement and signpost patients to other relevant modules. The programmes are:

cCBT for depression and/or anxiety and some that are associated with specific Long Term Conditions (LTC):-

cCBT Programmes

All programmes offered through the cCBT Service are interactive, during sessions patients can watch video clips, complete exercises and learn CBT techniques which will help them manage their depression and/or anxiety.

• Within each module patients are given activities to carry out between sessions.
• All programmes record patient’s activity and they resume automatically when they next log on.

Suitable for patients aged 16+ with:

• Mild to moderate depression and/or anxiety: including phobias and panic attacks
• Willingness to be pro-active in their treatment recovery and to use a computer programme

Not suitable for patients:

• With active suicidal ideas or plans
• Who are unable to read or write English (reading age below 10/11 years)
• In acute phase of psychosis or mania, or with cognitive functioning disorder, e.g. dementia

Evidence Base – Nice and Sign recommendation

cCBT has been proven to be an effective intervention for mild to moderate depression and anxiety, and is recommended by –

• NICE in its updated 2009 depression guidance: http://guidance.nice.org.uk/TA97/Guidance/Evidence
• SIGN guideline 114 (Non Pharmacological Treatment of Depression in Adults) recommends cCBT as a treatment option for patients with depression within the context of guided self-help as a level A recommendation: http://www.sign.ac.uk/pdf/sign114.pdf

Complete the attached Referral form and email it to - ccbt@ggc.scot.nhs.uk 

The course can be completed anywhere, at any time, but we would recommend in the patient's home or during working hours at any local library to ensure a degree of privacy. The patient will need an internet connection and a smart phone, tablet, PC or laptop.

The patient needs an activation link, which will be provided by email by the local cCBT administrator after a referral is received. A patient email address is essential.

The patient then visits the Silvercloud website and click on the "Activate Account" link found within the email received from the programme and then follow the on screen instructions.

Patients referred to the cCBT service will be given access to the program within 1 week from referral being received.

When the patient completes treatment you will be sent an "Effectiveness Report".

This report provides information collected during the completion of the course and includes results from the PHQ9 and GAD7 psychological measures that the patient completes at the end of every session.

At regular intervals, the patient will be asked to complete the PHQ9 and GAD7 questionnaires. Within the PHQ9 questionnaire they will be asked if they have had suicidal thoughts. If they answer yes, they will then be asked to rate their level of intent on a scale of 0 to 10 for the Silvercloud programmes. If this level is above 4, a member of the cCBT team is required to inform the referrer and/or the GP (depending who is most appropriate to respond to risk at that time) to provide details relating to the risk alert.

During the session, patients will receive a standardised message to contact an appropriate clinician or the Samaritans if they have had suicidal thoughts. If they complete the session outside of standard working hours the programme recommends they contact NHS 24. When an overnight alert is received the cCBT Administrator will then inform the referrer and/or the GP by the end of the next working day.

Less than 10% of sessions completed have a suicide alert and less than 2% with a serious intent of over 5 on the 0-8 scale.

• Daylight is an effective clinically evidenced digital CBT for anxiety and worry. Results from a Randomised Control Trial demonstrated 71% of participants anxiety reduced from ‘clinical’ to ‘non-clinical’ levels.

• Sleepio is an effective long-term solution to sleep difficulties, validated in 12 randomised controlled trials and over 100,000 UK users to date. In a large-scale, placebo-controlled trial, Sleepio helped 76% of poor sleepers achieve healthy sleep.

Your patients can gain instant access to the programmes using the following links: 

• Daylight (CBT for anxiety) at www.trydaylight.com/nhs
• Sleepio (CBT for insomnia) at www.sleepio.com/nhs

To learn more about Daylight and Sleepio visit https://go.bighealth.com/howtorefer where you will find a helpful training session video for referrers and ‘Patient Welcome letters’ which can be provided to patients when signposting them to the programmes.

If you would like further information regarding our service or the programmes we provide, or you wish to speak with our Service Coordinator or Clinical Lead, you can contact the service directly on -

Telephone: - 0141 287 0295 Email: - CCBT@ggc.scot.nhs.uk