Using Tabletop Role Playing Games Therapeutically
Tabletop role-playing games (TTRPGs) first entered the mainstream with the release of Dungeons & Dragons in the 1970s, and their popularity has grown exponentially in recent years. Today, these games span a wide variety of systems, settings, and play styles, revealing tremendous potential for clinical application. If you’re here, you already know that gaming isn’t just for entertainment. From improving fine motor coordination and visual scanning to strengthening problem-solving, emotional regulation, communication, and teamwork, therapeutic gaming offers a motivating, measurable, and meaningful way to support participation in daily life.
TTRPGs provide a uniquely powerful framework to blend these therapeutic benefits with enhanced creativity, adaptability, and immersion. By combining storytelling, collaborative problem-solving, and goal-directed tasks, TTRPGs allow clinicians to seamlessly embed therapeutic interventions into engaging narratives, transforming therapy into an experience that feels purposeful, empowering, and fun.
See below for different strategies to use gaming therapeutically!
But First…
If you’re a therapist who’s new to TTRPGs, or curious about how to use them therapeutically, you’re in the right place. We’ve created a step-by-step guide that leads you to fully fleshed-out one-shots (single-session adventures) you can confidently use in practice across a wide range of clients and clinical goals. We call it the Therapeutic TTRPG Generator. Click below to get started!
*Before facilitating a session with a client, please ensure you have reviewed the Rehab Arcade TTRPG manual and the one-shot adventure produced by the Therapeutic TTRPG Generator.
The Rehab Arcade TTRPG System
Within the world of TTRPGs, a wide range of systems exists, from Dungeons & Dragons to Kids on Bikes to Call of Cthulhu. Each offers unique settings, rules, and play styles, and each brings its own strengths to the table. In developing the Rehab Arcade TTRPG one-shot system, we aimed to draw from the shared mechanics and narrative elements that make these games so engaging, while creating a framework that can be quickly learned and easily implemented in a clinical setting.
Our goal was to design a system that feels intuitive for both therapists and clients, minimizes setup and cognitive load, and keeps the focus on therapeutic outcomes, without sacrificing the excitement, creativity, and immersion that make rolling dice and collaborative storytelling so powerful. By striking this balance, the Rehab Arcade system transforms therapy into an engaging experience that is both purposeful and fun.
This system is fully integrated into the one-shots generated by our Therapeutic TTRPG Generator, and it can also be used independently to design customized therapy sessions from the ground up.
Click the button below to download the Rehab Arcade TTRPG system.
Dice Mechanics
This system uses a 2d6 model, meaning players roll two six-sided dice, add the results together, and apply any relevant modifiers. This approach reduces complexity by eliminating the need to choose different dice, making game-play accessible for both new players and the clinician. The predictable probability curve supports a simple success-based outcome system, allowing the GM to interpret results quickly and keep sessions flowing smoothly.
Success Threshold System
All dice rolls use a three-tier resolution system:
10+ → Full success
7-9 → Success with a complication
6 or less → Failure with narrative consequences
This structure encourages problem-solving, emotional regulation, and adaptability while keeping game-play moving forward, even during setbacks.
Stats & Archetypes
Characters are built using six broad stats, Might, Agility, Dexterity, Mind, Heart, and Luck, paired with streamlined Hero Archetypes. This combination simplifies character creation, while allowing therapists to align game-play with therapeutic goals such as fine motor coordination, executive functioning, communication, and emotional regulation.
Life & Combat
Characters track “hits” instead of complex health values, keeping tension high without overwhelming cognitive load. Combat uses the same mechanics as all other actions, ensuring consistency and ease of play. Encounters remain fast, flexible, and story-driven, allowing clinicians to prioritize therapeutic engagement over mechanical detail.
Narrative-First Design
The Rehab Arcade system prioritizes story, flexibility, and clinical adaptability. Its lightweight mechanics allow therapists to easily adjust pacing, challenge level, and task difficulty, embedding therapeutic goals seamlessly within immersive game-play.
Features of the Rehab Arcade TTRPG
*Portions of the development and writing process for the Rehab Arcade TTRPG one-shot modules were supported through the use of generative AI tools, including ChatGPT by OpenAI and Google Gemini by Google. These tools were used to assist with brainstorming ideas, organizing content, and refining written material. Therapeutic design, clinical framing, and final content decisions were reviewed and directed by the author.
Research in Support of Therapeutic TTRPGs
Therapeutic TTRPGs are at a turning point. Though formal studies are still catching up to the trend, the existing evidence for their utility is compelling. By breaking these games down into their fundamental mechanics, we can see exactly why they are such potent tools for the clinical setting and can demonstrate how these specific elements align with established therapeutic best practices.
Gamification: Defined as the "use of game design elements in non-game contexts" (Deterding et al., 2011), gamification leverages mechanics, dynamics, and aesthetics to foster "gameful experiences" that support value creation and behavior change (Huotari & Hamari, 2012).
Randomized controlled trials show that gamified and game-based interventions improve coping, help-seeking behaviors, emotional well-being, and psychosocial functioning in adolescents and youth populations (Egan et al., 2021; Lee et al., 2025)
Studies in adult rehabilitation demonstrate that gamified physical therapy is non-inferior to conventional care for improving functional capacity and motor outcomes (Randriambelonoro et al., 2023; Kilicoglu & Unuvar, 2025)
Collectively, this evidence supports gamification as a clinically meaningful, engaging, and adaptable intervention approach across mental health, pediatric, and rehabilitation settings.
Narrative Agency: Defined as the client’s capacity to co-construct and influence their own therapeutic journey through role enactment and purposeful engagement (Bean & Connell, 2023), narrative agency leverages social collaboration and imaginative play to foster "occupational identity" and self-efficacy (Hazlett et al., 2025). This framework allows individuals to explore personal meaning and exercise autonomy within structured, health-promoting environments (Connell, 2023).
Quantitative and randomized controlled trials show that structured, narrative-driven and game-based interventions improve self-concept, reduce emotional distress, and enhance psychosocial functioning in adolescents and community-dwelling adults (Lee et al., 2025; Merrick et al., 2024).
Qualitative and clinical evidence indicates that role-based participation supports social competence, identity exploration, and emotional growth, providing a platform for clients to navigate complex social landscapes and process life experiences (Orr et al., 2020; Rosenblad et al., 2025).
Collectively, this evidence supports narrative agency as a core therapeutic process that promotes high levels of engagement, emotional resilience, and social integration across mental health, pediatric, and community-based settings.
Interpersonal Competence: Defined as the ability to navigate social interactions effectively through improved communication, empathy, and social problem-solving (Orr et al., 2020), interpersonal competency is a core outcome of collaborative, game-based interventions that require players to negotiate, cooperate, and resolve conflicts in real-time (Rosenblad et al., 2025).
Randomized controlled trials indicate that structured, game-based interventions significantly improve psychosocial functioning and emotional regulation in neurodiverse populations, such as adolescents with Tourette Syndrome (Lee et al., 2025).
Qualitative research demonstrates that participants in collaborative gaming environments perceive measurable gains in social competence, interpersonal engagement, and the ability to maintain meaningful social connections (Hazlett et al., 2025; Orr et al., 2020).
Collectively, this evidence supports the use of structured social-occupational interventions as a valid approach to enhancing interpersonal competency, providing clients with the necessary skills to participate fully in social and community life.
Meaningful Occupations: Defined as the everyday tasks and activities that are named, organized, and given value and meaning by individuals and a culture (AOTA, 2020), the use of meaningful occupations in therapy focuses on aligning interventions with a client's intrinsic interests and identity to improve health and participation (Hazlett et al., 2025). By centering therapy on activities that hold personal significance, such as collaborative play or creative storytelling, occupational therapists enhance motivation and therapeutic adherence (Zlotnik et al., 2023).
Clinical reasoning and expert synthesis suggest that when interventions are framed as meaningful occupations, they facilitate deeper identity exploration and emotional processing, allowing clients to develop skills within a context that feels authentic and personally relevant (Bean & Connell, 2023; Rosenblad et al., 2025).
Randomized controlled trials in rehabilitation settings show that incorporating game-based mechanics into functional tasks increases engagement and improves motor and sensory outcomes by transforming repetitive exercises into meaningful, goal-oriented occupations (Kilicoglu & Unuvar, 2025; Randriambelonoro et al., 2023).
Collectively, this evidence supports the integration of meaningful occupations, including modern modalities, such as TTRPGs, as a high-quality, evidence-based approaches to improving functional capacity, social participation, and overall well-being.
Therapeutic TTRPGs Categories
Cognition:
Cognitive skills occupy essential functions that an individual requires to live independently. Cognition allows for the acquisition of knowledge and how one translates that knowledge to understanding through their experiences. Taking it a step further, functional cognition is “how an individual utilizes and integrates his or her thinking and processing skills to accomplish everyday activities,” (American Occupational Therapy Association, 2021).
Sensory:
Sensory skills are foundational functions that enable an individual to engage safely and effectively in daily life. Sensation allows a person to detect, interpret, and respond to information from the environment and their own body. Sensory processing involves the detection, organization, and interpretation of sensory information, which supports meaningful engagement and participation in daily occupations (American Occupational Therapy Association, 2021).
Mental health:
Mental health encompasses one’s psychological and emotional well-being. A decline in mental health can lead to decreased activity and self-worth in everyday life. Gaming has been shown to improve one’s feelings of self-worth and reduce anxiety, depression, and stress.
Physical Disabilities:
Physical disabilities encompass any condition or diagnosis that prevents an individual from engaging in the world around them in a “normal” manner. Movement and physical activity that is focused on improving function and purposeful use of the body for tasks is also included in this section. The primary focus of these activities can include improving strength, flexibility, range of motion, and/or decreasing pain, along with adjust to the client’s environment in a way that enriches their day-to-day life.
Vision:
Vision encompasses the range of skills that allow an individual to perceive, interpret, and respond to the visual world around them. Activities in this area focus on improving how a person uses their eyes to gather and process visual information in meaningful ways. The primary focus of vision-based interventions can include enhancing eye tracking, visual scanning, depth perception, visual memory, and visual-motor integration, as well as adapting the environment to support participation in everyday tasks and enrich day-to-day life.
