Computerised cognitive behavioural therapy (cCBT)

Warning

Silvercloud

SilverCloud is NICE and SIGN approved, supported, externally hosted online CBT for mild to moderate anxiety and depression co-morbid with long term health conditions. It also contains programs for OCD, Perinatal, Panic Phobias, Covid-19, Diabetes, Health and Social anxiety.

Space from Depression
Individuals with mild to moderate symptoms of depression. The Space from Depression programme has been designed to relieve the symptoms of depression by: Focusing on developing more flexible ways of thinking. Increasing awareness and understanding of emotions. Increasing activity and motivation in daily life. Built in conjunction with leading content providers and clinical subject matter experts. Space from Depression is an easy to follow program that includes a range of tools, activities and education delivered in a safe and confidential space.

Space from GAD (General Anxiety Disorder)
Individuals with mild to moderate symptoms of GAD. Space from GAD programme has been designed to relieve the symptoms of GAD by: Focusing on developing more flexible ways of thinking. Increasing awareness and understanding of emotions. Increasing understanding of the role of worry in GAD. Focusing on problem-solving strategies to cope more effectively with worry. Built in conjunction with leading content providers and clinical subject matter experts. Space from GAD is an easy to follow program that includes a range of tools, activities and education delivered in a safe and confidential space.

Space from Depression & Anxiety
This is suitable for individuals with mild to moderate symptoms of depression and anxiety. Built in conjunction with leading content providers and clinical subject matter experts. Space from Depression & Anxiety is an easy to follow program that includes a range of tools, activities and education delivered in a safe and confidential space.

Space from Anxiety
Individuals with mild to moderate symptoms of Anxiety. Space from Anxiety is an online intervention aimed at alleviating psychological distress arising from anxiety related symptomology. Built in conjunction with leading content providers and clinical subject matter experts. Space from Anxiety is an easy to follow program that includes a range of tools, activities and education delivered in a safe and confidential space.

Space in Chronic Pain from Depression and Anxiety

Individuals with mild to moderate symptoms of depression and anxiety who are living with chronic pain. This is not suitable for people still undergoing investigations for their pain or those experiencing chronic pain in relation to a serious illness. The programme aims to relieve symptoms of depression and anxiety through cCBT. This programme is NOT suitable for individuals who need specific, targeted input to address self-management of their chronic pain.

Space in Lung Conditions from Depression and Anxiety

Individuals with mild to moderate symptoms of depression and anxiety who are living with a formal diagnosis of a long-term lung condition. This is not suitable for individuals undertaking treatment for cancer and/or receiving end-of-life care. The programme aims to relieve symptoms of depression and anxiety through cCBT. This programme is NOT suitable for individuals who need specific, targeted input to address self-management of their lung condition.

Space in Rheumatoid Arthritis from Depression

Individuals with mild to moderate symptoms of depression who are living with a formal diagnosis of Rheumatoid Arthritis. The programme aims to relieve symptoms of depression through cCBT. This programme is NOT suitable for individuals who need specific, targeted input to address self-management of their rheumatoid arthritis.

Space in Diabetes from Low Mood and Anxiety

Individuals with mild to moderate symptoms of anxiety and/or low mood who are living with a formal diagnosis of type 1 or type 2 diabetes. This programme is recommended for people with diabetes where psycho-social circumstances are the primary maintaining factors in their mental health difficulties. This programme is NOT suitable for people with diabetes who need specific, targeted input to address their diabetes self-care (i.e. non-adherence to a recommended medical regime characterised by insufficient/excessive blood glucose monitoring, avoiding insulin administration, or engaging in disordered eating behaviours).

Space in Chronic Heart Disease from Depression and Anxiety

This is suitable for individuals with mild to moderate symptoms of depression and anxiety who are living with a formal diagnosis of coronary heart disease (CHD). The programme aims to relieve symptoms of depression and anxiety through cCBT. This programme is NOT suitable for individuals who need specific, targeted input to address self-management of their CHD.

Space from Diabetes (Type 2 only)

Space from Diabetes is a purpose built interactive and practical program that provides psychoeducation, tools and activities to promote the self-management of diabetes. This intervention is tailored to the holistic, life-long needs of those diagnosed with Type 2 Diabetes who may have been struggling to self-manage their condition and are presenting with metabolic instability. Space from Diabetes has been specifically designed to improve users’ ability to self-manage their diabetes, improve user’s physical and mental health outcomes and reduce healthcare costs associated with diabetes for services.

Space from Perinatal Wellbeing

The perinatal program has been designed for parents/caregivers who are in the perinatal period (expecting a baby to one-year post birth) to relieve subthreshold symptoms of clinical depression and/or anxiety in the perinatal period, as well as helping with sleep difficulties. It enables the client to identify if further support is required for an anxiety disorder or clinical depression.

Space from OCD

The Space from OCD programme has been designed to relieve the symptoms of OCD by:

Focusing on developing more flexible ways of thinking
Increasing awareness and understanding of emotions
Increasing awareness and understanding of obsessions and compulsions and their role in maintaining anxiety
Using the exposure response prevention technique to learn to cope with anxiety provoking situations without engaging in compulsions.
Space from Panic

The Space from Panic programme has been designed to relieve the symptoms of panic.

Space from Phobia

The Space from Phobia programme has been designed to relieve the symptoms of Phobias.

Space from COVID-19

This package helps to normalise worries and emotions, provides coping strategies and gives practical solutions for maintaining wellbeing in a time of crisis. This short program is suitable for anyone who is struggling specifically in relation to COVID-19.

Space from Health Anxiety

This package is suitable for people with mild to moderate anxiety about becoming ill (e.g. excessive reassurance seeking, excessive focus on possible or perceived symptoms, excessive researching of illnesses, etc.). This package is not suitable for people who have anxiety about a physical illness they do actually have, nor those where a physical illness diagnosis is still being assessed.

Space from Social Anxiety

This package is suitable for people with mild to moderate anxiety in relation to social situations.

Additional modules - please choose all relevant. (Not all additional modules are available for every program).

Low Mood & Getting Active

Available on programs for the treatment of anxiety.

This module will help your client to understand the cycle of low mood and its emotional, cognitive, physical and behavioural aspects and draws from the Behavioural Activation protocol recommended by the NICE guidance for the treatment of depression. Specifically, this module focuses on the core maintaining issues of depression, inactivity and lack of motivation, and utilises Activity Scheduling to address these

Worry

Available on programs for the treatment of depression.

This module aims to increase awareness and understanding of worry and anxiety and provide practical strategies for managing worry that help the user to feel empowered and in control. Users are encouraged to determine whether a worry is practical or hypothetical, using the Worry Tree tool. The user can then focus on dealing effectively with these worries, either with problem solving or worry time techniques, or learning to let the worry go.

Facing Your Fears

Available on programs for the treatment of depression.

This module provides psychoeducation on avoidance and how it can maintain anxiety and increase fears over time. The user is introduced to safety behaviours and the avoidance cycle, and encouraged to identify their own safety behaviours. A main focus of this module is a CBT technique called 'graded exposure'. The user is invited to make a plan to gradually overcome their fears using graded exposure.

Money Worries

This module aims to help individuals understand how their financial difficulties are impacting their mental health and vice versa. Users are encouraged to reverse patterns of financial avoidance and impulsive spending and replace with more active and helpful ways of coping. Users can reduce levels of worry, self-criticism and shame about money problems, and increase hope and perceived ability to cope around finances in the future.

Challenging Times

The scale of the COVID-19 crisis is disrupting our personal and working lives. We are facing new challenges that are having an impact on our mental health. This module aims to support users in finding helpful ways to cope and adjust to these extraordinary circumstances.

My Self-Esteem and I

This module gives your client an opportunity to reflect on their beliefs, as well as how they tend to act and talk about themselves. It will allow them to assess whether they think about themselves in an unbalanced or unfair way. Your client will also have the opportunity to learn and practice how to be self-compassionate, by being mindful of their thoughts and feelings and how to be kind to themselves.

Sleep Difficulties

This module takes a closer look at sleep and helps your client to understand their difficulties with sleep. It will help your client to identify the things that may be influencing their sleep disruption and allows them to become aware of any habits that could be contributing to their sleep difficulties. This module also includes a number of suggestions which can help to improve your client’s sleep.

Relaxation

This module introduces your client to some relaxation techniques that they can use in their day-to-day life. However, relaxation is a skill and like any skill, it improves with practice. Your client is encouraged to set aside five minutes a day to practice one or more of the relaxation exercises that this module covers, such as a breathing exercise, progressive muscle relaxation or visualisation. This module includes audio clips to help your client with practicing these exercises.

Employment Support

The Employment Support module takes a look at some of the difficulties that your client may encounter in work, or when returning to work after a period of unemployment. There is an opportunity for your client to identify how (un)employment can have an impact on ones mood, how to cope with stress at work and to reflect on ones work-life balance. This module can also help your client in looking for a job, making their CV and how to prepare for and perform in an interview. A number of services are also recommended regarding employment and returning to work.

Behavioural Experiments

In this module, your client will learn how to test their negative thoughts and predictions. Behavioural experiments are a way for your client to test out whether what they predict will happen in a certain situation is an accurate prediction, or whether there are other ways that these situations might turn out.

Anger Management

This module will help your client to gain a better understanding of their anger and how to manage it more effectively. Your client may already be familiar with the TFB cycle. Therefore, this could be helpful for your client to learn how anger can affect their thoughts, feelings & behaviours.

Communication and Relationships

The Communication and Relationships module gives your client an opportunity to reflect on the ways in which they communicate and relate to the people in their life. It looks at what they can do to make their relationships more positive and satisfying. Whilst your client can only control their half of any relationship, there are a number of things they can do to positively contribute to them, which will be explored in this module.

Grief and Loss

This module aims to help your client understand and accept their own unique grieving process. It explores the nature of grief and debunks myths around the ‘right way’ that someone should grieve. It will give your client some suggestions on how to confront their grief and rebuild their life, hopefully helping them to make sense of their loss.

SilverCloud programs are suitable for patients with:

Mild to moderate depression & anxiety co-morbid with Chronic Pain, Diabetes Type 1 & 2, Lung Conditions, Coronary Heart Disease & Rheumatoid Arthritis. Health, Social and Covid-19 anxiety. Panic, Phobia, OCD and Perinatal.
Aged 16+
Being treated with or without medication

Exclusion criteria

Recent (4 weeks) active suicidal thoughts or ideation. Note: Indication of suicidal thoughts will be flagged as a suicide risk alert and be communicated back to the referrer as soon as possible by the local coordinator.
English reading/writing age below 10/11 years
Schizophrenia, acute phase of psychosis or mania, or with cognitive functioning disorder, e.g. dementia
Patient access to technical Requirements:

  • Desktop computer, laptop, tablet, or Smartphone, with speakers / earphones, broadband connection.

 

Referral procedure North Highland

Currently referrals are only accepted from GP’s

All referrals must be received via the SCI gateway pathway: Highland > Highland Non-GP > New Craig’s > SilverCloud > H cCBT – SilverCloud

You may choose only 1 program from the drop down menu and unlimited additional modules.

 

Referral procedure Argyll & Bute

Referrals are accepted from GP’s/Healthcare Professionals.

SCI Gateway referral – Highland → Highland Non-GP Locations/Providers → Argyll & Bute Mental Health → Silver Cloud → H cCBT Silver Cloud → Referral Clinic (select preferred programme – 1 only)

SCI Gateway is the preferred referral route however we do also accept paper referrals that can be emailed to: nhsh.beatingtheblues@nhs.scot

Current patient email MUST be included on the referral as this will be used to generate patient account.

Please be aware that if the patient does not log into their SilverCloud account within 90 days of receiving their login invite email they will be automatically discharged from the service and will no longer have access to SilverCloud.

Patient information

References

Further information for Health Care Professional 

(scroll down to see all references) 

SilverCloud is NICE and SIGN approved.

 

 

 

Last reviewed: 28 September 2022

Next review: 31 October 2025

Version: 2

Approved By: Approved TAMSG of the ADTC

Reviewer Name(s): Fiona Van Buren Psychologist

Document Id: TAM450

Internal URL: https://nhshighlands.azurewebsites.net/umbraco/#/content/content/edit/12064