pesky gnats!: using technology to adapt cognitive … · · 2017-06-16prof gary o...
TRANSCRIPT
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
Young person & parent
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. Pesky gNATs (Core CBT Principles for Anxiety & L ow Mood)
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
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
Young person & parent
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
Young person & parent
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
Pesky Gnats Feel Good Island RCT
0
5
10
15
20
25
30
Pre Post 3 Month FU
Glasgow Anxiety Scale ID - Total
Pesky Gnats TAU
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
Pesky Gnats Feel Good Island RCT
0
2
4
6
8
10
12
Pre Post 3 Month FU
Glasgow Anxiety Scale ID – Worries Subscale
Pesky Gnats TAU
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
Pesky Gnats Feel Good Island RCT
0
1
2
3
4
5
6
7
8
9
Pre Post 3 Month FU
Glasgow Anxiety Scale ID – Physiological Symptoms
Pesky Gnats TAU
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
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
1. Pesky gNATs (Core CBT Principles for Anxiety & L ow Mood)
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