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Subject: [Ars Technica] Dungeon-mastering emotions: D&D meets group therapy
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Date: Fri, 11 Oct 2024 11:27:01 +0200
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Source: 
https://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 
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