The Therapeutic Potential of TTRPGs: An Annotated Bibliography of Scientific Evidence

Yuliawati, L., Wardhani, P. A. P., & Ng, J. H. (2024). A Scoping Review of Tabletop Role-Playing Game (TTRPG) as Psychological Intervention: Potential Benefits and Future Directions. Psychology Research and Behavior Management, 17, 2886–2900.

Methodology: This scoping review analyzed 51 papers published between 2013 and 2023 to map the current extent of empirical research on TTRPGs as a psychological intervention.

Findings: The review identifies TTRPGs as a "developed and engaging" form of role-play therapy rooted in client-tailored storytelling. It highlights benefits in promoting cognitive and psychosocial skills, mitigating stress, and intervening in conditions such as social anxiety and autism spectrum disorders (ASD).

Clinical Contribution: It positions TTRPGs as a viable gamified intervention that can engage "difficult-to-engage" patients who might find traditional talk therapy uncomfortable. It also suggests cultural adaptability, particularly in Asian contexts where mental health stigma remains a barrier to formal counseling.

Henrich, S., & Worthington, R. (2023). Let Your Clients Fight Dragons: A Rapid Evidence Assessment regarding the Therapeutic Utility of 'Dungeons & Dragons'. Journal of Creativity in Mental Health, 18(3).

Methodology: A Rapid Evidence Assessment (REA) of 13 studies evaluating the psychological benefits of Dungeons & Dragons (D&D).

Findings: The assessment yielded four core themes: the lack of a "maladaptive" personality type among players, positive stakeholder attitudes, a lack of maladaptive coping, and significant potential for psychological benefits. The results show TTRPGs can support mindset change, build self-esteem, and improve interpersonal relationships.

Clinical Contribution: This study provides a foundational evidence base for clinicians looking to implement D&D as a structured modality for treating teens and adults with social difficulties or low self-concept.

Kroplewski, Z., Łoś, R., & Pawlicki, B. J. (2025). Impact of Participation in Role-Playing Game (RPG) Sessions on the Perceived Level of Social Anxiety and Received Social Support. Brain Sciences, 15(11), 1158.

Methodology: A quantitative study involving 30 participants (aged 18–28) with non-generalized social anxiety disorder. The study utilized a 3-month intervention using structured RPG scenarios and standardized tools (LSAS and ISSB).

Findings: Results showed a statistically significant reduction in both anxiety and avoidance. A high effect size (Cohen’s d = 0.94) was observed in the group attending weekly sessions, alongside an increase in perceived social support.

Clinical Contribution: The study suggests RPGs function as a "transitional stage" in exposure therapy, allowing participants to simulate anxiety-inducing scenarios in a controlled, safe environment before attempting them in real life.

Billieux, J., Fournier, L., et al. (2025). Can playing Dungeons and Dragons be good for you? A registered exploratory pilot programme using offline tabletop role-playing games to mitigate social anxiety and reduce problematic involvement in multiplayer online video games. R Soc Open Sci, 12(4), 250273.

Methodology: A 10-week Single-Case Experimental Design (SCED) targeting socially anxious gamers with problematic levels of online video game involvement.

Findings: The study reported reductions in social anxiety (LSAS), loneliness (UCLA-LS), and gaming disorder symptoms (IGDT-10). Approximately 33% of participants showed improved loneliness scores in the short term.

Clinical Contribution: As the first TTRPG study to adhere to all "open science" canons, it provides a reproducible framework for non-medicalized treatments for behavioral addictions and social isolation.

Rosenblad, S. R., Wolford, T., et al. (2025). Mastering Your Dragons: Using Tabletop Role-Playing Games in Therapy. Behavioral Sciences, 15(4), 441.

Methodology: This paper utilizes case studies to examine the integration of RPGs with Narrative Therapy, Choice Theory, and CBT for diverse concerns including trauma, Dissociative Identity Disorder (DID), and nightmares.

Findings: The study highlights "narrative transference," where game mechanics (like dice rolling) mirror real-life uncertainty. Case examples showed long-term symptom relief in trauma survivors and successful emotional regulation in pediatric patients.

Clinical Contribution: It demonstrates how TTRPGs engage non-verbal memory systems, providing an alternative pathway for processing trauma by allowing clients to externalize pain through a fictional character.

Hugaas, H. (2024/2025). A Conceptual Model of Bleed and How Bleed-out from Role-playing Games Can Affect a Player's Sense of Self. International Journal of Role-Playing, Issue 14.

Methodology: A conceptual analysis drawing from identity theory, social psychology, and neuroscience to define "bleed"—the spillover between player and character.

Findings: The paper distinguishes between "bleed-in" (player-to-character) and "bleed-out" (character-to-player). It suggests that by managing the "bleed perception threshold," clinicians can help clients integrate positive character attributes (e.g., bravery) into their real-life identity.

Clinical Contribution: Provides a psychological framework for understanding how fictional role-play can lead to genuine identity transformation and the restructuring of maladaptive self-schemas.

Merrick, A., Li, W. W., & Miller, D. J. (2023). A Study on the Efficacy of the Tabletop Roleplaying Game Dungeons & Dragons for Improving Mental Health and Self-Concepts in a Community Sample. Games for Health Journal, 13(2), 128–133.

Methodology: A repeated-measures design over 8 weeks with 25 participants, measuring depression, stress, anxiety, self-esteem, and self-efficacy at four time points.

Findings: Significant decreases in depression, stress, and anxiety were observed, alongside increases in self-esteem and self-efficacy. These gains were maintained at a one-month follow-up.

Clinical Contribution: This quantitative study validates the utility of D&D as a "wellbeing intervention" or prevention program for broader community populations.