Therapeutically Applied RPGs to Support Adolescent Social Connection and Growth During the COVID-19 Pandemic

ABSTRACT

The COVID-19 pandemic’s negative impact on youth social and emotional health in the United States and worldwide is well documented. This study explores the ways in which virtually delivered Therapeutically Applied Role-Playing Games can support youth social/emotional development. The current study used parents and youth interviews to assess youth’s experiences with such a group. Inductive thematic analysis was used to explore participants’ descriptions of their experiences with therapeutically applied role-playing games, social and emotional development, and online programming during the pandemic. Benefits of the intervention included social connections with peers, practice with challenging scenarios, opportunities for self-expression, practice perspective taking, and engagement with storytelling and creativity. Results also suggest that there are benefits to these groups during the pandemic, as noted by participant reports in the areas of social connections and collaborative problem solving. Virtually delivered therapeutically applied role-playing groups may be a cost-effective and accessible intervention to support youth during the pandemic and beyond.

KEYWORDS:

• therapeutically applied role-playing games
• COVID-19
• social skills
• social emotional learning
• tabletop role-playing games
• creativity in counseling

The COVID-19 pandemic has negatively impacted the social and emotional health of youth in the United States and worldwide in multiple domains, including increased loneliness, decreased social connections, increased home stressors, reduced access to valued activities, and barriers to screening and care (Courtney et al., 2020). There has been significant disruption to the support that youth rely on for social emotional learning (SEL), and many youth have faced increased demand for these skills in the face of new or exacerbated stressors (Ettekal & Agans, 2020). Further, social distancing and other public health measures to reduce the spread of COVID-19 diminished or eliminated many pathways for youth interaction (Elmer et al., 2020).

In the present research, we explore the ways in which Therapeutically Applied Role-Playing Games (TA-RPGs) can address many of these concerns and provide a dedicated space for youth to intentionally develop skills that enhance social growth. TA-RPG groups are social skills groups that leverage role-playing games with structured rules to support collaboration, insight, and change in players. We focus specifically on a community-based TA-RPG group based in the greater Seattle area that uses Dungeons & Dragons (D&D) as an intervention in youth social skills development. Using interviews with youth and their parents, we examine the utility of this intervention for social skills development via an online format during the COVID-19 pandemic in 2020 and 2021. This research is intended to address the call for more research in the area of applied TTRPGs (Henrich & Worthington, 2021). Though we believe TA-RPGs have value independent of the COVID-19 pandemic, we believe it is important to contextualize the current work within this context, as it was central for both the participants of the groups and the design of the study.

Impacts of COVID-19 on youth’s lives

Between the effects of the pandemic itself and public health responses, youth have lost access to many of the activities that provide structure and create meaning in their daily lives, such as school, social activities, sport/recreation activities, and other out-of-school time activities (Courtney et al., 2020). Ettekal and Agans (2020) note an unfortunate paradox of the pandemic – though youths’ access to leisure opportunities are severely restricted by public health measures set in place to combat the pandemic, many youth have more free time than ever due to these restrictions. Youth’s access to activities and spaces for them to build peer relationships, confidence, and autonomy have been similarly impacted, hindering SEL during an important developmental period (Blakemore & Mills, 2014; Gabriel et al., 2021; Patton et al., 2016).

SEL refers to the growth of skills such as problem-solving, healthy communication, emotion regulation, and the use of coping strategies. These skills help to further build protective factors such as social connectedness and social support; however, lack of such skills can exacerbate academic and behavioral struggles (Tan et al., 2018; Yoder et al., 2020). Safe and supportive spaces where youth can practice these skills have been limited by public health measures designed to promote community and individual safety from COVID-19, while the experience of isolation, economic hardship, and stress in youth has increased (Courtney et al., 2020; Yoder et al., 2020).

Multiple challenges exist in addressing the negative impacts of the COVID-19 pandemic on youth. Some of these challenges include the loss of in-person services, overtaxed support systems, and fears of COVID-19 infection (Courtney et al., 2020; Lee, 2020). For example, SEL support has traditionally been delivered in-person, which is often not feasible during the pandemic (Yoder et al., 2020). Previously existing barriers to accessing mental health care also continue to be present, including lack of access to treatment, treatment fatigue, stigma, and lack of parental support (Clark et al., 2018; Cummings et al., 2013; Ebert et al., 2019; Reardon et al., 2017). Calls for an increased focus on SEL in youth have been made to support youth from the adverse effects of the pandemic, especially in those further impacted by historical inequities (Kearney & Childs, 2021).

Pandemic adaptations for social emotional learning

The need for social connection and growth for youth during the pandemic is further evidenced by the coping strategies that youth have developed during this time. Youth have worked to find social-focused coping strategies during the pandemic, including staying connected with others (e.g., phone calls with friends), participating in quarantine community activities (e.g., community recognitions, physical signs of support in windows), and using networked technologies (e.g., social media platforms; Orgilés et al., 2021; Pitt et al., 2021; Waselewski et al., 2020). Youth participation in such coping strategies is in line with research that suggests voluntary participation and sense of belonging are important parts of youth peer relationship development (Berger et al., 2020).

Interventions that are delivered virtually, and thereby not reliant on the current social restrictions, maybe one way of overcoming barriers associated with the COVID-19 pandemic (e.g., public health restrictions, access concerns). In response to the need for access to services during the pandemic, the use of internet-based interventions has increased significantly (Courtney et al., 2020; Nicholas et al., 2021; Ros DeMarize et al., 2021; Yoder et al., 2020). Internet-based interventions, commonly through the use of video and voice-based platforms, have been found to be an effective means of service delivery for youth (Nicholas et al., 2021; Reay et al., 2020).

Role-playing games

TA-RPG groups combine collaborative role-playing games with established therapeutic techniques in a supportive group environment to elicit social emotional learning in participants (Connell et al., 2020; Goodall & Truong, 2021). To understand how these groups operate, it is important to define relevant terms and provide context surrounding their application. In this section, we aim to outline what a tabletop role-playing game (TTRPG) is, how TTRPGs and their therapeutic application differ from other games, previous research findings, and the rationale for the current study.

Tabletop Role-Playing Games

Within TTRPGs, the collaborative nature of the game combines with the dynamic of the players to define the play space and players’ roles (Mearls et al., 2014). In addition, TTRPGs utilize structured rules to establish the boundaries of player actions and outcomes. The games take place around a physical or virtual table, and the participants each play the role of a character within the game’s narrative. TTRPGs are inherently collaborative, with players working together to accomplish goals. Each player’s character has their own strengths and weaknesses, growing and changing over time. A “Game Master” (GM) sets up the environment and storyline, and plays the part of any non-player characters (NPCs). Additionally, randomizing agents, usually dice, are used to simulate luck and chance within the experience. The use of chance, structured rules, and an overarching storyline with goals separate this experience from a less formalized improvisation exercise. TTRPGs require minimal equipment and are primarily delivered through a shared “theater of the mind.” The theater of the mind experience can be supported through physical or digital materials, including maps, images, and tokens to represent characters and monsters. These games are not video games, but can be played online through the use of a video conferencing system and digital supports.

Therapeutically applied role-playing games

TA-RPGs utilize the framework of TTRPGs and the fantasy space of the game to create intentional scenarios in which players can practice skills such as assertiveness, conflict resolution, emotional regulation, and communication (Connell et al., 2020). The use of characters provides the players distance from their in-game actions, supporting increased insight and perspective taking (Bowman, 2010; Daniau, 2016). Instead of a direct instruction model, skills are typically taught and supported through the game environment (Connell et al., 2020). The facilitator designs in-game challenges as part of the game’s narrative designed to support the group’s relationship and utilize natural consequences to encourage insight and functional change. Because of the encompassing role of the GM in TTRPGs, facilitators in TA-RPGs can create opportunities to practice skills through the design of NPC interactions, environmental challenges, and even combat scenarios (Connell et al., 2020).

Though the use of TA-RPGs to support social skill development and mental health has increased in the last 15 years, there is relatively little research on the efficacy of such programs (Arenas et al., 2022; Henrich & Worthington, 2021). There has been some research that examines the translation of skills from game to real life, as well as the use of TTRPGs like D&D to address skills with youth identified as “gifted” or with neurodivergent diagnoses (Daniau, 2016; Kato, 2019; Rosselet & Stauffer, 2013). Some of the previous research on TTRPGs was in response to the “Satanic Panic,” in which sensational claims about the dangers of collaborative role-playing games were common in the media (Peterson, 2021). Many of these concerns have been addressed as the public has developed a greater understanding of TTRPGs, and studies have found that TTRPGs do not appear to be related to self-reported criminal behavior (Abyeta & Forest, 1991), depression, suicidal ideation, psychoticism (Carter & Lester, 1998), or emotional instability (Simon, 1987). There is an article that outlines potential challenges related to unsupported and self-led play of TTRPGs in particularly vulnerable groups – in this case, adolescent boys in an inpatient psychiatric unit (Ascherman, 1993). As TA-RPGs should be led by a facilitator with experience working with the group’s population, the concerns noted related to rapport and social hierarchy are unlikely to be present in TA-RPGs. Further, as TA-RPG groups are facilitated by trained professionals, the in-game content is developmentally appropriate.

Rationale for current research

The current study aims to increase the understanding of the use of TA-RPG interventions within the context of the COVID-19 pandemic. These groups have historically been delivered in-person, but due to the pandemic, this intervention was offered through a video conferencing format. Internet-based interventions have been found to be effective for treatment of depression, ADHD, social anxiety, and anxiety in youth, which suggests that other talk-based interventions may show similar rates of effectiveness through online formats (Hepburn et al., 2016; Peros et al., 2021; Ros DeMarize et al., 2021; Topooco et al., 2018). TA-RPGs can be delivered electronically, and as such, meet calls for increased virtual treatment opportunities (Lee, 2020).

There is a growing recognition of the need for research and applied programming that contributes to our understanding of TA-RPGs as a social skills development intervention (Henrich & Worthington, 2021; Zheng et al., 2021). This study adds to the research literature by examining the ways in which youth practice social and emotional competencies during virtual TA-RPG sessions that utilize the popular TA-RPG, Dungeons and Dragons (D&D). We focus specifically on the opportunities for youth to practice social skills (e.g., collaboration, confidence), enhance creativity and imagination, and apply perspective-taking – both vicariously through their character in the game and through virtual peer interactions. Given that this study took place during 2020 and 2021, we foreground the utility of such an intervention for social and emotional development within the context of the COVID-19 pandemic. The research questions guiding this study were the following: (1) What barriers and opportunities did youth experience during the pandemic?; (2) What is the utility of this intervention for youth?

Current study

To answer these questions, we utilized a qualitative approach, featuring interviews with youth about their experiences participating in a 20-week virtual therapeutically applied role-playing game group. We also examine the perspectives of their parents about the utility of this intervention for their child’s growth and development. Due to the lack of qualitative research about youth’s experiences with TA-RPGs, and novel changes in the lives of youth due to the COVID-19 pandemic, we prioritized semi-structured in-depth qualitative interviews for this study.

Methods

The research team conducted semi-structured in-depth interviews with youth and their parents about potential social and emotional learning development in a community-based program providing TA-RPG services. For individuals younger than 18, the research team provided parents with information about the study and gave them the option to accept their youth’s participation. Youth participants under 18 provided written assent, and adult participants over 18 provided written consent. The research team obtained foundry10 Institutional Review Board approval (Approval Number: 2021.007) before recruitment, and all participants were treated in accordance with American Psychological Association ethical guidelines.

Program description

The community-based organization studied in the current research is a nonprofit that offers weekly therapeutic social skills groups to support youth to become more confident and socially capable through the facilitation of collaborative gaming experiences. In particular, this organization tailors D&D experiences to help youth who may have trouble socializing and building community. Many of the youth in these groups struggle with social challenges such as ADHD and anxiety; play in these groups have the potential to help youth test new ways of behaving, hone their social skills, and boost their creative problem-solving abilities in a supportive environment.

The program focused in the current research is a weekly game-based social skills group that serves youth aged 10–13. Youth met weekly to collaboratively play D&D under the guidance of group facilitators specializing in education, family therapy, and/or drama therapy. The group facilitators provided structured story narratives where participants practiced behaviors through an avatar, collaboratively built a fantasy world, and developed interpersonal skills through interactive play. In these settings, group facilitators controlled the pacing of the story and dynamics between characters as a way for participants to engage in more complex social scenarios. Group facilitators used guided storytelling and character development with the aim for youth to develop in the following areas: self-regulation, perspective-taking, communication and collaboration, and imaginative play.

Participants

Participants had the opportunity to participate in two virtual quarters of the program: a 10-week quarter in Fall 2020 and a 10-week quarter in Winter 2021. Sixteen youth participated in the Fall session and of those youth, 14 youth returned for the Winter session and two new youth joined the group. Organization staff assigned youth to small groups (four youth per group) for the duration of each 10-week session. Participants of the program ranged in age from 10–13 (M = 11.88, SD = 1.02) and were diverse in regard to gender representation (10 boys and six girls in Fall session; 10 boys and six girls in Winter session). When considering interview participants, 12 parents (M = 43.15, SD = 4.01; 11 women, one man) and eight youth (M = 11.71, SD = 0.5; three girls, five boys) participated in interviews.

The original aim of this study was to assess the experiences of youth who participated in weekly in-person sessions at schools in the greater Seattle area (the location of the organization). The COVID-19 pandemic disrupted recruitment methods via school programs since extracurricular activities were canceled in the Seattle school district. Recruitment, therefore, shifted to schools that expressed interest in virtual participation. Importantly, a transition to online sessions for the program created a larger pool of participants and a greater range of options for assembling well-matched cohorts in terms of age and goals for the group. It also provided an opportunity for the research team to examine the role of virtual programming for youth during the pandemic.

Procedure

Organization staff recruited youth participants via teacher/counselor announcements at two Title I schools in the U.S. located in the southwest and east coast. Schools were identified by their Title I status (i.e., schools with high numbers or high percentages of children from low-income families) and ability to find a contact at the school interested in sharing information about the program. Since the program was free for youth, organization staff recruited youth from Title I schools so families who may not have financial resources could participate in the program. Youth and their families were given information about the research study after signing up for the Fall 2020 session. Participation in the research study was voluntary and did not affect their membership in the program. Notably, participants in these research groups presented as less distressed than the organization’s typical participants, as reported by each research group’s facilitator. This may be due to participants being recruited for free services, as opposed to seeking out services for themselves or services sought by a parent.

The research team conducted online interviews with parents at the end of Fall session and youth at the end of Winter session. Given COVID-19 and school closures, the research team interviewed youth and parents at separate times to logistically meet the demands of familial schedules. At the beginning of the interviews, participants were informed that they could skip questions or stop the interview anytime. Each interview was approximately 45 minutes in length, and participants were compensated $25 for their time. All interviews took place on Zoom and were recorded for transcription.

The research team created a semistructured interview protocol in partnership with the organization staff. The research team used questions as a guide for conducting the interviews with the understanding that flexibility is integral in interviewing, especially when asking participants to recall personal experiences (McIntosh & Morse, 2015). Parent interviews covered topics about their child’s problem-solving, empathetic concern, frustrations, and confidence before and after participating in the TA-RPG program. Youth interviews covered topics about character development, successes and challenges during gameplay, collaboration with their group, approaches to problem-solving in the game, and the development of empathy for other players. Parents and youth were also asked to reflect on the impact of the COVID-19 pandemic on peer relationships, family dynamics, and interest in virtually-delivered TA-RPGs.

Analysis

All interviews were recorded and transcribed verbatim. We used an inductive thematic analysis to explore participants’ descriptions of their experiences with TA-RPGs, social and emotional development, and online programming during the pandemic (Braun & Clarke, 2013). Since we used an inductive strategy, we developed separate codebooks for youth and parent interviews. Across all interviews, coding and analysis followed a three-step process. First, two of the authors (Rubin and Scanlon) grouped participants’ responses and identified potential emergent codes. These authors then collectively discussed the data and sorted them into more refined codes. The two coders met weekly to discuss the codes, build consensus, and resolve discrepancies over the course of two months. Second, we organized data within these categories into subcategories. Themes were created from subcategory codes through collaborative consensus. The third stage involved refining themes to ensure that each theme had sufficient supporting data. In the third stage, we focused on interpreting the meanings associated with each theme. See Braun and Clarke (2013) for a detailed description of thematic analysis procedures to ensure consensus-making across participant interviews.

Journal editors and peer reviewers are often guided to publish qualitative research based on foundational principles of quantitative research, such as notions of replicability, inter-rater reliability, and internal validity checks (Sheard, 2022). However, applying quantitative standards and processes to qualitative research is inappropriate since the aims of each method are different (Morse, 2020). In qualitative research, we are interested in deepening our understanding of experiences rather than testing hypotheses, theories, or causality (Rubin et al., 2017). For example, we do not report the frequency of themes found in the data (see Brinkmann, 2015; Gergen et al., 2015; Valsiner, 2014). Qualitative researchers aim to gain insight into how participants describe their lived experiences; as such, it would not make sense to equate frequency of a particular idea with its meaningfulness (Braun & Clarke, 2021).

Results

This article reports two larger themes: (1) Youth and parent experiences during the COVID-19 pandemic captures the ways that participants navigated social isolation and remote schooling in the past year; and (2) TA-RPGs during the COVID-19 pandemic reports how virtually delivered TA-RPGs provided unique opportunities for youth’s social emotional development during a period of pandemic-related social isolation; Participants’ excerpts are followed by their age; all names and character names provided are pseudonyms.

Youth and parent experiences during the COVID-19 pandemic

Youth participants described challenges at school and home amid the pandemic and the lockdown that followed. A common thread throughout youth experiences was difficulty concentrating on schoolwork due to fatigue from remote schooling. For example, Danny (12 years old, boy) transitioned to homeschooling because he was not thriving in the online learning environment; yet, he continued to encounter challenges with motivation and time management given the absence of structure outside of in-person classroom learning:

It’s been hard and staying inside a lot more and not getting as much exercise. I’ve been homeschooling because the online work wasn’t working for me. It’s definitely a lot harder because I feel like sometimes I can just blow it off and sometimes I won’t show up to homeschooling on time. Whereas, at school I felt like I had to listen. I had to do the stuff most of the time.

Youth participants also talked about navigating social isolation during the pandemic. Youth often described feeling disconnected from important social groups or communities, contributing to feelings of loneliness. For example, Audrey (12 years old, girl) expressed that she longed for her established daily routines and peer support systems: “I miss not being six feet away from people. I miss having no masks and actually getting to do what I want. I’d normally hang out with my friends after school but with COVID, it’s been dialed down.” Other youth discussed navigating social isolation due to fears of illness for a family member, often contributing to heightened anxiety. Lucie (12 years old, girl) detailed the emotional burden of health concerns during the pandemic: “My dad had an ongoing lung issue, so we were pretty locked down…So that’s been hard. We’ve been very isolated for a long time.”

Although several participants indicated challenges, some youth experienced benefits from social distancing and remote learning. Youth participants who traditionally experienced anxiety in social situations enjoyed additional opportunities for being alone: “Remote and social distancing is more or less, no different than how I usually act. I don’t really mind being by myself. I’m an introvert” (Katie, 11 years old, girl). Some youth talked about the benefits of remote learning for social bullying since peers could no longer make disparaging comments during class or recess. As Colin (12 years old, boy) explained, “Since I didn’t have to physically go to school, people that used to bully me didn’t because they couldn’t do the things they used to do to me. As bad as COVID-19 is, if I could just keep doing this, I’d be very happy with myself.”

Parent participants described a different set of challenges mostly focused on emotional and behavioral concerns at school and home. For some parents, the inability to make in-person contact with classmates and teachers was a setback to their child’s social and emotional development. Sandra (34 years old, woman) offered insight into relationship between remote learning and her son’s heightened stress and anxiety:

We obviously went remote in the spring and it was horrible for everyone. I’m an educator and Lee was in fifth grade, which is middle school here. So, it was really, really, really hard. He had a great year last year. He kind of broke through some anxieties that he had in fourth grade and tried new things and joined new clubs and then the year came to a halt…there was a lot of disappointment and the spring was awful.

For other parent participants, their descriptions of the pandemic focused on their children’s loss of interest in activities that they previously enjoyed. Loss of interest was often tied to anxieties about illness or social isolation. For example, Tania’s (46 years old, woman) son had heightened anxiety about disease transmission that ultimately impacted opportunities for peer interaction: “They started a new school, it’s an overnight school, and he refuses to consider it, whereas it’s something in the past that he’s been very interested in. With the pandemic he’s just shut down any interest in doing things like that.” Brenda (45 years old, woman) similarly reported that her son’s anxieties about social isolation impacted the activities he engaged in during the pandemic: “It is very isolating, and that has been hard. He used to be a lot more active outside and go biking, and we’d go on walks, and we’d go find trails, and watering holes and such, but that’s really just stopped.”

Therapeutically applied role-playing games during the COVID-19 pandemic

We examined several characteristics about the value of the intervention in participants’ descriptions through a close examination of the themes in the interview data. Importantly, this section focuses specifically on the role of the intervention in fostering social skills development during a period of social isolation (e.g., school closures) in youth’s lives. If participants explicitly talked about connections to the COVID-19 pandemic, we situate those findings within the context of the pandemic. We also report participants’ general perceptions of the intervention. Several themes stood out across the interviews: the role of connecting with peers to limit pandemic-related social isolation, engagement with challenges, considering the perspectives of others, practicing storytelling and creativity, creating space for self-expression, and bolstering self-confidence.

Connecting with peers

Social distancing measures may have slowed the spread of COVID-19, but they also contributed to the subtle erosion of regular social interaction for youth (Elmer et al., 2020). Throughout the interviews, youth participants indicated that they often experienced social isolation due to the pandemic; however, they described the virtually-delivered TA-RPGs as providing an opportunity to connect with peers and develop satisfying relationships. As Lucie explained, the online environment for weekly gameplay was vital in fostering social connection during quarantine: “I get to play Dungeons & Dragons with people that I wouldn’t have otherwise played with because Andrew [Game Master] is in Seattle, so I would never have thought to play with him. So, it sort of connects people. And I think it’s pretty good.” For other youth participants, the opportunity for online peer connection and enjoyment became a highlight during social distancing: “[Group] was making friends, having some good laughs and yeah, it’s been something to look forward to” (Danny).

For youth participants who experienced bullying during in-person school, virtually delivered TA-RPGs not only provided an outlet for social connection during the pandemic but also a buffer from incidences of peer mistreatment. The dynamic facilitation strategies of the adult facilitator – such as guided gameplay, opportunities for social skills development, and laying groundwork for a welcoming online environment – fostered a space for safe interactions among youth. Colin described the importance of guided gameplay by the game master in the development of friendships in his group:

It’s definitely a good way to work on interacting with others. That’s something that I really saw is the more I played with the group, the more I saw them slowly but surely open up…It was kind of difficult to be like, “Should I trust them? Are they going to back stab me because of all the trauma I had in school?” But I’d say this is a really great way to meet people because they usually can’t do anything to you if they are cruel. I really appreciate the rules of how Andrew works with the group. It’s like, “Is it okay if we fight this person?” “No.” “Okay, then that’s it.” I kind of appreciate that because there’s a barrier.

Parent participants discussed concerns about changes in routine as a result of the pandemic and the role of weekly gameplay sessions in facilitating social connection. Some parent participants expressed anxiety about disruptions in their child’s lives (e.g., exploration of hobbies, gaining social and emotional skills) and the perceived benefits of virtually-delivered TA-RPGs in meeting those needs. This dynamic can be seen clearly in how Rene (34 years old, woman) talked about the value of online sessions for peer connection during the pandemic:

Unfortunately at this time of her life, we were trying to find other hobbies and things for her to do. So when COVID hit, it was like a total stop to that, which stunk, you know? I’m trying to get her into things, so for me, [D&D] was an opportunity to get her to do something besides just sitting around the house. I saw it as a bonus for her during this time.

Lastly, some parent participants described virtually-delivered TA-RPGs as providing a space for enjoyment amidst a year of profound change and instability. The consistency of weekly meetings, coupled with guided collaborative activities in each session, helped alleviate some of the social isolation that youth experienced during the pandemic. For example, Ella (40 years old, woman) expressed that D&D sessions were integral in her child’s happiness and overall mental health over the past year:

This has been a really great opportunity, and Kendra [daughter] in general isn’t somebody who necessarily needs counseling or those kinds of skill-building in such a way that I would reach out for that, but I think it’s been really good for her anyway, to have this experience…And adults. They’re all so happy, especially because there’s so much isolation right now for kids, that this really feels, really like an important part of what’s kind of kept them happy and healthy this year.

Overall, youth and parent participants discussed the importance of weekly D&D sessions during the pandemic in facilitating social interaction, decreasing social isolation, and fostering a space for safe interactions among youth.

Engagement with challenges

Participants described collaborative problem-solving as fulfilling a need that was absent during the pandemic due to remote schooling and physical isolation from peers. Youth discussed navigating several challenges during weekly gameplay sessions that encouraged them to collaboratively brainstorm, identify potential solutions, and act in concert with the group toward a goal, often within the context of a time-sensitive scenario. This kind of collaborative problem-solving can be seen as an important social cognitive activity (Larson & Christensen, 1993), or as an opportunity for problem-based learning (Sancho et al., 2009). Youth participants recognized that team-based problem-solving was important to the game, and having the group rally around a common plan was crucial to success. When describing the best part of the program, players often mentioned large accomplishments in problem-solving that took place virtually. Players took particular joy in trying out creative and novel solutions:

My highlight was probably coming up with a good plan to sneak into a castle and then having to pretend I was one of the workers … Each person has an important role in the plan. I was a worker, so I can take a special ring that we needed to steal. Another person had to distract the King and another person had to make sure that we could get out safely. (Audrey)

Decision-making requires players to pay close attention to the details of the problem at hand, consider the problem from a few different viewpoints, and anticipate potential outcomes for a certain action. Crucially, the virtual game environment was set up in a way that allowed students to take their own individualized approach to group decision-making and problem-solving. One player noted her tendency to use verbal skills rather than physical power to solve problems:

I think that mainly [my character] Miri played also like the negotiator, if there was a high stakes situation, because she was a Bard and she had a very high charisma compared to the rest of the group. So, she would step in and do the negotiating. (Lucie)

In addition to identifying and playing to one’s personality strengths in the face of problems, the online group format allowed players to try out new and unfamiliar ways of working within a group. Ethan (11-years old, boy) was more willing to suggest solutions in his small group on Zoom knowing he had support from the other players:

Definitely [prefer to work] with others because we could… Because I could think of a plan that doesn’t have… That has quite a few holes in it and then people could help me and tell me what’s good and bad about it and then we could come up with a solid plan.

In the case of disagreements, participants needed to discuss their rationales and persuade others to take their side. This was the case not just for tactical approaches but also for ethical dilemmas. One group had a disagreement about what to do with an NPC (non-player character) who had made their campaign difficult:

We were all just half of us really wanted to kill him because he caused all of our problems. And then of course our Druid, who’s very much goody two shoes of the group, was just like, “Wait, no, he’s a person.” We were like, “Yes, he’s a bad person.” … We let him live in the end, I think. Did we? I don’t remember if we did or not. I think we did. I think he had to make us bacon though. Yeah. He had to make us dinner before we let him live. That was our agreement. (Lucie)

This example of disagreement and deliberation shows how players make use of multiple social skills in the course of problem-solving, such as listening, perspective-taking, brainstorming, critical thinking, persuasion, and compromise.

Some parent participants noted that virtually delivered TA-RPGs had a positive impact on their children’s ability to problem-solve at home. Parent participants discussed challenges with the pandemic, such as decreased opportunities for collaborative problem-solving at school, and the role of the program intervention in meeting this need. Leslie (woman, 39-years-old) highlighted the importance of virtual weekly sessions in her son’s ability to collaboratively problem solve with his parents on challenges at home:

Him and his sister are still struggling with problem solving in groups due to the pandemic closures of schools … He didn’t know how to solve the problems, so it was obviously my problem and I had to fix it for him. Now we are able to work through it with him. [since participation in the game]

Overall, participants identified collaboratively finding a solution to challenges as fulfilling a need during the pandemic. Through the virtual format of the program, players were able to interact with their peers and think ahead about the potential outcomes for a certain action despite social isolation from peers. Due to pandemic restrictions, parent participants often described lacking in-person contexts (e.g., school, after school programs) to fulfill this need and the importance of this intervention in strengthening their child’s approach to challenges.

Considering the perspectives of others

Youth and parents talked about the importance of weekly D&D sessions in fostering opportunities for social perspective-taking (i.e., the capacity to make sense of others’ thoughts and feelings; Selman, 1975). Youth participants expressed that many of these opportunities emerged naturally given the fantasy elements of the game – choices youth made in the game were often based on their character’s perspective and required them to understand the perspectives of other characters before moving forward in a campaign. For instance, Danny discussed that once his group could view conflict both from their own perspectives and the perspectives of other players, they could more easily reach a resolution to their disagreement:

Definitely a lot of disagreement towards the end…should we kill the mayor? Or should we break the statue? What should we do? There’s definitely a bit of arguing, but it all gets resolved in the end and we usually make a good decision…we all kind of understood why we shouldn’t smash the statue. I think we listened to each other and understood what the other person was saying.

Echoing Danny’s experiences, parent participants expressed that practicing perspective-taking helped youth understand others’ feelings during and after weekly sessions. Penelope (40 years old, woman) offered insight into her daughter’s experiences with learning negotiation through the collaborative aspects of TA-RPGs. Her daughter was having difficulty managing her emotions since the start of the pandemic, and the social skills gained during gameplay ultimately had a positive impact on her emotional regulation at home:

I haven’t seen her shut down as much lately. She’s more likely to talk. If you’re in a group game that you kind of end up having to talk through what you’re doing and it’s all on tabletop, it’s all talk. So, I think that’s maybe helped instead of her just saying, “I’m just not going to do it.” And again, when you’re on, you know, you’re in a group game, you’re not going to just walk away from that, you’re just going to figure out how to talk through it.

Finally, some parent participants discussed the importance of reflection exercises in strengthening perspective-taking. Participants recounted that the game master would often ask the group, “how would that make you feel if you were on the other side?” (Megan, 40 years old, woman). For youth participants, reflection questions centered the importance of listening to others’ concerns and giving space for all players to voice their opinions. Katie shared the following about learning to acknowledge the viewpoints of others as she progressed through weekly sessions:

Definitely trying to work on it [when someone has a differing opinion in the game]. I am very, very good at just talking and talking and talking and now if someone has an idea that’s completely different from mine, I try to be like [to myself], “Okay, make sure you’re not taking over and listen to what other people are thinking.”

This sentiment was shared among a majority of participants who reported that facilitation questions guided their consideration of others’ opinions and feelings during the game.

Storytelling and creativity

Youth and parent participants noted that TA-RPGs transported players to a fantasy world co-created by participants and facilitators. Acharya and Wardrip-Fruin (2019) suggested that TA-RPGs are fundamentally well-designed for world building and co-creation. As players interact with the characters and challenges introduced by the DM, they add their own details, possibilities, and solutions. For example, Lucie found it exciting that “you can just make whatever you want, do whatever you want to do, and it doesn’t affect your life in the real world.” Players took advantage of opportunities to customize their characters further as they leveled up, both through adjusting their character’s skills and adding pets to their party.

In the youth interviews, many players spoke about opportunities to inject humor into the storytelling, and took joy in creating a world that was surprising and fantastical. Participants described co-creating worlds during weekly gameplay sessions as a creative break from virtual school. Some players found it fun to do unexpected actions, like eating spiders or hugging a gargoyle, while others amused themselves by pranking NPCs in a relatively consequence-free environment. Lucie used the language of “making up a world” when describing an instance when her party developed a funny recurring gag in their campaign:

There’s definitely a lot of goofing around in the group, which I think is awesome. That we’re not just super stone-faced and serious all the time. I think one of our players pretended to be a painting. It was certainly funny in the moment. So that character has now become a essential piece of the world because we just made up this funny character and now he plays into other scenarios too.

This description from Lucie is an example of how the party makes decisions that bring players together and impact gameplay beyond just that one moment.

Parent participants echoed youth experiences by highlighting the role of creativity and storytelling in strengthening their child’s social and emotional skills at home. For example, Ramona (36-years-old, woman) discussed the importance of creativity in building her child’s ability to consider the perspectives of others. Ramona described his development as especially important since her child was having challenges with peer connection during the pandemic: “Creativity. I don’t know how else to kind of put that. The idea of being something else or someone else. And I think that can help again, like she’s trying to see things from different perspectives and I’ve enjoyed watching that.” Similar to Ramona, Rene emphasized the role of storytelling in spurring conversation with her child after remote schooling: “[My child] talks to me when silly things happen, like hugging the gargoyle … And then she’ll say briefly, ‘We make characters, or we did this.’ It’s nice, and drawn out, and a conversation.” Thus, as evinced by youth and parent experiences, the program provided space for young people to develop complex narratives and express their creativity in the process of storytelling with skills generalized to real-world relationships.

Creating space for self-expression

Youth participants talked extensively about choosing and refining role-playing characters as a form of self-expression. Bowman (2010) argues that character development within role-playing contexts is a playful way for players to imagine alternate selves and ways of being, and that role-playing games are a safe space for players to “try on” personality traits that may be more extreme than how they act in the real world or contradict their real-world selves. Developmentally, adolescent role-playing is an extension of pretend play in childhood, and the game world is a flexible and low-risk environment for identity exploration and expression (Bowman, 2010).

Within the program, youth participants choose from a set of pre-made characters for their campaign. In their discussion of their characters, participants pointed out their character’s emotions, feelings, and values:

I really haven’t gotten the chance to play rogues much, just because I went through a barbarian phase. They’re very handy. I could sneak and convince people to give me information or stuff, and that was really fun to do. (Katie)

My character was a Wood Elf druid. And I liked him because he was very caring about nature. And he’s also very powerful… I got to play off of him being a Wood Elf and that connection is nature, but also being a dude. And yeah, the one thing I didn’t like about the character is that for some reason, he wasn’t very smart. (Danny)

Colin was aware of how the role-playing world gave him the opportunity to act more reckless than in the real world:

And also with his personality, he’s very based on revenge, which means he’s usually going to, if something happens to him, he’s going to do it back to you. And I kind of liked that nature, but also I know that in real life it can cause trouble. And I completely understand that.

Similarly, Audrey described how her character acted differently than she does in real life:

My character became more comfortable speaking with people because I’m very comfortable. I’m a people person, but my character is not. So, my character then kind of became more comfortable in her situations where she had to interact with other people and we found out in the game that she had some connections with the evil-ish side.

Role-playing allows for deep self-exploration and discovery, which is a crucial developmental process for adolescents (Bowman, 2010; Goodall & Truong, 2021). Throughout the campaign, players found ways to further develop their characters. Several participants noted how their characters changed over the course of the campaign. For example, Lucie expressed that the GM asked questions that encouraged players to add new elements to their characters, and that her own character’s personality shifted as a result:

So I think that was really interesting … [My character] definitely did change quite a bit. She went from being sort of like, I don’t like a lot of people to being like, I’m going to help everybody today. Which sometimes got me in a bit of trouble, but it was worth it.

Some players also created more detailed backstories for their characters over time. Audrey found character development rewarding: “I like to make up characters on my own when I’m drawing and one of my favorite parts has always been the backstories because I feel like you can put so much feeling and emotion into those.”

Players in the program expressed themselves not just through individual character development, but also throughout gameplay. Sometimes it was important for players to engage playfully within the game, and at other times the game set up important opportunities for players to express their core selves. As an example of playful self-expression, Katie discussed how coming up with wild and entertaining ideas was an important form of self-expression:

I really liked how when playing D&D, it was a very fun. I’ve played with DMs who are really great, but they kind of stick to the rules and nothing kind of crazy and outside the box. I really like to enjoy being able to express myself and be like, “Oh yeah, we should make a hot air balloon out of floats to cross the chasm, instead of making checks to jump over it.”

On the more serious side, Danny found that it was important, and sometimes difficult, to convey his viewpoint:

I was a little frustrated near the end when we were trying to figure out what to do with this mayor that we had pretty much kidnapped or because we all have different ideas of what we should do. Most of us were saying kill him. I was like, no, maybe we shouldn’t. We should just have him make peace with the other town. [What was frustrating about that situation?] It was frustrating because it doesn’t always feel like you’re being heard. I mean, I think everybody was heard and listened to, and all their opinions are thought about in the end, but it sometimes took a while, especially in that one situation I feel.

In summary, the program gave players a space to be flexible with their identities and self-expression, to explore possible ways of acting with their characters, and to develop their characters and the story over time in a way that reflects their beliefs, thoughts, and values.

Bolstering self-confidence

Youth participants in this study shared insights about how the fantasy elements of the game helped bolster their self-confidence. Youth discussed that TTRPGs taught them to pivot quickly when faced with a challenge – for every new challenge, they had to creatively come up with ways to escape from the puzzle and share their ideas with the group. For Lucie, creatively coming up with solutions to a challenge sometimes meant practicing self-confidence and taking a leadership role in the story:

There were a couple times where I had to do more stuff, I guess, without any help from our team. Like we had to escape from a prison. With a bunch of Drows and they were super powerful. So I was the one that had to, I guess, take charge in that situation. Because I had the spells that we needed and the charisma to get the guard to come over.

Through the role-playing aspects of the game, youth talked about becoming immersed in the story and finding ways to practice confidence in a low-stakes environment. For instance, Audrey explained that it took a certain amount of confidence for her character to challenge a nemesis who was accusing her of wrongdoing: “I had to stand up against the warlord because he was saying some things about me turning evil. I had to be like, ‘no, you’re evil! I think they [Audrey’s character] felt pretty good, like “yay, I’m stepping up. I’m doing the right thing.”” Other participants discussed the importance of group decision-making in providing opportunities for practicing confidence during game challenges: “It felt pretty good and once we got the plan, someone would take a suggestion and we’d all kind of take turns being the leader” (Callan, 12-years-old, boy).

Parent participants observed changes in their children’s approach to confidence due to the collaborative aspects of the game. Since youth had to communicate with each other to advance the story, the game encouraged some participants to openly share their ideas with the group. For example, Rene reflected that when her child started playing the game, she didn’t know the other players and had to work on voicing her ideas: “I think they [the other players] helped her build confidence in ‘I need to put myself out there. I need to talk to these people in order to play the game.’” Sandra echoed these sentiments in that practicing group communication helped her child speak up during challenges:

He has to give his reasons and he can’t just say, “I wanted to go left.” Why do you want to go left? Well, because there’s something over there, we can get to help us beat the monster over there. He has to explain it more, and I think that gives him a little more confidence … It’s not just because I want to go left, but there’s something over there we need, and I saw it and you guys didn’t.”

Overall, the role-playing attributes of the game may strengthen participants’ self-confidence in contexts outside of the program.

Discussion

Therapeutically Applied Role-Playing Game groups appear to be a valuable source of safe and engaging social connection during the pandemic, as well as a space to develop social and emotional skills. In this study, youth participants and their parents reported that youth participants practiced social emotional skills such as perspective-taking, engaging with challenges, self-expression, storytelling, and creativity. Participants noted growth as a result of intentional support by the facilitator, interaction with group members, and engagement with the low-risk fantasy environment. Falling in line with anecdotal experiences, participants also reported the ability to connect with peers through the groups was a valuable source of support to offset social isolation due to COVID-19 pandemic restrictions (see Consumber & Kjeldgaard, 2020; Hughes, 2021).

Though the literature on the utility of TA-RPGs is still emerging, findings of the current study are consistent with the current literature in this area. For example, the outcomes reported by this study’s participants align with a quantitative study that explored the impact of TTRPGs on quality of life of autistic adolescents in Japan (Kato, 2019). After engaging in TTRPG groups, participants in that study reported increases in social connections and emotional well-being. Results from a case study using an Adlerian approach to RPGs identified shifts in creativity and self-awareness (Rosselet & Stauffer, 2013), results similar in theme to those reported here by youth and their parents.

Further, TTRPGs and TA-RPGs have traditionally been delivered in an in-person format; however, the current study utilized a virtual delivery method due to public health restrictions in response to the COVID-19 pandemic. Though participants were novel to this intervention, they did not cite the virtual platform as a detriment. In contrast, one participant noted how the online platform allowed them to connect with people in other parts of the country, which would not have been possible in person. The successful delivery of the TA-RPG group virtually is consistent with literature that has found telehealth interventions to be successful for adolescents across a range of intervention and goal types (Nicholas et al., 2021; Reay et al., 2020).

Therapeutic recommendations

Due to the popularity and approachability of TTRPGs as an interpersonal game experience, mental health professionals are harnessing its appeal to support individuals in therapeutic gaming contexts (e.g., Allison, 2021; D’Anastatasio, 2017; Krieger, 2021). TA-RPG groups may be an effective intervention for individuals to develop and practice social skills, as well as engage in creativity, problem-solving, and perspective-taking. Additionally, the game-based approach to these groups may create an inviting opportunity for individuals who may not be otherwise willing to engage in therapy. Though detailed recommendations for intervention are beyond the scope of this paper, there are key components for clinicians to consider whether they plan to start TA-RPG groups themselves or refer their clients to existing TA-RPG groups. As research on the efficacy and safety of such groups continue to emerge, it is vital facilitators utilize best-practice approaches from related modalities until specific guidelines for TA-RPGs can be developed across populations and goal areas. Consistent with recommendations on training in evidence-based practices, facilitators of TA-RPG groups should have adequate training with applied gaming/roleplay interventions, as well as with the population and population goals (i.e., adolescents working on social connection, adults with a history of trauma working on developing relationships; Beidas & Kendall, 2010). When developing and implementing groups, participants should be screened for potentially triggering materials, and so-called “safety tools” should be introduced early in session to provide support and direction for players who experience unexpectedly upsetting events. Though contra-indications have yet to be firmly established by the literature, participants who have challenges with reality testing and whose symptoms are exacerbated by group content should not participate in TA-RPG groups, nor should participants whose engagement could present a risk to themselves or others. Finally, many TA-RPG interventions pull from established therapy modalities and techniques. Consistent with the psychotherapy literature, common factors, such as alliance, therapist empathy, cultural adaptation, and client expectations are likely important to outcomes across modalities (Wampold, 2015).

Limitations and future directions

We acknowledge limitations that future research will want to address. First, the current study consisted of a relatively small sample size, with 18 youth participants total. A small sample size may not capture the range of experiences associated with participating in a virtual TA-RPG program. Second, parents were generally unfamiliar with TA-RPGs. Though this reduced the potential for confirmatory biases, it is possible some of the effects of the groups remain unidentified by parents. Third, because this sample was less distressed than the organization’s typical TA-RPG groups, different skill development or functional changes may be present in a more distressed population. For example, youth participants with attention challenges may have more difficulty with self-regulation in the program setting; our sample may not have captured these experiences due to the relatively low levels of distress reported by parents and youth. Finally, there was a large reliance on child self-report, with minimal observer report. As a result, participants’ narratives may be biased in favor of coherence and may be affected by the passage of time.

This study does provide unique strengths as a result of using interview methods to investigate experiences with a sample of youth and parents. Through the youth and parent interviews, participants were able to share their in-depth experiences with researchers. As research on the uses of TA-RPGs is an emerging area, the semi-structured interview design and the use of inductive thematic analysis allowed for this study to be firmly grounded in participant experiences. A key limitation with our use of in-depth interviews is that it did not include additional methods for triangulation which may further support our exploratory findings, nor were we able to utilize validity checks such as member checks or an external auditor. Nonetheless, conducting this study provided valuable insights into the ways in which virtual, social/emotional focused groups may be especially beneficial during the COVID-19 pandemic. Future research should continue to establish the efficacy of such interventions outside of the context of the COVID-19 pandemic. As such, qualitative and quantitative research on the efficacy of TA-RPGs with other populations and contexts remains necessary.

Beyond creating avenues for connection and social growth during the pandemic, this study identified benefits of TA-RPGs independent of the pandemic context. Participants noted growth in the areas of perspective-taking, storytelling and creativity, and self-expression. Further, the online delivery method may be especially helpful to connect those who have mobility challenges, less access to transportation, or live in more rural areas with fewer opportunities for positive social connection and safe spaces for personal growth. Though more research is needed to fully understand the potential of TA-RPG groups, this study articulates the perception of value across social and emotional areas of growth as perceived by youth participants and their parents.

Disclosure statement

No potential conflict of interest was reported by the author(s).