Dungeons & Dragons as Therapy – The Radical Clinic Using Tabletop Games to Treat Anxiety.

A Louisville therapy session contains a moment that is unlikely to be found in any clinical textbook. In the context of a Dungeons & Dragons campaign, a child, perhaps ten years old, is seated across from a gigantic cockroach man and asked to converse with it. The youngster freezes. Then they speak haltingly, slowly. At the conclusion of the session, they shrug and say something along the lines of “Yeah, he’s all right, I guess.” That’s more than a minor triumph in a fantasy game. That is exposure therapy operating as intended.

The 50-year-old tabletop game has been used as a structured clinical tool for children with anxiety, OCD, ADHD, and related conditions in what the Louisville-based clinic OCD & Anxiety Colorado refers to as Anxie-D&D sessions. Clinician Payge Wyman, a Licensed Social Worker pursuing certification as a therapeutic game master, creates each campaign based on the unique anxieties and difficulties of each player. It wasn’t an accident that the cockroach bartender was reimagined as a “souptender,” since these sessions are open to all ages. It was a purposeful, well-planned therapeutic encounter.

Exposure and Response Prevention therapy, or ERP, a proven treatment for OCD and anxiety disorders that entails progressively facing the things that cause fear or obsession, is the foundation of the entire strategy. Traditionally, this entails working through anxiety-inducing scenarios verbally or through carefully planned exercises while seated in a therapist’s office. A dungeon, a set of dice, and a table full of children who believe they have just arrived to play a game are the alternative containers that Wyman and her colleagues have discovered for the same idea.

Skeptics might write this off as novelty—therapy dressed in dragon costumes. However, the clinical reasoning is actually sound. What psychologists refer to as psychological distance is created by the game. In addition to being themselves, players are not themselves. They are taking on the role of a character, making decisions that feel important in the narrative but have no real-world consequences if they go wrong. That distance isn’t a ploy for a child whose anxiety makes everyday social situations seem disastrous. That’s the whole idea.

Similar initiatives have been steadily expanding across the nation. Since 2020, William Nation, a staff psychologist at Johns Hopkins, has led a D&D therapy group called Social Skills Quest, where students use their characters to process everything from religious trauma to social anxiety. One student created a druid whose god had died as a metaphor for their own spiritual crisis, which they were still unable to discuss openly. They mourned inside the game. It can be difficult for traditional talk therapy to provide that kind of therapeutic access.

Anxiety, depression, dissociative identity disorder, and social development in autistic people were all significantly improved by RPG-based therapy, according to research published in 2025 through NIH-affiliated journals that looked at case studies from seven to nineteen years of age. Although researchers are cautious to point out that there is still a lack of long-term impact data, the results are encouraging. Even though the academic framework is still catching up, there is a feeling among the clinical community that something genuine is taking place here.

When you watch this develop from the outside, it’s amazing how intuitive everything feels when you sit with it. Kids can comprehend games. They are aware of stakes, rules, teamwork, and creativity. Wyman creates puzzles in which the group can only be saved by a character’s unique strengths, such as a high wisdom score. All of a sudden, the hero of the moment is a young child who has confidence issues. That’s not a coincidence. The therapy is that.