Last Friday, David Coyle, Bristol Univeristy’s Senior Lecturer in Human Computer Ineraction, came to the Studio to talk about his new company Handaxe Limited and their flagship game Pesky gNats. In February of this year, David and Clinical Psychologist Gary O’Reilly set up Handaxe Ltd, a not-for-profit company dedicated to designing new tools to support child and adolescent mental health services. Pesky gNats has specifically been developed to aid face-to-face clinical interventions with adolescents aged 9-15.

David started his talk by introducing some of the problems that Handaxe are setting out to tackle. He told us that Mental Health Disorders are currently one of the leading causes of disability and loss of life in the UK. David quoted Economist Richard Lanyard, who has said that ‘Mental Illness is now our biggest social problem’. To put it into economical perspective, it costs 2% of Britain’s annual GDP. Most mental health disorders begin during youth, and one in 5 adolescents are estimated to have diagnosable mental disorders. David said in order to try to tackle this statistic, we need to increase access to and engagement with mental health services, and we need to do this in a clinical and cost effective manner.

Over the past few years, David has been developing a 3D computer game, structured around a series of in-game conversations, which implement the core aspects of Cognitive Behavioural Therapy. CBT is built around a series of meta-cognative tasks. It explores the relationships between thoughts, feelings and behaviours, and teaches people to think about, classify and challenge their own automatic negative thoughts. These meta-cognitive tasks do not always come naturally to younger people; the challenge lies in translating CBT into an appropriate form for young people.

In Pesky gNats, players visit a tropical island and meet a team of wild life explorers. This team introduces mental health concepts using spoken conversation, embedded animations, videos and questions regarding the player’s own situation. Cognitive Behavioural Therapy concepts are introduced using concrete metaphors. Negative automatic thoughts are presented as little creatures called gNats that can sting people, causing negative thinking.

Having a three-way dynamic between computer, patient and therapist can make face-to-face clinical interventions feel a bit less daunting for adolescents. At the age where eye contact with adults can be difficult, the game acts almost as an external mediating factor, creating a context for more detailed conversation between patient and therapist and helping to build a positive therapeutic relationship. Using this sort of technology as a therapeutic tool could bridge the gap between cuddly toy-filled child therapy clinics and adult face-to-face therapy.

In a controlled clinical evaluation with the HSE, 9 – 16 year olds who had Pesky gNats as part of their treatment showed more improvements in interaction with family and friends and performance at school than those who had been treated as normal. The game is also said to have favourable effects on adolescents showing signs of anxiety or depression in a non-clinical setting (e.g. schools) but David stressed that the way in which the clinician introduces the game and monitors expectations is vital, and that he wouldn’t be happy with the game being used as a tool without training. Handaxe are taking steps to develop an online training system that clinicians will need to access in order to use the game.

Handaxe have received funding from the Random Acts of Kindness Foundation and NHS England’s SBRI Healthcare to develop Pesky gNats. They have been working with Opposable Games to improve the game mechanic and add new features. David told us that one of the key improvements was adding more ethnically diverse and appealing avatars for players to choose to represent them. Handaxe are also creating an app that the patients can play at home to reinforce the messages in the game.

Pesky gNats provides a positive and fun experience of mental health services for vulnerable young people, helping to reduce the stigma surrounding therapy. They are looking for interaction designers, web developers and creative thinkers to help them. Get in touch with them through the Handaxe website if you would like to find out more or offer your support for the project.