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!
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.
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:
Interpersonal Competence:
Meaningful Occupations:
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).
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
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.
