Video: Can playing Dungeons & Dragons improve mental health?

Dr. Gary Colman from Game Therapy UK shares how therapeutic gaming is really similar to existing therapies, such as art and creative therapy, leveraging imagination and creativity for healing. What’s compelling, in the case of my project, is how these gaming environments allows players to practice and rewind their communication and interactions, providing a safe space to practice their face-to-face social skills in a comfortable and familiar gaming environment.

Finbar Westall, a complex needs worker, suggests that for those overwhelmed by conventional therapy, therapeutic gaming offers a welcoming alternative. This idea particularly strikes a chord with my research, highlighting how the familiar environment of gaming can make such therapeutic play more welcoming and accessible to my target gamers. This structured play could help them feel more comfortable and open, helping them along with practicing their face-to-face interactions.

Gary mentioned in the video that they are currently working on a project for young neurodivergent adults, and they have organizations coming to them asking them to develop projects for the prison population, and even hospitals asking them to help develop a project for the cognitive impaired, Gary said that they are able to tailor scenarios to fit different individuals. This made me wonder if there could be a way to tailoring TTRPG scenarios to specifically help affected gamers bridge their online social prowess to real-world social interactions? Moreover, I’m also quite curious about potential overlaps between the groups – young individuals with neurodivergence and gamers – who might both benefit from such therapeutic gaming environments.

Game Therapy UK’s work and their openness to adapting scenarios for different groups hints at a promising avenue for collaboration. If I can show a need or interest within the gaming community, maybe it could lead to new therapeutic approaches tailored just for them?

Interview with a Socially Anxious Gamer

This interviewee is a 27 year old Taiwanese male, self identified gamer, has consistently spent the majority of available time on online video games. The interviewee considers himself socially outgoing and comfortable when interacting with people in online gaming environments, but is uncomfortable and shy in offline face-to-face social interactions.

Q: What types of games do you usually play, and how often do you play? How many hours a week do you spend on games?

A: I mostly play FPS (First-Person Shooter) games. Typically, I play a few hours every night after I get home, about two to three hours. On weekends, if there’s nothing else to do, I stay home and play. Overall, I think I spend around 30 hours a week gaming.

Q: When playing these games, do you participate in any online gaming communities or friend groups?

A: Yes, I usually play with people I meet in games. We add each other as friends and use voice chat like the Discord app to play together. I have different groups of friends in different games, I usually check and see who’s online and ask if they want to play. My online friend group is very small and fixed.

Q: In the past few weeks, have you had any face-to-face conversations where you felt uncomfortable or shy? Can you describe these experiences?

A: It happens quite often actually. When someone starts a conversation with me, I might feel awkward after a while, not know how to keep up the conversation or to start a new one. It feels unnatural and forced, unlike when I’m talking to people online where I feel more relaxed.

Q: What if the person you’re talking to face-to-face is a friend you are able to chat with comfortably online, do you think there would be any awkwardness in real life? Would it be different from chatting online?

A: Based on my experience, there’s still a difference. Playing games in my room is very comfortable, and I don’t have to face anyone. In real life, meeting face-to-face makes me a bit nervous as I see their eyes, expressions, and interactions, which makes me uncomfortable despite being able to chat comfortably with the same person in games.

Q: Have you ever thought about overcoming your shyness in face-to-face interactions?

A: I thought about it, but it is difficult. Playing games at home is more relaxing for me, it helps to relieve stress. Reducing this time for socializing outside would keep me tense and unable to release stress.

Q: Have you played board games before?

A: Rarely. But I have gone to board game cafes with my friends a few times, so I have some experience with board games.

Q: When you went play board games with friends, were these friends you knew in real life or were they your online friends?

A: They are my classmates from real life.

Q: When you interact with these real-life friends, do you still feel awkward, or is it natural?

A: It mainly depends on whether there are people in the group who can carry the atmosphere. If there are people who are good at talking and creating a good vibe, the tension is lessened, and I can relax more. If everyone is quiet, it makes me very nervous.

Q: Do you feel more relaxed socially when playing board games? Does the awkwardness decrease?

A: Playing board games definitely reduces awkwardness in the group. When interesting or funny things happen in the game, the vibe becomes very light, good, and relaxed. However, there are also times when the game gets stale, and I will start feeling awkward and nervous again.

Q: There are professional therapists out there who holds therapeutic roleplaying board game sessions to help people practice social skills. Do you think this method will help you? Would you be interested in participating?

A: I think it’s a good idea. Playing games at home and playing games outside both have the same common element of games, which makes me feel more comfortable. It’s just changing to face-to-face interaction. So, yes, I would be interested in trying it out.

Q: If you find any information about such an activity, either through advertisement or resources shared online, would you actively try to participate on your own or would you need someone to invite you?

A: I would probably first look up information online to see others’ experiences and then decide if it’s suitable for me. If someone actively invites me, I will most probably go.

Q: What would make you feel that it’s suitable for you to participate?

A: If most people give positive feedback, I will find it suitable. If I see many positive reviews and comments from others who have tried it, I would want to try it myself.

Thoughts:

This interview provides a practical case that reflects my previous findings. He describes a strong preference for the safe and controlled interactions within online gaming environments, which echoes the research I’ve read previously that suggests such environments offer a sense of safety for the socially anxious individuals.

Linking my interviewee’s experiences with academic insights shows a pattern: the comfort provided by online interactions often leads to a cycle of increased dependency on these virtual spaces, which may weaken real-world social skills due to a lack of use. For instance, my interviewee mentions feeling awkward and nervous during face-to-face interactions, despite being comfortable with the same individuals online. My interviewee also mentioned having thought about improving his face-to-face social confidence, but finds it too challenging.

An important aspect in this interview was his openness to using board games to help practice face-to-face social skills. Transitional activities like board games could serve as effective intermediary steps for those struggling to bridge their online confidence into face-to-face settings. However, a mere nudge in that direction might not be sufficient, a more structured and supportive approach might be necessary. Targeting not only the gamers but also their friends and family could be crucial. Providing these supportive circles with resources and encouraging them to actively engage with their socially anxious peers could result in more significant progress.

Key Takeaways

Online Gaming as Comfort Zone: Online gaming offers a controlled, comfortable environment for socially anxious individuals.

Board Game Therapy: Using board games as an intermediary gaming environment could help transition online social confidence to face-to-face interactions.

Community and Support: Gamers are more likely to participate in sessions if they see positive case studies and reviews, and even more so if directly invited by friends or family.

Evidence

The full recording and transcript can be accessed here. Please note that this content is hosted on UAL OneDrive and requires you to be logged into your UAL student or staff account for access. The video is restricted to internal use and is available exclusively for academic purposes.

Understanding Social Anxiety in the Online Gaming Community

The virtual worlds of online gaming often serve as a safe space for socially anxious individuals to retreat from real-life social interactions. However, this can often mask or even deepen the challenges faced by these individuals. Recent studies have shed light on the complex relationship between gaming and social anxiety, suggesting a unique dynamic that both comforts and confines.

Research by Marino et al. (2020) highlights that people experiencing social anxiety may gravitate towards online games as these platforms provide an alternative to distressing face-to-face interactions. These individuals often prefer the control and safety of online environments, giving them the agency to manage their online social interactions more comfortably (Marino et al., 2020). The digital environment provides a temporary sense of safety, but it can also intensify feelings of isolation and anxiety if not balanced with real-life interactions.

Gioia, Colella, & Boursier (2022) have also explored this phenomenon, noting that online gaming interactions are perceived as safer than real-world interactions by those with social anxiety, which leads to a preference for online socialization over face-to-face interactions. “Online videogames might offer other alternative virtual environments where highly socially anxious individuals transfer most of their social activities, alleviate their stressful life event-related negative feelings, and feel safer and more comfortable than in face-to-face socialization” (Gioia, Colella, & Boursier, 2022, p. 1). This kind of behavior may predispose individuals to problematic online gaming, which may interfere with their wellbeing and daily life (Gioia, Colella, & Boursier, 2022, p. 1).

I see a challenging cycle: social anxiety drives individuals towards online games as a form of escape, which, while initially soothing, can worsen their social confidence due to a lack of real-world interaction. My project aims to try to break this cycle by nudging people towards an intermediary space, a safe and structured environment where gamers can gradually bridge their online confidence into offline social settings.

Negative Feedback Loop
References

Marino, C., et al. (2020). ‘Exploring the relationship between online gaming and social anxiety.’ Journal of Behavioral Addictions, 9, 617-618.

Gioia, F., Colella, D., & Boursier, V. (2022). ‘The impact of social anxiety on online gaming behaviors.’ Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 1.



Scale of Gaming

Following my presentation at the Dragon’s Den session, I realized the need to quantify the scale and opportunities within the gaming industry and the gaming hobby itself. Despite my background in the area, I lacked specific quantifiable insights, so I wanted to do a thorough exploration of recent data to allow myself to better communicate the scope of this project’s opportunity.

Global Gaming Market: A Comparison

In 2020, the global gaming market reached a valuation of 159.3 billion, including revenue from console games, PC games, mobile games, and esports. To contextualize this scale, Gavin Divers highlights, “The music industry was valued at $19.1 billion in 2020, while the movie industry was valued at $41.7 billion. That means the gaming industry is making more than three times as much money as the music industry and almost four times as much as the movie industry” (Divers, 2020).

UK Gaming Statistics: A Look at the Demographics

Gaming is really popular in the UK, it reflects global trends but also highlights some unique regional specifics. According to online gaming statistics collected by Uswitch, a significant portion of young adults aged 16-24 are engaged in video games, with 71% actively participating in gaming (Baker, 2024).

The engagement with online gaming in the UK is most common in 12-15 years old, with over 76% stating that they play online games (Baker, 2024).

(Source: Uswitch)

Moreover, gaming extends beyond casual play on the mobile phone among children aged 7-18. Over two-thirds (68%) own their own games console, with an additional 9% having consistent access to a console (Baker, 2024). This level of investment in gaming from a young age suggests that as these individuals grow older, the scale of opportunities and challenges within the gaming community with also likely expand.

References

Divers, G. (2020) ‘Gaming Industry Dominates as the Highest Grossing Entertainment Industry’, GamerHub. Available at: https://gamerhub.co.uk/gaming-industry-dominates-as-the-highest-grossing-entertainment-industry/ (Accessed: 10 June 2024).

Baker, N. (2024) ‘Online Gaming Statistics’, USwitch. Available at: https://www.uswitch.com/broadband/studies/online-gaming-statistics/ (Accessed: 10 June 2024).




Expert Interview Recap: ANVG

As we move towards our independent study period, I want to look back at the steps that I have taken that shaped my current project to help me sharpen my focus for the upcoming independent study period. As I revisited my notes of an interview I did previously, I felt this was a good moment to do a quick recap as this particular interview played a part in shaping what my current project is focusing on.


Back in April, when I was still exploring the theme of my project, I was looking into how games could serve as therapeutic tools. his lead me to reach out to Alex, the founder of Association of Neurodivergence in Video Games (ANVG), an organization based in the UK that hosts gaming sessions with the aid of support workers, for neurodivergent individuals who requires assistance.

In this interview, Alex shared with me how these gaming sessions have been helpful for participants. These sessions are not only just fun and engaging, but also enabled the participants to practice important life skills such as planning, teamwork, and situational awareness. Participants were able to demonstrate their ability to plan approaches, navigate game maps, and engage socially with peers and support workers, all through the medium of gaming. Alex emphasized that these skills are not just game-specific, they are transferable to real life, showcasing the immense potential of gaming as a therapeutic tool.

This conversation was really important, and I’m writing this recap to remind myself again, especially as I set my focus towards a distinct group: gamers who are socially shy in real-life settings but find comfort and safe space in online games. My current project aims to bridge the gap between online comfort and offline social challenges. The goal is to nudge people towards an intermediary safe space where these gamers can gradually practice and improve their face-to-face social skills.

Evidence

The full recording and transcript can be accessed here. Please note that this content is hosted on UAL OneDrive and requires you to be logged into your UAL student or staff account for access. The video is restricted to internal use and is available exclusively for academic purposes.

Email Exchange with Alex (Click for Fullscreen)

Dragon’s Den Feedback

This Wednesday, I had the opportunity to present my project at the Dragon’s Den session. It was a very valuable session as I was able to get feedback from external experts, including Dominic Stone, the former course leader for Applied Imagination. Below is a rundown of how it went and some key takeaways from the experience.

Positive Feedback and Putting the Opportunity into Perspective

Feedback from the session was very encouraging. Dominic, a gamer himself, brought a personal perspective to the discussion. Realizing that I hadn’t fully articulated the scale of the project’s opportunity, Dominic helped to provide a broader context. He highlighted that the games industry is larger than Hollywood, which helped frame the scale of the project.

Despite not having personally engaged in board games (Dungeons and Dragons etc.), he acknowledged their inherently social nature based on his observations. He was also supportive of including “Family and Friends” as stakeholders, recognizing them as an essential part of the support network for socially shy gamers. He said he could absolutely see where I am going with this project, which was a really big encouragement for me.

Caution

One of the most important pieces of feedback that day was about my portrayal of the “shy gamer.” I was advised to avoid leaning in on the stereotype of shy or reclusive gamers, which is a view that doesn’t accurately represent the diverse gaming community. This was a reminder to carefully consider how my use of language might affect the perception of my project.

Redefining Terms

Last Monday’s tutorial prompted me to do a dive into the definition and terms of my research question. Originally, I asked, “How Can Young Gamers with Low Self-Esteem be Supported to Improve their Self-Assurance?” The terms I’m going to define here are self-esteem and self-assurance, so I can have clarity on the accuracy of my research focus.

Understanding Self-Esteem and Self-Assurance

Self-esteem, as defined by Adler & Stewart (2004), refers to an individual’s overall sense of value or worth. It’s about how much one values and appreciates oneself. Self-assurance, on the other hand, according to the Collins Dictionaries (2024), is depicted as the confidence one has in their own abilities.

Looking into these definitions, I realized a critical oversight in my assumptions. The target audience I’m focusing one – those comfortable in online social interactions but hesitant offline – don’t necessarily suffer from low self-esteem. It isn’t about their self-worth but rather their confidence in face-to-face social settings. I’m now even more aware of the importance of using precise language in research.

Shifting Terms

Further research led to me a term that more accurately describes the challenges faced by my target audience: social confidence. Individuals who are socially confident are generally optimistic about their social performance and are not hindered by fears of negative evaluation. They tend to engage more successfully in social interactions because they do not focus excessively on potential failures or negative outcomes (Heimberg et al., 1985; Lorr, Youniss, & Stefic, 1991). I found a mental healthcare website that described social confidence in a way that’s easier for me to grasp, they stated that social confidence is “the ability to feel comfortable interacting with others in a variety of social situations. This can look like being able to talk to family members or peers, freely express opinions and feelings, join in conversations without feeling self-conscious, and navigate complex social dynamics” (Ascend Healthcare, 2023).

With this new understanding, I’ve updated my research question to better reflect the nature of my project: “How can young gamers who struggle with social interactions in real-life scenarios be supported to improve their social confidence?

This will align my research question more closely with the actual problems some of these gamers face.

References

Adler, N.E. & Stewart, J., 2004. Self-Esteem: The Puzzle of Low Self-Regard. New York: Cambridge University Press.

Ascend Healthcare, 2023. Social Confidence | Assessing Teen Confidence. [online] Available at: https://www.ascendhc.com/teen-rehab-blog/assessing-a-teens-social-confidence/ [Accessed 26 May 2024].

Collins Dictionary, 2024. Self-assured. [online] Available at: https://www.collinsdictionary.com/dictionary/english/self-assured [Accessed 26 May 2024].

Heimberg, R.G., Becker, R.E., Goldfinger, D.A. & Vermilyea, B.B., 1985. Cognitive-behavioral treatment of social phobia: Effectiveness at five-year follow-up. Journal of Consulting and Clinical Psychology, 53(1), pp.22-26.

Reconsidering My Approach

As I look deeper into the development of tabletop game designs aimed at enhancing social skills for gamers, I’ve been looking at a lot of existing games for inspiration and context. Surprisingly, I discovered a vast array of games designed specifically to improve social skills, many of which targets predominantly to the younger underage audiences. Coming across this was both enlightening and daunting.

The more I looked, the more I realized how crowded this field already is. Many games are already out there, offering everything from simple card interactions to complex role-playing scenarios, some even requiring professional therapists to facilitate like the D&D therapy sessions. This saturation made me question the uniqueness of my initial intervention idea – to create a game that blends role-playing elements of games with therapeutic elements for gamers who struggle socially offline.

Despite the crowded landscape, my passion for helping this specific community, gamers who find online interactions more comfortable than offline ones, remains the same. However, I acknowledge that creating another game from scratch might not be the most effective approach.

Reflecting on this, I’m considering a shift in my approach. Instead of building a new game, why not leverage the plethora of existing games? Many of these games, though already well-designed for therapeutic purposes, might not be reaching or resonate with the audience I want to help. My new vision involves making a guidebook, curating a collection of these games, each selected for its potential to develop specific social skills, but still fun enough to also grab the attention of my target audience.

Imagine a guidebook that not only lists games but also explains how each can be used therapeutically, and also categorize what type of social skills each game will help build. This resource could be helpful for individuals or even organizations like Game Therapy UK, which already utilizes trained professionals and tabletop gaming as a form of social therapy. If I could partner with such organizations, I could gain insights into practical application of these games in therapeutic settings and refine the guide to ensure that it truly benefits gamers.

Moreover, I’m also thinking of including a marketing approach to help elevate the guidebook and this practice of using games as a form of social skills training, increasing visibility and impact, encouraging more widespread adoption and helping it reach those who could benefit most. This potential pivot from creating to curating doesn’t diminish the project’s value; rather, I think it enhances the feasibility and potential impact.

The road ahead looks clear: research, connect with experts, and start compiling a guide that could make a real difference. But I need someone to check my ideas first, not sure if I’m on the right path or no.

EDIT 5/13/2024 4:56PM

After the tutorial today and the incubator session, I was able to share my intervention with a few tutors and students, I’ve also talked to them about the challenges I’m currently facing (create or curate?), and why I have the urge to change track. A lot of the people I spoke to today thinks that I should stick to my guns, the target audience I am going to address is very different and unique. I will seek more feedback in the next few days.

EDIT 5/15/2021 11:52PM

Went to see Richard during office hours today to seek feedback regarding my current predicament, it was quite enlightening. I want to approach the problem of supporting gamers with low self-esteem, guiding them to more accessible help, and I proposed two different ways to approach: a specially designed game or a zine helpbook. I was thinking in the line of committing to one and only doing one approach, but Richard pointed out to me that why not test both? It’s quite complementary to each other. Just like that, it’s like that mental block in my head is removed. In hindsight, it was quite obvious that I was being way too solution-focused, even having a solution directly embedded into my “how can” question. With this new insight, my new refined question, without being too solution-focused, is “How Can Young Gamers with Low Self-Esteem be Supported in Improving Their Self-Assurance?” This way, I can try different approaches and adjust as needed.



Early Intervention Reflection

I tested my early barebones prototype of a card game today! When I first started to conceptualize this game last weekend, I thought that my extensive experience in both online and tabletop gaming would making the design process a breeze. Well, it turns about that crafting game mechanics is more challenging than I anticipated. After some intense brain-squeezing sessions, I pieced together a concept for a social deduction game I’m calling “Spycraft.” Here’s an overview of this barebones very early iteration of what I’m working on:

Game Components:

Role Cards: Each player randomly selects a role card that defines their character for the game. Example roles could include: Spy, Diplomat, Hacker, Journalist.
Character Traits: Alongside the role, each player is assigned traits that suggest specific behaviors or styles of communication they should exhibit, like “charismatic”, “suspicious”, or “secretive.”
Conversation Cues: Prompts that help start interactions, such as “What brought you here tonight?” or “I heard you have information on the upcoming tech launch.

Basic Rules:

Setup: Each player draws one role card which comes with traits at the start
Gameplay: The game revolves around players asking questions or making statements based on their roles and traits, trying to guess the opponent’s role while masking their own.
Point System: Points are lost for breaking character or making incorrect role guesses.
Ending the Game: It concludes when a player successfully identifies the other’s role or when a player’s role is revealed after losing three points.

Role Cards:

Spy: Traits include Observant and Persuasive
Hacker: Traits include Paranoid and Resourceful
Diplomat: Traits include Charismatic and Elegant
Journalist: Traits include Inquisitive and Persistent

Conversation Cues:
  1. What do you do in your free time?
  2. Have you ever been in a situation where you had to think on your feet?
  3. What gadget or technology do you find most indispensable on your missions?
  4. Ever had a cover nearly blown? How did you handle it?
  5. What’s your strategy for blending into a new environment?
  6. Is there a particular location where you always wanted to go undercover?
  7. How do you unwind after a high-stakes operation?

The game was designed to immerse players in their roles and to practice conversation skills in a fun, engaging setting. For a first test of the game mechanics and effects, I created a very simple barebones prototype using cardboard and markers.



I tested this early version with a subject who is an avid tabletop gamer, and is also someone who struggles with public speaking. We played for about 40 minutes, tweaking as we went. Here’s some of the feedback I received:

Before the Game:

Question: Do you play online games? Do you have online friend groups that you play with?
Answer: I do a lot of mobile gaming and yes, I do play with friends online frequently.

Question: Do you feel socially anxious in the offline world as opposed to the online world?
Answer: Compared to online? A little bit, but it doesn’t really affect me too much besides doing public presentations.”

After the Game:

Question: Do you think the game has helped you in any way to help make you feel more socially confident?
Answer: The game feels very unfinished and the game flow is too fast. I’m just starting to get immersed into my character and the game abruptly ends. I played too little to tell you, I can’t really give you an answer.

Question: Do you think the game was fun or engaging?
Answer: Playing the game was fun and refreshing, trying to be subtle with my character and even trying to misdirect you to make you think I’m another character, while still staying true to my real role really had me thinking about how I should act and how I can act to trick people. But again, the game feels unfinished and is too fast.

Feedback on Mechanics

Question: Do you have any feedback about the game mechanics?
Answer: It was very hard to roleplay characters I am not familiar with, I have to roleplay it but also still be subtle about it to keep you from guessing who I am, it feels a little be contradictory.

Question: Was there anything you find disturbing about the game?
Answer: One thing about the rules where the gamemaster deducts points from the players when they don’t act accordingly to their roles sounds a bit problematic. You have to either really define the game rules and define what is acting accordingly and what is not, or else the gamemaster could get really biased and the game wouldn’t be fun or immersive for anybody. Also, when a GM tells you you’re doing badly it could be discouraging.”

These are great feedback. It’s clear that I need to refine the game, particularly around incentivizing role-playing rather than penalizing players for breaking character. My next steps include tweaking some rules to enhance gameplay consulting with more experienced designers in the industry to perfect the mechanics.