D&D and Mental Health

by Brandon Gregory

Dungeons & Dragons has exploded in popularity over the last few years, with many turning to it during the high-stress pandemic as a way to relieve stress and bring friends together. We often lean into it during rough periods like major transitions, loss, or even just high school when we don’t fit in. Many of us know that tabletop gaming can help mental health. It turns out there’s some science to back that up.

D&D and other TTRPGs have been used for years in mental health settings to help people with social skills, self-confidence, and coping mechanisms for mental health issues. Some core aspects of D&D, like improvisational play and exploration of diverse ideas and scenarios, have been in use in the mental health field for decades. Many games can help both children and adults with social and psychological issues, but D&D is uniquely suited to this task, and there’s some evidence to back that up.

For those who have read things on this site and don’t know, I have a serious mental illness, and many of my friends and family struggle with that too. Mental health is a serious issue for me, and I have a whole podcast about movies and mental health. This is my first time talking about mental health here, though, and tying it to D&D. Whether you have a diagnosed mental health issue or just feel the pressure of everyday life closing in on you, I’m hoping this article will help you.

Role-playing games like Dungeons & Dragons may aid with mental health recovery

Meaning and purpose are necessities for mental health. Everyone wants to feel like the hero of something. We often create or discover meaning in our lives through the stories we tell about our lives, but it can also help to explore stories of heroism through others. Modern hit movies like The Hunger Games or Star Wars help us feel this heroism, and ancient stories like Beowulf and The Odyssey show that it’s much more than a modern trend.

Dungeons & Dragons helps bridge this gap by letting us play the heroes that we want. It allows us to make heroes out of the characters we want to see as heroes. The heroes we play in D&D and other TTRPGs often have traits similar to us, but often have struggles similar to ours too—struggles that may not be well represented in popular media. Sometimes, exploration of what it means for a character like that to become a hero can help teach us how we can be the heroes of our own life stories.

Dungeons & Dragons focuses on overcoming adversity and exploring alternative identities. In that way, it mirrors many aspects of the mental health recovery process. It has several unique characteristics that make it a great tool for children and adults in therapy:

Dungeons & Dragons is a collaborative game, getting participants to understand each other, work together, and build bonds to achieve common goals
The role-playing aspect of Dungeons & Dragons allows players to step into someone else’s shoes and see the world through their eyes, as well as try out new ways of interacting with the world or other people in a lower-stakes environment
Dungeons & Dragons offers unlimited freedom, allowing for creativity in problem-solving and exploration of many different identities and ideas

There are both studies and practicing mental health professionals that back this up. (Sources are listed at the end of the article.) Possible benefits of playing Dungeons & Dragons include:

Improved social skills
Increased self-esteem and self-confidence
Improved ability to express yourself and your needs assertively
Improved impulse control
Stronger creative thinking and problem-solving skills

Structured role-play has proven benefit in clinical mental health practice

At the end of a hectic week, smashing foes as a strong Barbarian or altering the world around you as a magical Wizard can be just the release we need. Whether you’re depressed or just dealing with a lot of stress, we all know the therapeutic value of role-playing.

While role-playing games like D&D have only been around since the 70s, mental health professionals have understood the value of improvisational roleplaying for much longer. TTRPGs like Dungeons & Dragons closely mirror established forms of therapy and mental health treatment that have been in use for decades.

Play Therapy has been used in treating children since antiquity, and was recognized in the mental health field when Sigmund Freud wrote a book about it in 1909. It harnesses a child’s natural need to explore to meet and respond to developmental and mental health needs. Though Play Therapy is commonly used for both children and young adults, adults can also benefit from structured play, with benefits including improved social skills, self-confidence, assertiveness, and impulse control.

Psychodrama Therapy, which was developed in the 1920s with its first organization formed in 1942, is a form of supervised group therapy for adults in which a person dramatizes a personal problem or conflict, enabling them to reflect on and explore alternative ways of dealing with them. It offers relief from mental health problems, helps with managing grief, and aids in general well-being.

Drama Therapy is a more general application of theater techniques to facilitate personal growth and promote mental health. Psychodrama Therapy is a form of Drama Therapy, but other forms get back to the roots of improvised and spontaneous theater, using creativity and dramatic action to explore more general emotional issues. In addition to exploring specific situations, it can also be used to explore more general scenarios to delve into personal truths and explore and transcend unhealthy personal patterns of behavior and interaction.

Dungeons & Dragons has been used in therapy for decades

Roleplay has been used in mental healthcare for a long time, but what about Dungeons & Dragons specifically? Dungeons & Dragons has not only been shown to help people deal with mental health issues; it’s also been used in actual therapy sessions. Using Dungeons & Dragons as a part of therapy is not a new concept. It was used in mental health practice as early as the 80s.

Here are some notable examples:

In 1994, a psychologist was treating a 19-year-old with an obsessional, schizoid personality. He encouraged the patient to describe his experiences in D&D as a form of self-therapy, and that allowed the patient to work through his emotions safely.
Psychologist M.L. Kallam studied a group of “mildly handicapped” adolescents who played D&D twice a week for 9 weeks. The group gradually developed higher self-efficacy and problem-solving skills compared to a control group.

I have a serious mental illness, and my son is on the autism spectrum. Dungeons & Dragons has been specifically recommended to both of us for therapeutic purposes.

D&D has been shown to have psychological benefits

Dungeons & Dragons isn’t just about winning. Those of us who have played for a while know that successfully playing the game means learning things like creative problem-solving, empathy for your fellow players (and often NPCs), confidence and assertiveness in dealing with the problems in front of you, and analytical skills. These are all things that mental health conditions can make difficult, and learning to be better at them can help us.

Several studies have found tentative links between Dungeons & Dragons and psychological benefits such as increased creativity and empathy. D&D in a smaller therapeutic setting can help increase confidence, as well as the ability to confront situations and cope with unexpected events.

What’s important, though, is that these studies showed that the skills learned in D&D transferred into the real world and better prepared people to deal with similar issues in their lives. The lessons we learn at our tables become lessons we learn in real life as well.

Other psychologists have suggested that it’s not just the role-playing part of D&D that helps with mental health issues, but also the rules and environments. In other words, it’s not just the stories we tell that can help us, but the act of playing the game itself that can provide more mental health benefits. The rules and mechanics of the game can reduce anxiety around the decisions we have to make in-game, and this builds familiarity with working with rules and social customs in the real world.

D&D outside of clinical settings has been shown to help general mental health and social skills

D&D in clinical settings is interesting, but most of us are not playing during our therapy appointments. Thankfully, the benefits of D&D outside of clinical settings have been studied too, and it was similarly shown to help players.

D&D is not just a game we play and leave at the table. A psychologist analyzed an online chat log of a 9-person D&D group over 3 years and found that the group members’ real-world emotional needs were being met through in-game interactions. As the group played, they learned how to work together toward a consensus, build and maintain friendships outside of the game, experience great things together, and explore what concepts of good and evil meant for the players.

A similar study interviewed six players and found that playing the game helped them with social anxiety and allowed them to explore their own emotional issues in ways that weren’t possible outside of the game. Five of the players were able to navigate through childhood trauma while playing D&D. The players experimented with their characters, which led to improved real-world social skills and better relationships, which helped them deal with stress.

Our characters are not just stats on a piece of paper. Another psychologist suggested that D&D characters aren’t random—they’re often well-thought-out pieces of ourselves. They exist independently, but our characters can be expressions of ourselves, helping us see ourselves succeed in ways that we might not be able to in the real world.

D&D has been shown to assist in recovery from mental health issues

Just like our characters are often little pieces of ourselves, our characters sometimes have the same struggles that we do—and need to find solutions for those problems.

In the world of mental illness and mental health issues, recovery isn’t about eliminating chronic medical conditions so much as staying in control of your life and keeping your symptoms in check to a degree that you’re able to lead a normal life. The Psychological Recovery Model details five steps on how to recover in a meaningful way:

Moratorium - Dark despair and confusion. This is where you realize that you have a problem.
Awareness - This is where you realize that recovery (meaning being able to live a normal life) is possible.
Preparation - This phase is the beginning of the work toward recovery, including setting goals and learning about the issues you’re dealing with.
Rebuilding - This is where most of the work is. Here, you work through the worst of your symptoms while looking for a way to cope with them in healthy ways.
Growth - This is the outcome of the whole journey. Here, you can confidently deal with the problems you face, and you develop a stronger sense of identity as a person with issues, not a person defined by them.

Those of us with mental health issues need to find ways to work through those (even if we can’t eliminate them), and our D&D characters can be an extension of that. In 2021, two psychologists studied 13 players with mental health difficulties. As the players played the game, even without any professional guidance, all five stages of the Psychological Recovery Model were observed in play. The psychologists also found that the players played D&D in a way that mirrored each of their own mental health recovery processes, each finding ways to meet their own emotional needs as their characters did.

D&D is a safe space for exploring characters and concepts

As you can see, Dungeons & Dragons has a long history of helping people deal with trauma, mental illness, and social issues. You too can benefit from this. Exploring other identities and aspects of self through a role-playing game can be a great opportunity to learn some things about yourself.

I’ve read stories about a shy teenager with a stutter who found she could sing without the stutter and played a Bard to explore that, or a teen shy from trauma who discovered what it meant to be brave and powerful by playing a Barbarian. There are many stories of people discovering their gender identity through D&D. Your story may not be as dramatic as theirs (or it might be!), but having space to explore that may very well help you work through some things in real life too.

If role-playing a character makes you feel more like you, do that! You might find out some things about yourself that would be harder to recognize outside of the game.

Sources

About the Author

Brandon Gregory

Brandon Gregory is a web developer and writer in the Kansas City area. He's been playing TTRPGs since 2020 and is involved in the disability-related TTRPG podcast Tales from the Crips. He's into classic movies, mental health, and, of course, DnD. Also, he's in a band. One time, they rocked so hard it killed a man.