By Hani Hamdan
Introduction:
People use fantasy as a safe place to escape from reality, and they play games to give them a sense of control under a set of rules they previously agreed on, and that’s what makes RPGs special: they blend between playing and fantasy worlds, creating a safe place where they have control over it. So let’s see how we can use RPGs in psychotherapy.
Support for autistic people:
For the first study, the authors brought 8 autistic adults and separated them into two groups, and had them play a 6-week campaign in the Dungeons and Dragons game. What they found was that playing D&D strengthened their desire for social connection, but they faced barriers like rejection and misunderstanding, despite that the game provided a safe social environment for the participants to communicate freely, reducing anxiety, and leading them to form strong friendships. This experience allowed the participants to explore their identity, giving them the space to express their emotions with comfort and to gain confidence. These benefits went beyond the game world and reached reality, as known for bleed (emotional crossover between in-game and real-life experiences), as some of them reported lasting positive changes in their self-perception and emotional well-being.
The potential benefits in mental health:
In this context, we have a study conducted during the COVID-19 pandemic, when a lot of people were in quarantine, leading to an increase in anxiety, stress, depression, and loneliness, which made the opportunity of exploring how RPGs can be beneficial in this situation, offering immersive, cooperative storytelling experiences. The results of the study showed that RPGs, and especially Dungeons and Dragons, increased empathy and helped in forming new relationships and peer learning, and improvements in self-efficacy and coping skills were also shown. Additionally, RPGs were useful in reducing social anxiety, trauma processing, and forming a sense of belonging and community.
RPGs and well-being:
In terms of well-being, we have a comprehensive review of existing research on the effects of role-playing games (RPGs) on players’ well-being, showing that RPGs empower social skills, cultural participation, and emotional resilience, contributing to well-being. The study also found an overlap between RPG practices and therapeutic approaches, such as sociodrama and role-playing therapy, which leads us to the final section.
The role of RPGs in therapy:
In the aspect of psychotherapy, we present a qualitative study that searches for the possible uses of RPGs in therapy for adolescents, discovering four major findings:
– Applicable for all ages: Although the study focuses on adolescents, practitioners stated that RPGs can be conditioned to any age and can fit every case for a variety of needs, from children seeking imaginative play all the way to adults exploring identities and processing traumas.
– Group Therapy Settings: Providing the chance for practicing communication, building strong and meaningful relationships, and trying new social roles placed in a low-risk environment.
– RPGs as exposure therapy: The safe world of the game can be a tool for safe stimulations, where players face metaphorical versions of real-life stressors, and they can rewrite their trauma stories in a way that gives them relief and fosters healing and agency.
The negative side of RPGs:
On the other side, some studies tried to link online RPGs with internet gaming disorder (which is a gaming behavior pattern that is shown in clinically significant maladaptive habits or distress). One of these studies tried to examine almost 5000 undergraduates from the University of Wisconsin-Madison, and it appeared in the study that the genre of RPG scored the highest in predicting IGD symptoms, with a strong correlation between the number of playtime hours and the symptoms. This study is an indication that, in some cases, beyond certain limits, RPGs could be dangerous and affect mental health badly.
Conclusion:
In this research, we learned how RPGs can help autistic people, their potential in contributing to mental health and well-being, how they can be used in therapy through multiple rules, and the negative side of them, leading us to say that RPGs should be studied more to reveal their hidden capacities in healing people and their risks to mental health.
Resources:
Atherton, G., Hathaway, R., Visuri, I., & Cross, L. (2025). A critical hit: Dungeons and Dragons as a buff for autistic people. Autism, 29(2), 382–394. https://doi.org/10.1177/13623613241275260.
Gutierrez, R. (2017). Therapy Dragons: A look into the possible applications of tabletop role-playing games in therapy with adolescents (Master’s project). California State University, San Bernardino. https://scholarworks.lib.csusb.edu/etd/527.
Lehto, K. (2025). Role-playing games and well-being. International Journal of Role-Playing, Issue 11. https://journals.uu.se/IJRP/article/view/284.
Baker, I. S., Turner, I. J., & Kotera, Y. (2023). Role-play games (RPGs) for mental health: Why not? Roll for initiative. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-022-00832-y.
Eichenbaum, A., Kattner, F., Bradford, D., Gentile, D. A., & Green, C. S. (2015). Role-playing and real-time strategy games are associated with a greater probability of Internet gaming disorder. Cyberpsychology, Behavior, and Social Networking, 18(8), 480–485. https://doi.org/10.1089/cyber.2015.0092