Development and Research

Feel Good Island

Pesky gNATs ID builds on the successful Pesky Gnats programme, a computer based CBT programme for use by mental health professionals who work with children and adolescents, developed by Prof. Gary O Reilly and Dr. David Coyle.

From its inception, Pesky gNATs ID has been guided by and evaluated through published research.

The first step in developing Feel Good Island was the completion of a systematic review of the evidence regarding cognitive therapy skills that assist the use of CBT for adults with intellectual disabilities, which was published in JARID:

Cooney, P., Tunney, C., & O'Reilly, G. (2018). A systematic review of the evidence regarding cognitive therapy skills that assist cognitive behavioural therapy in adults who have an intellectual disability. Journal of Applied Research in Intellectual Disabilities, 31(1), 23-42.

The findings of this systematic review guided the development of a prototype game based on the original Pesky gNATs programme and adapted for people with intellectual disabilities - this was called Feel Good Island.  The Feel Good Island prototype used the same CBT concepts as in Pesky gNATs but made adaptations to the structure, language, visuals, stories, exercises and workbook. In addition, five people with intellectual disabilities recorded the voiceovers for the games avatars.

A randomized control trial (RCT) was completed to examine whether Feel Good Island was successful, both in terms of adaption, and also its efficacy in supporting clinical change for people with intellectual disabilities experiencing mental health difficulties. The trial was published in the British Journal of Psychiatry:

Cooney, P., Jackman, C., Coyle, D., & O'Reilly, G. (2017). Computerised cognitive–behavioural therapy for adults with intellectual disability: Randomised controlled trial. The British Journal of Psychiatry, 211(2), 95-102.

This trial found Feel Good Island produced clinically significant change maintained at three month follow up for the treatment of anxiety symptoms in comparison with psychiatric treatment as usual (TAU) for adults with intellectual disabilities. The intervention had a medium-sized effect on anxiety symptoms post-intervention and a large-sized effect after a 3-month follow-up period. Furthermore, the intervention led to a clinically meaningful improvement for almost 40% of people three months after completing the intervention.

Based on the positive outcome from the RCT, the prototype was developed into the current Feel Good Island. This version builds on the prototype through:

  • Improved graphics and gameplay

  • Specially designed avatars to represent people with disabilities

  • Avatars voiced by professional actors with disabilities



Mindful Island

Participants involved in the RCT on the orignial prototpye commented on the usefulness of the mindfulness based interventions that are a part of the Feel Good Island. Based on this positive feedback, an additional prototype programme to translate and adapt mindfulness concepts for people with intellectual disabilities was developed - Mindful Island. This programme used the same gaming software but introduced mindfulness based interventions. 


People with disabilities experience of using this programme was also researched and published in the British Journal of Learning Disabilities:


Clyne, C., Jackman, C., Tully, M., Coyle, D., & O’Reilly, G. (2022). “We live in the moment”—Experiences of people with Intellectual Disabilities and Clinicians of Computer‐Assisted Mindfulness and Relaxation. British Journal of Learning Disabilities, 50(3), 422-432.


This research found mindfulness can be adapted to computer-assisted technology for use among people with intellectual disabilities. Participants found the intervention an enjoyable experience and saw a number of benefits to engaging in it including perceived improved confidence and perceived reduction of worries