Therapeutic Dragon Taming: the effectiveness of a therapeutically applied Dungeons and Dragons group program in a community mental health setting - a randomised controlled trial.

The 8-week intervention consists of a game of Dungeons and Dragons that was specifically adapted for maximum therapeutic benefit and has elements of cognitive behavioural therapy infused into the game. There are 3 main means that elements of CBT are delivered during the game sessions. 1) Psychoeducation and social skills training are embedded into the storyline. For example, participants will practice communicating with specially designed characters and will be given guidance and feedback regarding their interactions. 2) The game structure will mimic elements of exposure in social anxiety treatment. Subjective Units of Discomfort Scale (SUDS) ratings will be used before, during and after each game to demonstrate to participants how their distress levels will drop over the time that they have participated in the game. 3) Teachable moments will be used throughout the game sessions. Participants will be asked to reflect on what other characters might be thinking and feeling, and to notice how they are behaving. This allows for further exploration of CBT principles. The structure of the overall program is as follows: Dungeons and Dragons Intervention group Session 1 includes introductions, safety planning, discussion of group rules, psychoeducation about unhelpful thoughts, a full explanation of how role-playing games work and what to expect in the group. The participants will then practice gameplay so that they are more familiar with the structure of the game. Sessions 2-7 include the core content of the group with the following structure: - First 10-20 mins- Introductions, safety measures, SUDS ratings, relevant feedback and information provided. - The next 1-1.5 hours- game play with the core content of the group. - Final 15-30mins- feedback, psychoeducation and de-roling. De-roling refers to a process whereby it is ensured that participants have completing shifted out of their fictional character and back into their everyday life. Session 8 includes the final role play encounter, participants strengths are reflected to them and certificates are distributed. Participants will complete outcome measures and a satisfaction survey. Participants are asked for verbal feedback about their participation in the group and they are provided with information about how to play Dungeons and Dragons in a social context. The PI will be the Primary Facilitator for all the Dungeons and Dragons intervention groups. This role is termed “Primary Facilitator” as the role requires the individual to both run the game and facilitate a clinical intervention group. A co-facilitator will be chosen from a pool of eligible mental health clinicians. The role of co-facilitator will be as follows: - Play their own character alongside the participants so they can provide in-game assistance to the participants. - Assist the primary facilitator with providing important observations of the engagement and mental state of the participants. - Be available to assist a participant if they needed to step out of the game for any reason which allows the primary facilitator to continue running the group. Each intervention group will be made up of the following: a) 6 research participants b) 1 primary facilitator c) 1 co-facilitator