The Art of the RPG: Using Role Play to treat Social
Anxiety Disorder
ABSTRACT
Social Anxiety Disorder (SAD) affects a broad swath of people in
the US regardless of age, ethnicity, and gender. SAD is marked by
anxious feels of negative social evaluation and performance.
There are currently multiple effective treatments that help
afflicted individuals learn to reevaluate social interactions and
situations to see them as less threatening. Tabletop Role Playing
. games (TRPGs) have been used as a treatment for SAD with
hopeful results. TRPGs allow for an individual to experience an
alternative world and the influence they can have within it in a
safe and low-risk environment. The TRPG experience ultimately
serves as a more enjoyable and lower risk method to learn social
skills and interpersonal navigation as compared to traditional
methods, such as CBT, exposure therapy, and social skills learning
programs.
INTRODUCTION
Social Anxiety Disorder (SAD), also known as Social Phobia,
currently afflicts 6.3 percent or roughly 15 million Americans
according to the Anxiety and Depression Association of
America. The underlying physiological evidence of SAD can
be seen through the implementation of fMRI, Functional
Magnetic Resonance Imaging, demonstrating hyperactivity
within the Prefrontal Cortex, Insula, and Amygdala. These
parts of the brain have demonstrated importance in
processing self-image and self-consciousness (Stein, 2015).
SAD most commonly surfaces around the age of 13 and
afflicts adolescence to a slightly higher degree than other
age groups, however, SAD is still quite persistent among all
other age groups. This literature review will mainly refer to
the affected population between adolescence and early
adulthood, in part because these groups comprise the
majority of facilitated research regarding SAD.
There are effective medications and psychotherapies for
dealing with SAD, such as cognitive behavioral therapies,
exposure therapies and social skills training (Adaa.org, 2019
& ). Medication used to treat SAD has seen success in the
adult population, however, many concerns exist about its
use on adolescents or young adults that are still developing
(Haller, Kadosh, Scerif, & Lau, 2015). Alternative, RPG,
oriented treatments of SAD take shape in two main ways:
Table-top Role-Playing Games:
Small group format, typically anywhere between two
and six players and one Dungeon Master (DM), who is
the overarching narrator of the story. They guide the
player’s narrative journey and help to draw parallels
between the struggles of the client and the character
they play in the game (Betz, 2011).
MMORPGs:
Inspired by the classic TRPG format, often allows total
customization of virtual avatar’s hair, eyes, face, and
body type, allow for a more unique player-character
bonding experience (Snodgrass, Lacy, Francois-Dengah,
Fagan, & Most 2011). There usually is not an entity
that takes the place of the DM in MMORPGs, rather
more conventional narrative techniques are
used(Moser & Fang, 2015).
RESEARCH POSTER PRESENTATION DESIGN © 2011
www.PosterPresentations.com
Andrew Stegenga
Wake Forest University Department of Counseling
METHODS DISCUSSION
• PsycINFO and Google Scholar yielded the most robust results; though PubMed provided articles that were used as well. There is not a large pool of research about the implementation of
RPG in therapy with SAD specifically. However, there are multiple
“social phobia” as well as "role play” OR “rpg” OR “d&d” were keywords that yielded the most robust results other studies that have proven such psychotherapeutic means have
• Implementation of RPGs into therapy is an emerging field proven successful in quelling issues that are parallel with many that
• Many conclusions were reached primarily on an inferential basis; replication would be beneficial to determine efficacy of emerge from SAD. I would recommend further research into the
direct effects’ RPG psychotherapy on symptoms of SAD. It has been
treatment.
noted that an increase in effect yield occurs with the inclusion of
• Literature search dates conducted between 1998 and 2006 as well as between 2011 and 2017 . reflection at the end of the session (Betz, 2011) therefore the
• Dungeons and Dragons: The use of a fantasy game in the psychotherapeutic treatment of a young adult, authored by Wayne inclusion of post-session reflection is paramount for any further
Blackmon and published in 1994, sheds light on the first inclusion of TRPGs as an avenue that possesses therapeutic qualities conducted experiment.
The relative stability in the persistence of SAD across all age
and was therefore included despite it being outside the suggested date range.
groups, at least as shown in the US, should mark the need for more
in-depth and diverse study of effective general treatments that can
work across all age groups, as current literature seems to be
RESULTS limited to adolescences through young adulthood. Since there are
differing socio-cultural conclusions regarding the method and
TRPGs importance of social interaction, it may be interesting to conduct
– George Enfield describes using TRPGs with four further research on the prominence of SAD and role-play therapy
– At the heart of the role-play experience is across varying cultures, as much research originates in the US.
healthy dissociation, moving beyond oneself to boys; two who experienced abuse and neglect
within their families and two others that
experience life or circumstances as someone
equipped with a different set of skills. experienced impulsive and aggressive attitudes
at home and school. He reported a reduction of RECOMMENDATIONS FOR FUTURE RESEARCH
disruptive and aggressive behavior at home and
– Blackmon (1994) used the emotions and in the classroom. An increase in communication • There is evidence in the effectiveness of Live Action
motivations experienced by a client’s Dungeons between the boys was also witnessed, they were Role Play (LARP) in treating elements parallel with
and Dragons character as a vehicle for personal able to cooperatively plan activities within the SAD, however, little research has been conducted
emotional expression. The client was eventually game. The boys were also seen to have gained between SAD and LARP directly.
able to talk about his own emotions without the leadership skills and were better at expressing
need to displace them upon his D&D character. their own needs and ideas.
• Virtual Reality (VR), is of interest for future research
because it allows users to interact with the
– Daniau’s 2016 study of a group of young adults MMORPGs
environment more directly as compared to standard
playing a simplified version of a TRPG concluded
means, this is because they are physically able to
that an experienced player could “learn to play
One of the most well-known (and researched) perform the actions (i.e. unsheathing a sword, picking
and explore a wide range of specific learning
MMORPGs to date is World of Warcraft (WoW). A apples, opening door).
possibilities,” through these possibilities, she
states that it may be possible for the skills 2011 survey study by Snodgrass, Lacy, Francois-
learned for the game to transfer into “human Dengah, Fagan, and Most of 264 WoW users, the
authors found support for a relationship SELECTED REFERENCES
skills” (p.26). Depending on the goal of the
game, it is possible for participants to learn “soft between “dissociation, relaxation, and positive Blackmon, W. D. (1994). Dungeons and Dragons: The use of a
skills” such as leadership, diplomacy, and well-being” (p.41). The game created a state of fantasy game in the psychotherapeutic treatment of a young adult.
relaxation for some because their level of American Journal of Psychotherapy, 48(4), 124–132.
spontaneous problem-solving that may help to
immersion of the game allowed them to Cook, M. P., Gremo, M., & Morgan, R. (2017). We’re just playing:
“improve feelings of self-efficacy and perceived
temporarily forget about real-life stressors, The influence of a modified tabletop role-playing game on ELA
competence” (p. 28). students’ in-class reading. Simulation & Gaming, 48, 199–218.
while other participants found WoW to create
stress that was positively stimulating and Daniau, S. (2016). The transformative potential of role-playing
– A TRPG of Richard Connell’s The Most Dangerous therefore enjoyable. games: From play skills to human skills. Simulation & Gaming,
Game, facilitated student’s creation of 47(4), 23–44.
characters to interact in the setting of the book. Enfield, G. (2007). Becoming the hero: The use of role-playing
This resulted a more thorough understanding of games in psychotherapy. In L. C. Rubin (Ed.), Using superheroes in
character motivation as well as more counseling and play therapy (pp. 227-241). New York, NY, US:
Springer Publishing Co.
constructive collaboration (Cook, Gremo, and
Morgan, 2017) . Kirby, A., Jones, C., & Copello, A. (2014). The impact of massively
multiplayer online role-playing games (MMORPGs) on psychological
wellbeing and the role of play motivations and problematic use.
– The use of an active learning style contributed to International Journal of Mental Health and Addiction, 12(1), 36-51.
the student’s deeper understanding of the story Orchard, F., Apetroaia, A., Clarke, K., & Creswell, C. (2017).
and the motives behind the actions of the Cognitive bias modification of interpretation in children with social
characters within. These results are echoed by anxiety disorder. Journal of Anxiety Disorders, 45, 1-8.
Wu, Yan, Kao, Wang, and Wu (2016). Stein, D. J. (2015). Social anxiety disorder and the psychobiology of
self-consciousness. Frontiers in Human Neuroscience, 9, 89-92.
Wilson, D. L. (2007). An exploratory study on the players of
“Dungeons and Dragons”. Institute of Transpersonal Psychology.