Two adults smile for the camera while sitting behind a table covered in Dungeons and Dragons pieces.

Credit: Will Kirk / Johns Hopkins University


Tabletop therapy: How Dungeons & Dragons can improve mental health

Staff psychologist William Nation offers an innovative approach to counseling with his D&D therapy group

Over the past few years, Dungeons & Dragons (D&D) has exploded in popularity, turning up in countless television shows, movies, and podcasts. Now, the game has once again found itself somewhere new: Mental Health Services Homewood, formerly known as the Counseling Center.

(Social) Skills Quest is a D&D-centered therapy group run by staff psychologist William Nation with help from doctoral intern Meagan Henry. Originally introduced in the spring of 2020, this innovative approach to group counseling combines role-playing with traditional therapy.

For the uninitiated, Dungeons & Dragons is a tabletop role-playing game in which players roll dice to improvise a fantastical adventure. It was invented by Gary Gygax and Dave Arneson in 1974 and has since become the most popular game of its type, having drawn in an estimated 50 million players worldwide.

Three adults play dungeons and dragons around a table.

Image credit: Will Kirk / Johns Hopkins University

"The game itself serves as this sandbox," Nation explained. "It allows you to experience things in a way that is different from the way you would experience them if they happened to you. There's a sort of psychological distance between you and whatever you're engaging in."

According to Nation, this "distance" can be extremely useful in a therapy setting, since players can explore real-life problems without the potential discomforts of a one-on-one counseling session.

"This feels accessible to them," he said. "It's a game, and they understand games."

Nation got his first taste of D&D as a high schooler in the early 2000s, though he didn't become a regular player until college. Since then, he's become an expert "dungeon master" (DM), leading countless campaigns both at work and in his own time.

A typical D&D session with Mental Health Services follows the same two-hour formula: First, 60 to 90 minutes are spent playing the game. Then, after the monsters are slain and the adventurers are resting around a campfire, the players take a step back to reflect on the session and how it relates to their own lives.

Each campaign has about three to six players, with Nation occasionally running multiple groups at the same time. The membership of these groups tends to change thanks to graduations and new semesters, but regardless of the roster, the support remains the same.

Different players can get different benefits from the group. For example, those struggling with anxiety can practice making choices and interacting with others without real-world consequences. Alternatively, those experiencing isolation on campus can break out of their shell and meet new people, improving their social skills.

And, according to Nation's players, this strategy works.

"You can test the waters with other players to see how they react to an action or dialogue, and see what kind of response you might elicit with your friends and colleagues [in real life]," explained one student, who asked to remain anonymous. "Overall, it feels like a more fun version of group therapy. There is a space for open dialogue as needed, and exploration of topics that would not come up in a normal group."

"I am beyond thankful to both our DM and the group for giving me a place to feel seen and have friends when I've struggled so much at school. … I wouldn't trade that experience for anything."
Undergraduate student

"This group has reduced my social anxieties," shared another of Nation's players. "I am beyond thankful to both our DM and the group for giving me a place to feel seen and have friends when I've struggled so much at school. … I wouldn't trade that experience for anything."

After working with so many students, Nation now believes that the D&D format can be tailored to support almost any mental health concern.

"I worked with somebody who had experienced religious trauma, and they found it very difficult to talk about that," he said. "[So] they created a character in Dungeons & Dragons that was a druid who had previously been a cleric and their god in the setting had died. … None of that is true, but the person was talking from their own experience of being a religious person in the real world. … They grieved the loss of their religious experience as this character."

D&D also offers a more universal benefit: Stress relief. Simply having a fun game to look forward to can be one of the greatest perks of the group, especially during midterms and finals season. Last spring, Nation even taught students at Peabody how to lead their own campaigns in hopes of relieving some stress on campus.

And students don't need to be experts to have fun with the game. Most of Nation's players had little to no D&D experience before joining his therapy group.

"You can teach someone to play Dungeons & Dragons pretty effectively in sub-20 minutes," he explained. "It's popular for a reason. It's a pretty easy system to learn and to get people into."

Interested in joining the group? There's plenty of room for new players next semester.

"As long as you're eligible for our services, we'd be happy to have you," Nation said. "We only do it because we know it works."

To learn more about (Social) Skills Quest or other counseling options available to students, visit the Mental Health Services website or call one of its clinics. Mental health crisis and suicide prevention services are also available at JHU through the Behavioral Health Crisis Support Team (410-516-9355) and nationwide by dialing 988.