Fungus gnats in forestry nurseries and their possible role ...
Pesky gNATs!: Using Technology in CBT with Young People€¦ · Works equally in clinic/community...
Transcript of Pesky gNATs!: Using Technology in CBT with Young People€¦ · Works equally in clinic/community...
Professor Gary O’Reilly,
Director
Doctoral Programme in Clinical Psychology,
University College Dublin
E-mail: [email protected]
Pesky gNATs!: Using Technology in CBT with
Young People
@peskygnats
www.PeskyGnats.com
1. What we have learnt from using technology to
tackle the lack of availability of mental health
services
2. Our experience at Pesky gNATs of using
technology to help young people understand
complex psychological models
Today…
Twomey, C. & O'Reilly, G. (2016). Effectiveness of a freely available computerised CBT programme (MoodGYM) for
depression: meta-analysis. Australian and New Zealand Journal of Psychiatry
Mood Gym 850,000 registered users
11 RCT studies demonstrated
MoodGYM’s effectiveness for
depression symptoms at post-
intervention, with a small effect size
(g=0.36).
6 RCT studies demonstrated
MoodGYM’s effectiveness for
anxiety symptoms at post-
intervention, with a medium effect
size (g=0.57,)
6 RCT studies did not yield
significance for MoodGYM’s
effectiveness for general
psychological distress
symptoms
Works equally in clinic/community
Developer/Non Developer no diff
Best when therapist assisted
Local origin works better
Drop-Out rates 0-73%
What have we learnt about building on-line mental health tools?
Therapist Personal Characteristics: 1. Empathic2. Respectful3. Kind 4. Sincere & Genuine5. Interested6. Confident
Are there benefits to blending technology
with traditional face to face therapy?
Therapist Relationship Positions: 1. Collaborative
2. Impartial 3. Curious
4. Open-minded5. Non-Collusive
6. Appropriately self-disclosing
Therapist Behaviours: 1. Communicates clearly2. Rewarding and encouraging3. Encourages active participation4. Reflective listening5. Directive
Therapist Behaviours: 6. Asks open-ended questions
7. Spends appropriate time on issues 8. Deals with frustration + difficulties
9. Non-confrontational challenging 10. Appropriate use of humour
The benefits of a high quality therapeutic relationship
We can support the client & therapist while maintaining their relationship
Children:
Anxiety & Low Mood
www.PeskyGnats.com On-line Training
www.PeskyGnats.com On-line Training
www.PeskyGnats.com On-line Training
• Psychological Well-Being Practitioner
• Post Graduate Degree Qualification in
an evidenced based form of
Psychotherapy,
• Post Graduate Qualification in CBT,
• Clinical Psychology,
• Educational Psychology,
• Counseling Psychology,
• Child and Adolescent Psychiatry, or
• Social Work.
A CBT computer game played in-session
with your therapist
Stimulus
Co
gnit
ive
Pro
cess
es
Schemata
Positive, neutral, negative
automatic thinking
feelingbehaviour
Automatic mode of processing stimuli
Interpretation
Memory
Attention
Attitudes/Beliefs
Cognitive
Behaviour
Therapy
Aw
aren
ess
& S
kill
Level 1: Surface Level
Cognition
Level 2: Intermediate
Cognitive Processes
Level 3: Deeper
Cognitive
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.
Therapist Personal Characteristics: 1. Empathic2. Respectful3. Kind 4. Sincere & Genuine5. Interested6. Confident
Therapist Relationship Positions: 1. Collaborative
2. Impartial 3. Curious
4. Open-minded5. Non-Collusive
6. Appropriately self-disclosing
Therapist Behaviours: 1. Communicates clearly2. Rewarding and encouraging3. Encourages active participation4. Reflective listening5. Directive
Therapist Behaviours: 6. Asks open-ended questions
7. Spends appropriate time on issues 8. Deals with frustration + difficulties
9. Non-confrontational challenging 10. Appropriate use of humour
CBT: Delivering a model developed for adults to children?
Piaget
Vygotsky
Donaldson
Bandura
Cognitive
Development
Zone of Proximal
Development
Social Cognitive
Development
Social Learning
Theory
Sensori-motor
phase (0-2yrs)
Pre-operational
phase (2-7yrs)
Concrete
operational
phase (7-12yrs)
Formal
operational
phase (12yrs +)
Abstract thinking
1. Attention to essential features of the model's behaviour;
2. Retention in memory of the model's behaviour so it can be
replicated in the absence of the model;
3. Motoric reproduction of the behaviour symbolically represented in
memory;
4. Reinforcement and motivation for the behaviour’s retention.
Therapist scaffolds the child’s application
of CBT concepts to his/her life
Concrete
operational
phase (7-12yrs)
Formal
operational
phase (12yrs +)
Abstract thinking
Children’s thinking is at its most
sophisticated in social contexts
Cognitive
Development
Zone of Proximal
DevelopmentSocial Cognitive
Development
Social Learning
Theory
Young person [& parent?]Therapist
Beck’s CBT
Model
filtered
through
Delivered by
a computer
game
Therapeutic Relationship
Piaget
Vygotsky
Donaldson
Bandura
The young person experiences a child friendly CBT intervention delivered through
a computer game played within the supportive relationship with their therapist
O’ Reilly, G., McGlade, N., & Coyle, D., (2009). David Gnatenborough’s Island. A Computerised Cognitive Behavioural Therapy Programme for
Children & Adolescents. Version 1.0
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Extremely"Poor" Below"Average" Average" Above"Average" Excellent"
Ireland"(n"="644)"
UK"(n"="265)"
USA"(n"="220)"
Overall"(n"=1142)"
Ratings of 1142 mental health professionals from Ireland, UK & USA of their overall impression of cCBT game Gnats Island
Key point!
93.7% of mental
health professionals
from 3 countries
rate Gnats Island as “above average” or
“excellent”
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
Individually monitoring engagement and outcome
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 together
2. 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
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 combined
with a nuanced personal experience of the intervention
4. Pace of progress through the game can be determined by
the therapist and supplemental material or consolidation
of skills added as appropriate
5. With younger children it can be very helpful to play the
game with a child and a parent together
UsingcomputergamestodeliverCogni veBehaviourTherapytoyoungpeopleduringtherapysessions
Therapist
Youngperson&parent
4. In-session computer game features: AssistedZone of
Proximal
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 about
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.
5. 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
6. In-session computer game features: Structure
1. A game character
defines a single CBT
concept in each level
Social
Learning
Theory
7. Game Features: Content: Pesky gNATs Level 1
Session 1: Meet Prof Alannah Karr who
teaches you that thoughts, feelings and
behaviours go together
Game Features: Content: 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
Game Features: Content: 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
Game Features: Content: 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.
Game Features: Content: Pesky gNATs Level 7
Session 7: Work with David Gnatenborough to Develop a Future Life Plan
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. Game Features: CBT content
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
8. 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
8. In-session computer game features: Pesky gNATs App
8. In-session computer game features: App & Workbook
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
Children:
Anxiety & Low Mood
Children:
PTSD; abuse;
trauma
Children:
Mindfulness Relaxation
Adults:
ID and a MH difficulty
A gift for you from today’s talk…
Mindful Gnats App
free from the iTunes store or Google Play
www.MindfulGnats.com
1. What we have learnt from using technology to
tackle the lack of availability of mental health
services
2. Our experience at Pesky gNATs of using
technology to help young people understand
complex psychological models
Today…
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
• Dr Clodagh Dowling
• 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