When you're enjoying a role-playing tabletop game like Pathfinder or Dungeons & Dragons, you might not think about the game much beyond having a good time. However, like many other forms of entertainment, RPGs can offer more than the usual fun experience for players. The impact tabletop gaming can have might not be discussed as much as video games or other media, but it can offer benefits when it comes to addressing mental health, including depression and social anxiety.

While this trend has been discussed to a degree as people share personal experiences, the opportunities tabletop RPGs provide are continuing to be explored more and more professionally. Dr. Megan Connell is a clinical psychologist who runs two D&D therapy groups at Southeast Psych in North Carolina. She first realized the game could be used for therapy when she was playing with her family and, as a psychologist, understood that the characters she created must share something in common. While studying them, she found commonalities and it hit her that she'd stumbled upon a central issue she didn't realize was still something she needed to work on. The experience made her want to use the game in therapy.

Now, one of the groups she runs is called The Self-Rescuing Princess. It focuses on girl empowerment and lessons like how to stand up for yourself, how to be a leader, and how to work together. Connell includes situations it's likely the girls will face in real life, such as recognizing when someone is in an emotionally abusive relationship and how they can help that person get out of it. The group allows members to practice what they would do in such situations and talk about it afterward. Connell challenges the girls to create characters who are strong in something they feel weak in and play up that strength.

One girl's weakness was always saying yes to her friends, who used her as their errand runner. She hated it but felt she had to say yes. After one game, the girl pulled Connell aside and told her the last time her friends asked her for something, she felt herself about to say yes, but then thought about her character who would never have agreed. The girl decided to be like her D&D character and said no.

"That was the first time she'd ever said no to one of her friends for just a selfish reason of 'I don't want to,'" Connell told SYFY WIRE.

Therapist Adam Johns and Adam Davis, who has an education background focusing on drama therapy, are the founders of the non-profit Game to Grow, which runs therapeutic social skills groups. Both played D&D as kids and have recognized the benefits over the years personally and in their work. Johns has seen how the game can be used to create a scene in which the player can self-advocate and build and reinforce a specific skill.

"It's a high fantasy world so you're distanced enough from it so that you're not really confronting the bully at school, but you might be confronting something that reminds you of that," Davis explained. "A mean bartender who's not going to serve you unless you stand up to him or whatever that small little thing is that lets you build some confidence or build some skill."

Playing through different scenarios with characters can lead to unexpected realizations. Davis sees a lot of people creating characters who are either idealized versions of themselves or "magnified versions of their current self, including extreme versions of their maladaptive behaviors." Johns and Davis' work often includes people who are socially isolated. One person they worked with who had severe depression and anxiety created a young female character who escaped from an insane asylum and whose only friend was a cat only she could hear.

"You can already tell there's a lot of projection into this character. The sort of antisocial tendencies this kid had totally manifested in the character and it was hard for some of the other players at the table to relate to him and thus her," Davis said.

However, when the adventurers turned to the last remaining dracolich for help in a quest, the dragon didn't want to leave his cave. He had no kin or friends so why should he help? That's when the kid's character stepped up and said he knew how he felt.

"He and the dracolich really connected about how hard it is to not have friends, to not have people you can relate to, and then the dracolich became an ally. They worked with the dracolich and convinced him to help them out, which is much different than making a deal with the devil and convincing him that he should," Davis said. "He empathized with the dracolich. We always ask a question at the end which is, ‘What is something you're going to take away with you?' and this young person said, ‘I never expected to have empathy with a dracolich.'"

Since then, the player's characters have changed in games, and the last character he played was an assassin who always had people around him.

Credit: Game to Grow

Role-playing has been used in therapy for years, but its use via tabletop games stands out. Dr. Raffael Boccamazzo is a psychotherapist and clinical director of Take This, a non-profit that educates the gaming community about mental health issues and runs AFK rooms at conventions. He works to develop and reinforce social skills in groups at Aspiring Youth in Seattle and works with a lot of kids with high-functioning autism. To Boccamazzo, the work is a "reapplication of techniques that have been used in psychotherapy for as [many] as almost 150 years." What's unique is their incorporation of special interests, according to psychologist Dr. Ryan Kelly, who also works at Southeast Psych and works a lot with kids who have Aspergers.

Davis, Connell, Kelly, Johns, and Boccamazzo actually play D&D together in a campaign called Clinical Roll. Connell started the group as a way they could work together and not just add another meeting to their calendars. They also invite others (or others ask to be included) who work with geek or RPG therapy in order to connect everyone in the community.

The Clinical Roll players are trying to raise awareness of how these games can be beneficial. Johns sees all their work as "recognizing the power that role-playing games have to deliver the other aspects of therapy and the other aspects of psychological growth and change that can come, but from the many different perspectives in much the same way that therapy does." He believes what the group is doing to be prolific with its therapy techniques as well as expanding on them is new in the area. In fact, Game to Grow is trying to go a step further with Critical Core, a future "social-skills intervention in the form of a tabletop role-playing game."

While there has been research in the area of how these games can have an impact, there is still a lot of potential in the area.

"I think right now it's just drama therapy which is great, but there's this huge horizon of D&D research that's just not done in a controlled setting yet so we're trying to hop on that," Dr. Kelly said.

Seeing the ways in which D&D can help people has not gone unnoticed by the game's publisher, Wizards of the Coast.

D&D product marketing specialist Chris Lindsay first realized the game's potential as a therapy tool when he played as a kid. He and his friends were able to come "out of their shells because of D&D" and their interactions around the table. Lindsay's also seen these benefits professionally beyond Wizards due to his background in education, where he saw plenty of students have the same experience. To Lindsay, D&D has added benefits because of the strong story element and how wanting to be a hero is something everyone can engage with strongly. It's a game that can help someone who's not usually an extrovert interact positively with people who share their interests. Lindsay has seen the firsthand benefits in his family, as well.

"When it comes to kids who have special needs, for example my second son who is going to be 26 this year grew up playing Dungeons & Dragons in our household and he learned some extremely valuable things about socializing and about taking turns and about sharing ideas," he told SYFY WIRE. "That is a big part, I think, of his personal success as an adult now."

The team at Wizards engages with experts about this topic whenever they can, according to Lindsay. It tries to answer questions about the game and story development that might be helpful in doctors' practices and, because of Lindsay's experience with his son, he provides "suggestions and ideas about things that I have seen work with him at the table and hopefully that helps them in their practice." For educational programs, they'll also try to provide product to schools that don't have the money to purchase materials but are interested in starting D&D programs or clubs.

Johns points out that benefits of playing can include "perspective taking, frustration tolerance, creative problem solving, and collaboration skills" that exist at "any reasonably decent dungeon master's table."

Video of Tips for DM's/GM's Psych at the table basics

Connell hosts a series of videos on YouTube called Psychology at the Table that offers tips for game masters who realize their players are facing certain issues. While it's focused on tabletop gaming, she said the discussions are applicable for anybody who has a friend with depression, anxiety, or who is struggling with PTSD.

"If your DM cares about you, is a good friend, and sees you're working with an issue, most of the time it shouldn't be a humongous therapy thing of dealing with a life trauma," she said. "[For example] my central issue that I figured out was never fitting in. Every character I've made never belonged where they were. They were always searching for their people and place. I've been through some trials and tribulations in the game I play in with my DM, but he figured that out and did a beautiful story arc for my character to help her really figure out where she wanted to be and was it where she thought she wanted to be or was it where she was?"

If there's something you want to work on, the opportunity is there in tabletop for you to do a lot just for yourself, too. Johns has experienced this personally; he creates characters who are jacks of all trades and masters of none because he has a desire to feel useful to others.

"My knowledge of that reflection gives me the opportunity to then see how I can use that within the game," Johns said. "There's a lot you can do without even having the buy-in from all the other players, although, obviously, if you have a support group and a great dungeon master you can even go further with it."