If the effect turns out to be insufficient, treatment is stepped up to a more complex, costly or taxing level. The aim is to ensure that all eligible patients have access to appropriate care, while reserving the most intensive treatments for those that have not to benefitted from lower intensity treatments. There is evidence to suggest that psychological treatments, especially cognitive behavioural therapy (CBT), are effective treatments for mild-to-moderate depression and anxiety (Otte, 2011, Driessen and Hollon, 2010, NICE, 2009).