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Permalinkhttps://arstechnica.com/science/2024/09/roll-for-insight-using-dungeons-dragons-as-a-group-therapy-tool/
Dungeon-mastering emotions: D&D meets group therapy
Research is ongoing, but therapists are happy with early results.
Kenna Hughes-Castleberry – Sep 30, 2024 3:42 PM
This year marks the 50th anniversary of the tabletop role-playing game
(TTRPG) Dungeons & Dragons (D&D). A game of creativity and imagination,
D&D lets players weave their own narrative, blending combat and
roleplaying in an immersive gaming experience. And now, psychologists
and therapists are working to turn it into a tool by exploring its
potential benefits as a group therapy technique.
Research is still in progress to determine if there are links between
playing D&D and enhanced empathy and social skills, but the real-life
impact of D&D therapy is slowly gaining traction as staff of counseling
practices that have embraced D&D group therapy say they are witnessing
these benefits firsthand.
“It seems particularly useful in combating the effects of social
isolation and improving both interpersonal skills and intrapersonal
skills (problem-solving),” explained Gary Colman, the chairman of Game
Therapy UK, a registered charity staffed by volunteer professionals who
are developing evidence-based therapeutic gaming projects. “In practical
terms, it can also be used for a range of purposes, including modeling
positive behavior and teaching soft social skills and basic educational
skills, including language and numeracy.”
What is D&D?
At the heart of D&D lies the power of imagination. The Dungeon Master
(DM), who plays the roles of all non-player characters (NPCs) and
monsters, sets the stage for various scenes and acts to open up the
limitless possibilities and creative potential of the game.
Players customize their characters’ abilities and personalities to
either participate in a roleplaying session, act out scenes with NPCs to
further the story, or engage in combat with terrifying monsters like
bugbears or gloomstalkers. Individual gaming sessions can run for
multiple hours and, combined, allow players to work through a larger
campaign that lasts for weeks or even years.
The game was created in 1974 by Ernest Gary Gygax and Dave Arneson.
Gygax’s company, TSR, Inc. (Tactical Studies Rules), steadily grew into
a multimillion-dollar business but was plagued by leadership and
financial issues for decades. Ultimately, TSR was acquired by its
competitor, Wizards of the Coast (the company responsible for Magic: The
Gathering) in 1997 (Wizards of the Coast would be acquired by Hasbro in
1999).
While D&D had humble beginnings as a niche fantasy game played only by
nerds, its popularity has skyrocketed, partially due to Netflix’s
blockbuster show Stranger Things. Since the show’s release in 2016,
sales of the game have reached a high not seen in 30 years. Netflix even
offered D&D tutorials to Stranger Things fans who wanted to learn to
play the game like their favorite characters. The show boosted D&D’s
popularity so much that Hasbro released a Stranger Things D&D starter set.
Unlike on previous shows where it has made appearances, such as The
X-Files or The Big Bang Theory, D&D is central to the plot of Stranger
Things, as it's played by the show’s main heroes as they try to learn
more about the mythical “Upside Down” realm in their town. Monsters and
villains like the Demigorgon and Vecna are even named after real D&D
baddies.
Stranger Things also accurately portrays the impacts that the 1980s
Satanic Panic movement had on D&D. The Satanic Panic was led by
religious fundamentalist groups who claimed that D&D promoted worship of
the devil, witchcraft, violence, and teen suicides. The backlash against
the game was so acute that it was banned from many schools in the early
1980s, and the second edition removed all devils and demons. Ultimately,
confirming that there’s no such thing as bad publicity, this helped the
game become more popular.
Links to the Satanic Panic can be found early in the show, such as the
disappearance of Will in season one, which was inspired by the real-life
disappearance of Michigan State University student James Dallas Egbert
III in August 1979—an event that helped kick off the Satanic Panic
movement. While Egbert III reappeared a month later, detectives working
the case believed that D&D had inspired Egbert to hide in his school’s
steam tunnels, a claim which Egbert III later refuted. Unlike in
Stranger Things, where Will is reunited with his family, Egbert III
committed suicide a month after his reappearance.
Fast forward to today, and D&D has climbed even higher in popularity
thanks to the 2023 multimillion-dollar movie Dungeons & Dragons: Honor
Among Thieves, which grossed $200 million, turning a profit despite its
$150 million budget.
D&D usage in therapy—more research is needed
For therapists like Colman, D&D’s rising popularity seems to help
persuade patients that it’s a possible therapeutic tool.
“I think that the popularity of TTRPGs as ‘niche’ games and as an
increasingly mainstream ‘brand’ (featured in popular movies, cartoons,
and TV shows) has helped us reach wider groups,” Colman said. “Whether
it’s potential clients or funders, when we ask, ‘Have you heard of games
such as Dungeons & Dragons?’ The answer is increasingly ‘yes,’ even if
they haven’t actually played them.”
D&D became the focus of therapeutic research in the mid-1990s, but only
a handful of papers have shown its possible effectiveness. “There is
currently very little good-quality, peer-reviewed evidence published in
scientific journals on the benefits of TTRPGs,” said Colman. “The
challenge has been the very small sample size of the research projects
and the challenge to find funding.”
Colman and his collaborators at Game Therapy UK are working with several
UK universities to create objective benchmarks to test the effectiveness
of D&D as a therapeutic tool. Colman said his team has “several very
interesting projects that [they] are currently exploring, including the
effects of using TTRPGs with military veterans with mental health
conditions caused by their military service, the experience of autistic
adults and young people playing TTRPGs, and the impact of lunchtime
TTRPG clubs on school attendance of children with special educational
needs.”
Some results are in
While the research is ongoing, many academics and therapists say they
have already seen positive results implementing D&D as a therapeutic
tool. Most recently, a group of researchers at the University College
Cork published findings in the International Journal of Role-Playing
showing that D&D can positively support a player’s mental health state.
How does this work? In a standard D&D group therapy session, gameplay
begins with an introduction to allow the patient/player to get into
their character’s mindset; the game then runs for 70 to 90 minutes,
followed by a 15- to 20-minute debriefing session to allow for
discussion. The session is intended to provide a safe space for people
to explore past trauma and work on social anxiety, depression, or other
issues in a productive way.
Through the session, the therapist creates specific scenarios for
individual players and the group to interact with. These scenarios may
be a partial re-enactment of an issue or memory an individual has faced
(such as dealing with a difficult person like a bully or abusive family
member) or a unique situation that challenges an individual with a tough
decision or invokes an emotional response. The player-driven narrative
of D&D enables players to respond to these scenarios however they
choose, allowing them to react candidly. The therapist may then allow
the individual to sit with their scenario while giving the other players
a separate situation or bringing the individual back into the larger
narrative after completing the scenario.
By interacting with situations as a character, players can potentially
enjoy some emotional separation from their personal responses. “A lot of
what I end up doing implicitly with D&D is helping people shift from a
self-focused view of their emotions as a problem to a systems lens
understanding... recognizing our emotions are adaptive and an outside-in
phenomenon instead of an inside-out judgment of our worth,” explained
Vinny Malik Dehili, a staff therapist at Vassar College.
“So D&D helps people mentalize and think in terms of ‘why does this
person feel this way or act this way?’ If I have a character that’s the
opposite of me—like I’m more accommodating by nature and I want to be
more assertive—I can think about their backstory and say, ‘Well, what
would have happened to them in their life to make them have to be this
way?’” he said.
The bleeding effect
I have personally seen the "bleeding" effect in my D&D group, which I’ve
been a part of for over a year. When building my character, a chaotic
good Bard named Corvie Inkberry, I found a lot of “bleeding in” happened
during the process. Corvie is a 92-year-old woman cursed with old age
(Howl’s Moving Castle, anyone?), blindness, and bad body odor. While she
plays a comedic relief character in our campaign, advertising her books
such as To Bard or Not to Bard, It’s a Bard-Knock Life, and Die Bard 4,
I’ve also been working to make her reconcile the real aspects of old
age, including memory loss. By attempting to role-play a character
struggling with memory loss, I’ve learned how to better navigate
relationships with family members who currently struggle or may struggle
with this in the future—even myself.
During these sessions, the therapist may temporarily pause the game to
briefly address the therapeutic processes the player is experiencing
outside of the game, depending on the player’s emotional state. However,
after the session, the therapist will typically dive much deeper into
the players' responses and reactions to the day’s scenarios. Addressing
the therapeutic processes post-game gives the session stricter
boundaries, containing therapeutic experiences and breakthroughs to a
specific space and time. These guidelines are similar to role-playing
techniques for other therapeutic processes, such as cognitive behavior
therapy (CBT). In all cases, these strict boundaries allow the character
and player to separate their identities and struggles more easily.
The cross-over effects between character and player are called “bleed,”
where “bleeding in” happens when part of the player’s personality and
backstory affects the character, while “bleeding out” occurs when the
character’s personality or backstory affects the player. According to
experts, this phenomenon helps when measuring the effectiveness of D&D
in group therapy settings.
“The main priority in using D&D as a therapeutic tool is the safety and
wellbeing of the participants, as ‘bleed’ can occur where something
within the game session can impact an individual while they are out of
that space,” said Dr. Jeremy Jones, a licensed professional counselor
and CEO of Thinking about Thoughts Counseling Services, which offers D&D
group therapy. “A trained facilitator can set up the environment,
incorporate safety tools, and have a skill set in working with a group
setting.”
The “group” in D&D group therapy
While D&D group therapy can help individuals, it has also been shown to
strengthen group dynamics, as it can encourage individuals to become
more sociable and assertive as ways to solve problems and further the
story. Experts found that these benefits seemed to be especially helpful
during the forced isolation caused by the COVID-19 pandemic. However,
this seems only to work when the group has a collaborative instead of a
competitive mindset.
“The more you can follow the group’s needs or energy rather than feeling
like I have to make this story or make this intervention happen right
now, that usually ends up being a better experience,” Dehili added.
To get the most productive and positive group experiences, therapists
using D&D as a therapeutic tool may need to create additional boundaries
and rules to ensure the session benefits everyone, not just one individual.
“It’s important to have safety tools within the game, talking about what
content is acceptable and what’s not acceptable based on the [players’]
traumas or histories,” Dehili said. “D&D, like most things within our
society, has a history of white supremacy and other kinds of racism, as
well as misogynistic tropes. So it’s really important to be intentional
with how you set up the frame of the group in terms of what’s going to
be leaned into and what’s not. We can use humor, slapstick, and other
modalities, but we’re trying not to make parallel political and social
references. We’re trying to avoid the stereotypes—for example, the name
‘hag,’ which is this monster, and it’s also usually in a feminine
figure, or orcs being darkly skinned and brutish. So we want to invite
people to notice what activates them and be able to shift within the space.”
The range of game settings, plotlines, and characters allows therapists
to create a huge variety of therapeutic scenarios for patients. “There
is no ‘standard’ way of playing D&D, and it can very much depend upon
the group that someone is in,” said Ian Baker, a professor of psychology
at the University of Derby.
Experts recommend combining D&D with other therapeutic sessions and
methods instead of using it as the only source of therapy. “D&D can be
complicated and very rules heavy, which can be a barrier to entry in
itself and should be a consideration,” said Jones. The game’s
complexities can dilute its impact on a patient compared to other
therapy techniques.
However, if the therapist/DM can navigate the rules-heavy format while
encouraging positive group dynamics, the results can be significant.
“Generally, if the group is thoughtful and considerate—and, most
importantly, keep the game fun for all involved—it’s highly likely to be
a positive gaming experience,” said Colman.
Kenna Hughes-Castleberry is the science communicator at JILA (a joint
physics research institute between the National Institute of Standards
and Technology and the University of Colorado Boulder) and a freelance
science journalist. Her writing focuses on quantum physics, quantum
technology, deep technology, social media, and the diversity of people
in these fields, particularly women and people from minority ethnic and
racial groups. Follow her on LinkedIn or visit her website.