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A 2000 survey estimates that 5.5 million people in the U.S. alone regularly play tabletop role-playing games (RPGs) like Dungeons and Dragons. The gameplay provides an immersive escapism as players lose themselves for hours at a time, sitting around a table with others, acting out the charismatic personality of an elven bard, or fighting with the sheer power of a dwarven barbarian. It can be therapeutic, so much in fact that one researcher, Hawke Robinson, has spearheading the research to discover whether RPGs can also help people gain physical and mental skills on a medical level.
Robinson believes that people who have a wide spectrum of disabilities can benefit from what he calls “RPG therapy”: autistic people, people with traumatic brain injuries, cerebral palsy or even schizophrenia. So far, he has seen evidence of RPGs therapeutic qualities ranging from building motor skills (physical movement) to increasing schizophrenic patients’ grasps on reality and lowering their dependence on anti-psychotic drugs.
Before before we get into the therapeutic benefits, it’s important to note that the typical RPG session comes with a heaping smorgasbord of life-improving qualities including social skills, problem-solving, increased creativity and learning how to work with a team. But some of the benefits are smaller. For instance, if you’re scribbling furiously on your character sheet or painting a miniature for a tabletop game, you’re growing your fine motor skills — skills that help with small, delicate tasks like handwriting and cooking.
Excercising these skills can come in handy if you have a disability that makes fine motor activities difficult. Many autistic people have poor fine-motor skills, leading to difficulties with everyday tasks like writing your name clearly— anything that improves those skills is a great boon.
There’s also a whole branch of RPGs that involves going out into the real world, donning costumes and picking up prop-weapons known LARP, or Live Action Role Play, a system where people collaborate in an imagined world with the same kinds of rules that one finds in a traditional tabletop RPG.
When a person LARPs instead of playing a sit-down, pen-and-paper game, they have the added benefit of practicing large body movement (or gross motor) skills. For people with physical disabilities, this is huge.
Beyond physical tasks, RPGs also exercise the brain for cognitive tasks and social situations. Players practice social interactions when role-playing by questioning villagers for information, plotting your next move with fellow players and practicing diplomacy with enemies. If a player feels socially awkward going to the grocery store and they decide to play as a bard with exceptionally high charisma (which for you non-nerds translates to “the exact opposite of socially awkward”), the bard character will help them practice conversation and social skills.
But Hawke’s research goes beyond the beneficial effects of everyday RPGs into RPGs specifically tailored towards helping people with specific disabilities. For example, Hawke wanted to teach some autistic people who were having trouble using public transit about how to ride the bus. Taking a cue from from smartphone RPGs like Habitica, which reward you with levels and virtual items for working on your life skills, Hawke developed in-person system to reward his players for mastering skills required for using public transit.
The autistic players in this therapy practice role-played as members of a crime-fighting group, and had to work together to read an actual bus schedule. Their LARP quest involved actually boarding a bus and practicing tasks like asking a homeless man for information regarding their quest. Simple tasks, but their quest was far more heroic: they had to stop a villain from releasing a zombie apocalypse upon the city.
After a few sessions, the players took the skills they had practiced on the tabletop RPG into the real world with LARP. Using a scavenger hunt structure, the players searched for information about how to stop the villain’s plot in-person: they could either stop the zombie apocalypse by correctly following certain clues, or they could fail and see zombies actually lumbering through the streets (courtesy of an annual zombie walk). First, though, they had to take the bus — the real bus — to a spot where they meeting up with other players.
Hawke emphasized that winning the adventure was not the goal of the LARPing. Regardless of whether the city gets overtaken by zombies, the players win because they’re exposed to therapy just by playing. If you go from not being able to use the bus to being entirely capable, you just leveled-up in real life.
Hawke went on to explain that not all therapeutic RPGs are structured like this one, with its heavy emphasis on life-skills education. RPGs created with motor- or social-skills therapy in mind provide a sense safety. Traditional therapy can be scary, after all, due to preconceptions about what it entails. Physical therapy can be painful and group therapy can be embarrassing and make you feel exposed. RPG therapy, on the other hand, comes at you with fun first. The therapy hides beneath a game, and that makes the medicine all that easier to swallow.
Therapeutic RPGs can also offer a formal structure, which can be massively beneficial to some patients, like those with autism or schizophrenia. Hawke spoke of two groups of schizophrenic patients, one of which was simply handed the handbooks to play a tabletop RPG and left to their own devices. Though they became obsessed with playing, disconnected from reality more often and became worse off overall.
The second group used structure. Instead of simply handing the patients the player’s handbook, the therapists gave them rules and worked with them to keep a healthy distance from the game’s escapism.
The results of this group were phenomenal; the patients’ ability to separate fact from fiction increased, they disconnected from reality less due to their new-found ability to go in and out of their character and, most notably, the group became less dependent on the amounts of anti-psychotic drugs needed to function.
Structure proved the key element, and this is really what differentiates RPG therapy session from other RPGs — it’s not just gaming; RPG therapy involves carefully tailoring of the play session around the needs of the players, a structure typically provided by a “Game Master Therapist.”
At the time of this writing, there is no industry standard to define what a Game Master Therapist is. Essentially though, a Game Master Therapist will be someone who has both the experience of a therapist and extensive experience as a gamer and a “dungeon master”, that is, the person plans the adventure and administers the gameplay. Most importantly, a Game Master Therapist needs the ability to assess player needs and change the game accordingly to accommodate them.
Sometimes the accommodations go beyond disabilities and life-skills. For example, some therapeutic RPGs accommodate a player’s gender to help work through past experiences with gender-based discrimination, even ones as common as being excluded from games due to being a woman. Fortunately, Hawke’s research includes a focus on gender-bias in gaming as well.
Hawke’s studies heartily confirm what many women and non-binary players already know: they’re sometimes excluded from playing and often experience discriminatory comments from fellow players. According to his research, 42 percent of all gamers experience derogatory comments; that is nearly half of the general gaming population experiences negativity in gaming. While online gaming and collectible card games had higher levels of discrimination, Hawke still found that tabletop RPG’s reputation is tainted with bias and discrimination.
Hawke explained that most of the work in making people comfortable comes from knowing what made them uncomfortable. For example, if a person has experienced heavy amounts of discrimination playing online RPGs, they might be more receptive to in-person gaming, like tabletop RPGs or LARP where the possibility of discrimination is less. If they go with Hawke’s therapeutic RPGs, it’s his job to ensure minimized bias. But the therapeutic RPGs almost does this work for him. He found that when people game together around a table, their prejudice eventually melts away because they see the players as actual humans rather than just abstract players. Hawke found that even players with biases against trans people became more accepting of trans teammates as the therapeutic gaming rolled on.
There are plenty of ways to help this gender-inclusive, nerd-endorsed therapy continue. If you want to be involved in the research as a participant, you can go to the RPG research website to sign up via an online form. If you qualify for research, you will be contacted! If you’re already a game-master, you can also participate by becoming a Game Master Therapist by contacting Hawke for training.
Of course, if you’re more interested in giving your help in the form of good ol’ cash, there is a fundraiser up to build a wheelchair-accessible gaming trailer. The trailer would take RPG therapy on the road, allowing Hawke to transport all of his materials easily while providing better access to therapeutic gaming for rural communities. The GoFundMe for the trailer is here. With your help, RPG therapy can become a reality, along with a healthier, nerdier generation.
(featured image via Henrique Zambonin)
Previously Published March 21, 2016.
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