Therapeutic Applications of Tabletop Role-Playing Games: A Sco- ping Review of Clinical Implications and Theoretical Integration

Abstract

The therapeutic use of tabletop role-playing games (TTRPGs) has gained increasing attention in clinical, psychoeducational, and community settings. This scoping review aimed to systematically map the literature on the psychological, therapeutic, and educational applications of TTRPGs, including Dungeons & Dragons and related analog systems. Following PRISMA-ScR procedures, 73 sources were identified through database searches, citation chaining, and grey literature review, then charted for study characteristics, populations, settings, intervention targets, and reported outcomes.

Analytically, the literature consistently links TTRPG participation to enhanced social connectedness, group cohesion, identity exploration, confidence, and structured interpersonal skill practice. These recurring patterns suggest that TTRPGs function as facilitated social-narrative interventions that may operate through mechanisms associated with group therapy processes, including cohesion and interpersonal learning, as well as narrative identity reconstruction and self-determination theory principles of autonomy, relatedness, and competence. However, the evidence base remains methodologically heterogeneous and is dominated by qualitative, descriptive, conceptual, and non-empirical sources, with limited use of validated psychological measures or controlled designs. Consequently, current findings support conceptual plausibility and promising mechanisms more strongly than demonstrated therapeutic efficacy or generalizability.

From a clinical standpoint, TTRPGs show potential as a clinically plausible adjunctive modality for populations such as neurodivergent individuals, trauma survivors, and those seeking group-based relational work. These benefits appear contingent on skilled facilitation, clear alignment with therapeutic goals, appropriate participant screening, and the use of structured debriefing to mitigate risks such as emotional bleed between player and character. Clinical interest currently exceeds the strength of the evidence base, highlighting the need for stronger outcome measurement, clearer facilitator guidelines, and more rigorous evaluation of risks, ethics, and implementation. Consistent with scoping review methodology, this review maps the breadth and characteristics of the field rather than establishing efficacy or causal effects.