Tabletop roleplaying games, or TTRPGs, are kind of like improv theater, but with some structured rules and an element of random chance.

It can be a lot of fun to gather around a friend’s table and tell a story together. And it can be emotionally rewarding, too.

In fact, a lot of players like to joke that TTRPGs can be just as good as going to therapy. And the therapists… they noticed. Not only that, but some of them agreed and started researching how to really, actually turn tabletop games into therapy.

For real. Here’s how. [♪INTRO] If you’ve heard of any TTRPG, it’s  probably Dungeons and Dragons, or D&D for short, with its  elves and dwarves and goblins. And dungeons!

And dragons! But there are actually a ton,  from D&D’s cousin Pathfinder, to spooky investigation games like Monster of the Week or Call of Cthulu. Which is apparently not how  Lovecraft pronounced it.

Which is what we learned  while researching this video. It is objectively Cthulu. I will fight anybody who tells me otherwise.

Then there’s the really niche  stuff, like a game that asks what it would be like to be an in all-female  Soviet night-flying bomber pilot squadron in World War II  called “The Night Witches” – which was actually a thing  that happened in history – and is also a roleplaying game. They run the gamut, but what  most TTRPGs have in common is: that they are social experiences where players are communicating and cooperating. In general, each player creates  their own custom character, and there’s some sort of narrative  story you’re all telling together.

And each player actively takes  part in shaping both their character’s story and the larger  narrative through roleplaying – that is, thinking through  whatever imaginary scenario is in front of them, whether it be an  angry dragon or a spooky mansion, imagining what their  character might think or feel, making decisions about what to do next… and then facing the imaginary consequences. Besides being fun, there are  some scientific studies that suggest that engaging in this  kind of play can be good for you. Some of it simply falls under the general benefits one gets from having a social hobby.

Like reducing stress and making friends. But there have been some studies that have shown specific benefits with TTRPGS. One study, for instance, conducted  interviews of 10 players and found that playing Dungeons and  Dragons improved their overall well-being in terms of creative  expression, social support, and routine.

Other studies, meanwhile, have highlighted communication and conflict resolution. So that’s really cool. Now, to be fair, TTRPGs are not like pizza.

There is such a thing as a bad RPG experience. Like any other game or social activity, if the people you’re playing  with don’t work together well or are being toxic, it’s  going to ruin the experience. So although we like to joke, it’s not  actually a subsitute for real therapy.

If only the person running the  game was an actual therapist… Oh wait, that’s a thing: having  a therapist as the game master. In fact, a lot of mental health  professionals are now studying not just how TTRPGs work out in  the wild, but how they can be used in the more structured  setting of a therapist’s office. But before we learn about that,  all science needs funding, so here’s a quick break.

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Now, role-playing in general is pretty common in different forms of therapy. Pretending to be other people  can give patients a safe place to explore real-life emotions they might  be feeling, like anxiety or stress. Or it can help people work through things it’d be hard to just plainly say out loud.

But, as therapists are finding, in some cases, going from just role-playing  into a role-playing game may actually make that process more effective. What do we mean? Well, for one thing, there’s the  game part of role-playing games, which can hook in people who are  otherwise closed-off or reluctant.

Another edge roleplaying games  may have is the fact that these games often come with an element of chance – the story isn’t completely up to  either the player or the therapist. This can be good, since it can help players work through unexpected disappointments. Sorry, that dice roll means you do  not get the treasure, which was, let me check my notes, yes, yes,  a jar of endless mayonnaise.

So sorry. Also, the first step of many  TTRPGs is to make a character, which can be a helpful way for a  therapist to talk through how a person sees themselves, their  perceived strengths and weaknesses. Like, if this character is based  on you, are they charismatic?

Strong? What are their weaknesses? Et cetera.

Therapists have also used TTRPGs to help patients explore identities and narratives. For example, one study suggested  people who were LGBTQ+, but who couldn’t openly express that in real life, could use RPGs to explore those  identities in a story where they’re able to be more open than  they might in the real world. They cite a number of examples  where people said this kind of roleplaying helped them  understand parts of themselves.

But even more generally, we, as  humans, like to try to fit how we think of our lives into  neat little narratives, like, “I grew up poor, but I’m a hard  worker, and now I’m successful” or “Good things happen to  me because I deserve it.” Stuff like that. The problem is that these  narratives aren’t always helpful. “Good things happen to me  because I deserve it” is, for one thing, not necessarily correct. And it can easily mutate into “Bad things happen to me because I deserve it.” Which, if that’s the story you  tell yourself about yourself, can be a road to a bad place mentally.

But roleplaying games can allow players to explore and reflect on these narratives. And since TTRPGs are often heroic stories, they may be especially helpful for  cultivating a positive self-image. Sometimes the dice just roll bad, no matter how good your character is.

But that doesn’t mean the story is over. Another big theme in the way therapists are using TTRPGs is helping players talk  through behavioral patterns. Similar to how our brains fall back on narratives to make sense of our lives in general, they also tend to fall back on tried-and-true thought patterns when  confronted by new situations.

Unfortunately, not all patterns are  helpful, so therapists have looked at whether RPGs could help patients  confront these unhealthy patterns. In particular, they use the  lenses of attachment theory, which is all about how  people bond with each other, and cognitive behavioral therapy,  which is all about reframing thoughts. In a few case studies, therapists looked at children processing traumas or phobias, such as parents getting a  divorce or a fear of ghosts.

Traumas and fears can resurface  with surprising intensity when they’re triggered, which can make  it tricky to talk through normally. But by framing traumas or fears as  part of a fantasy story, it can offer the patient a way to distance themselves  a little bit and get the space to experiment with different  emotional reactions to the triggering. In these cases, the games can  help with emotional resilience and regulation, regaining  a sense of agency or trust, and learning to recognize  unhelpful thought patterns.

The last big theme we wanted to  highlight is that roleplaying games could be used by therapists to give patients a kind of safe practice  space for real-life skills. For example, easing social anxiety and improving communication in people with  Autism Spectrum Disorder. For instance, in one case  study, there were two players who named their characters “Blood Owl” and “Egg”.

I love it. At one point, Blood Owl’s impulsiveness frustrated the more analytical Egg. In this case, Egg was able to  express his feelings about how Blood Owl’s actions affected him, and Blood Owl was able to recognize that  he wasn’t completely in line with how the group wanted to play the game.

These are skills the players  might have had trouble with outside of the context of the game, so, in this case, the TTRPG gave them a way to practice them in a safe environment. Now, this all sounds great,  but to do our due diligence, what are the caveats? Firstly, evaluating therapies  like this often relies on squishier data than something like drug trials.

Sample sizes are often small, and you can’t really give someone a D&D placebo. So it’s hard to know how  widely these results apply. Also, how well TTRPG therapy  works might depend on how much you’re already open to  gaming as a creative outlet.

Some folks just aren’t into  D&D. Hard to believe, I know. But overall, it does seem like TTRPGs might be a promising tool for therapists, especially in terms of helping us  think about narratives and choices and in terms of giving people a  safe place to experiment and grow.

In the hands of a trained professional,  D&D really can be therapy. Which is pretty cool for a type of activity where, I must reiterate, you can get  a jar of endless mayonnaise. [♪OUTRO]