pesky gnats!: using technology to adapt cognitive … · · 2017-06-16prof gary o...

Prof Gary O ’’’’ Reilly, Director Doctoral Programme in Clinical Psychology, University College Dublin E-mail: [email protected]

Pesky gNATs!: Using Technology to Adapt

Cognitive Behaviour Therapy for Young People

@peskygnats

www.PeskyGnats.com

The therapeutic space

between client & therapist

Therapist

Young person & parent

Is there a space to add technology to traditional face-to-face therapy?

3. A smartphone App to transfer learning from therapy sessions to home, school & community

Therapist


1. A suite of web-based on-line training videos for mental health professionals

2. A CBT computer game played by young people & their therapist in therapy sessions

Our computer games and apps drop technology into the existing therapeutic space between client & therapist

Our current range of games

1. Pesky gNATs (Core CBT Principles for Anxiety & L ow Mood)

4. Pesky gNATs Trauma Recovery Island (PTSD; abuse ; trauma)

3. Mindful Gnats (Mindfulness and Relaxation Skills )

2. Pesky Gnats: Feel Good Island (Adults ID and a M H difficulty).

CBT is developmentally out of synch with childhood cognition


1. We can deliver psychological interventions through technology solving many problems along the way.

StimulusC

og

nit

ive

Pro

cess

es

Schemata

Positive, neutral, negativeautomatic thinking

feelingbehaviour

Automatic mode of processing stimuli

Interpretation

Memory

Attention

Attitudes/Beliefs

Cognitive Behaviour Therapy

Aw

are

ne

ss &

Sk

ill

Level 1: Surface Level Cognition

Level 2: Intermediate Cognitive Processes

Level 3: DeeperCognitive

Organisation

The Cognitive Behavioural Model

Dozois, D. & Beck, A. (2011) Cognitive therapy. In J. D. Herbert, & E. M. Forman (eds). Acceptance and Mindfulness in Cognitive Behaviour Therapy. Understanding and Applying the New Therapies. New York: Wiley.

Making a CBT model accessible in the

therapeutic space between client & therapist

Piaget

Vygotsky

Donaldson

Bandura

Cognitive Development

Zone of Proximal Development

Social Cognitive Development

Social Learning Theory

Pesky gNATs A CBT computer game for young people with

anxiety or low mood

Prof Gary O’ Reilly and Dr David Coyle

1. In-session computer game features: Avatars

Standardised measures of psychological functioning used in CY-IAPT are embedded into the game. They are completed, scored, profiled and displayed to the young person instantly

- The Revised Children’s Anxiety and Depression Scale (RCADS)

- The Children’s Outcome Rating Scale (CORS)

- The Children’s Session Rating Scale (CSRS)

2. In-session computer game features: Measures

A child friendly concrete metaphor for standard CBT ideas that unfolds in each level of the game :

1. Intro to the CBT model = TFBs go together2. Negative Automatic Thoughts (NATs) = gNATs or little flies

that sting without you noticing. 3. Thought Monitoring = gNAT trapping .4. Cognitive Restructuring becomes gNAT swatting .5. Identifying Core Beliefs becomes gNATs Hive Hunt. 6. Core Belief challenging = Splat a Hive

7. Relapse prevention = Future World Cinema

3. In-session computer game features: MetaphorsCognitive Development

A social story delivered through the narrative of the game world to support a young person’s introduction to these CBT concepts

The child plays a computer game where they control a custom built Avatar who represents them on a visit to an island where they help a world famous explorer called David gNATenborough and his team of investigators.

As the narrative of the game unfolds they learn abo ut themselves, gNAT trapping, gNAT swatting, and tracing gNATs back to their hive by helping with experiments devised by David gNATenbourough and his team in the world’s first gNAT lab.

4. In-session computer game features: StoriesSocial

Cognitive Development

3. Young person & therapist work together apply that CBT concept

to young person

4. Young person transfers that learning to their home, school & community with

a between session task

2. An in-game “previous player” provides a social model of how that

CBT concept applied to them

5. In-session computer game features: Structure

1. A game character defines a single CBT concept in each level

Social Learning Theory

Played with your therapist…

1. All the benefits of a therapeutic relationship

2. Allows for zone of proximal development for CBT concepts

3. Ensures integrity of CBT programme delivery combin ed with a nuanced personal experience of the intervent ion

4. Pace of progress through the game can be determin ed by the therapist and supplemental material or consolid ation of skills added as appropriate

5. With younger children it can be very helpful to p lay the game with a child and a parent together

Using computer games to deliver Cogni ve Behaviour Therapy

to young people during therapy sessions

Therapist


6. In-session computer game features: AssistedZone of

Proximal Development

Game Level Core CBT Concept

1 Thinking-Feeling Behaviour Go Together

2 Cognitive Monitoring: Introducing 6 Types of Negative Automatic Thinking

3 Cognitive Monitoring: Introducing 5 More Types of Negative Automatic Thinking

4 Cognitive Restructuring

5 Identifying Core Beliefs

6 Challenging Core Beliefs

7 Relapse Prevention

7. In-session computer game features: Content

Pesky gNATs Level 1

Session 1: Meet Prof Alannah Karr who teaches you that thoughts, feelings and behaviours go together

Pesky gNATs Levels 2 & 3

Sessions 2 & 3 : Meet Scott Livingstone, an explorer who is an expert on catching gNATs.

Introduces young player to the gNAT gallery & teaches them how to set a gNAT trap…aka Thought Monitoring

Pesky gNATs Level 4

Session 4: Meet Shona, the young person who played the game before you who shares her examples in each level

Learn how to swat gNATs…aka cognitive restructuring

Pesky gNATs Levels 5 & 6

Sessions 5 & 6: Hunt gNATs back to their hive with Kirsten Katcher with some help from Shona & Pesky Pup.

Learn how gNATs come from Hives…aka Core Beliefs and how to gather your gNATs into their Hives.

Pesky gNATs Level 7

Session 7 : Work with David Gnatenborough to Develop a Future Life Plan

Lots of mindfulness, relaxation, breathing and activity scheduling skills available within the game.

1. Controlled Breathing 2. Progressive muscular relaxation 3. Activity Scheduling 4. Mindfulness of sounds 5. Leaves on a stream 6. Mindfulness of an object 7. Mindfulness of what’s on your mind 8. Mindful seeing

This Leaves on a stream video is available on Youtube

8. In-session computer game features: Skills

Transfer learning to home, school

& community


9. In-session computer game features: App & Workbook

• Its free!

• Available for Android and iOS

• Searching on iTunes you will only find it as an iPhone app (not while searching for iPad Apps) even though it works for both

• We collect no data from young people

• Content is locked-down on download from Google Play or iTunes Store

• Young person requires an individually generated access code from a registered Pesky gNATs therapist to unlock the app

• You create this code for them by logging into your Pesky gNATs account

9. In-session computer game features: Pesky gNATs App

1. Reminders of the content of each session

2. Between session practice of CBT skills, mindfulness skills and relaxation

3. Beautifully illustrated

9. In-session computer game features: Workbook

Visit our website: www.PeskyGnats.com

Follow us on Twitter: @peskygnats

Please share your knowledge about our work with other people…

Find us on Youtube

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Time 1 Time 2

Pesky Gnats

TAU

Parent Report (CBCL) Internalising Scores – 16 Pesky Gnats V 13 TAU young people 9-16 yrs attending a Health Service Executive child mental health setting

Clinical Range

Borderline Range

Normal Range

F values: group = 1.14; time = 31.98 ***; group x time = 2.54 Ryan, A., O’ Reilly, G., Coyle, D. & Delahunty, A. (2013). A Pilot-Study of a Computer-Assisted CBT Game in a Chid and Adolescent MentalHealth Setting. School of Psychology; University College Dublin

Pesky Gnats Feel Good Island RCT

Cooney, P., Jackman, C., Coyle, D., O’ Reilly, G., (2017) A randomised controlled trial evaluation of Pesky Gnats: The Feel Good Island: a prototype cognitive behaviouraltherapy computer game for adults who have an intellectual disability and anxiety or depression. British Journal of Psychiatry


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Pesky Gnats TAU


www.PeskyGnats.com On-line Training

• Clinical Psychology, • Educational Psychology,• Counseling Psychology, • Child and Adolescent Psychiatry, • Post Graduate Degree Qualification in

an evidenced based form of Psychotherapy,

• Post Graduate Qualification in CBT, or • Social Work.

Our current range of games


3. Pesky gNATs Trauma Recovery Island (PTSD; abuse ; trauma)

4. Mindful Gnats (Mindfulness)

2. Pesky Gnats: Feel Good Island (Adults ID and a M H difficulty).

1. We can deliver psychological interventions through technology solving many problems along the way.

4. Here’s something useful you can take home from today and introduce to your team and clients

A gift for you from today’s talk… Mindful Gnats App

free from the iTunes store or Google Play

• Pesky gNATs and all of its related assets are owned by Handaxe - A Community Interest Company (CIC)

• All of its activities are directed towards the benefit of the community on a not-for-profit basis.

Prof. Gary O’ Reilly, Clinical Psychologist

Dr. David Coyle, Computer Scientist

Handaxe CIC was co-founded by…

Who owns Pesky gNATs?

Pesky gNATs was funded by the SBRI

Pesky gNATs was supported by University College Dublin & University of Bristol

Thank you…

• Areaman Productions• BBC • Dr Mary Belton • Ann Blackwood• Connie Booth• Dr Jessica Braham • Laura Canavan• Prof Alan Carr • John Cleese• Patricia Cooney• Sadhbh Coyle • Laura De Burca• Alan Delahunty• Dr Roger Davies • Dr Gavin Doherty • Chris Donnelly • Patricia Duggan • Yagiz Erkin• Eamon Franklin• Caroline Gill • Clare Gormley• Katie Hendrick

• Prunella Scales• Staff at HSE Galway • Staff at NEPS Fredrick Court • TEDxUCD• Conal Tunney • Dr Cait Verling• Darren Walsh• & everyone who has tried to

help us

• Catherine Jackman• Muriel Keegan • Dr Yvonne Kelly• Rob Kennedy• John Mathews• Dr Nicola McGlade• Gavin O’Connor • Maurice O’Donoghue• Paul O’Donoghue• Aisling O’Dwyer-O’Brien • Nicholas Offer • Charlie O’ Malley• Tomas O’Suilleabhan• Doireann ni Chorragain• NOVA UCD • Opposable Games (EVERYONE!) • Dr Karl Quinn • Dr Aisling Ryan

• Andrew Sachs • SBRI Healthcare • Dr John Sharry• Jackie Shipp

pesky gnats!: using technology to adapt cognitive … · · 2017-06-16prof gary o...

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