The effectiveness of a therapeutically applied Dungeons and Dragons group intervention in a community mental health setting – Protocol for a randomised controlled trial.

Background: The use of Therapeutically Applied Role-Playing Games (TA-RPGs) in mental health treatment settings has grown in popularity in recent years and early results appear promising. Up until recently, the use of TA-RPGs for the treatment of anxiety and depression has not been studied in people who present with complex mental health issues. However, one recent waitlist-controlled trial explored the use of TA-RPG’s in an adult community mental health setting, in NSW, Australia (Rae et al., 2025). This study reported that a TA-RPG (Dungeons and Dragons with elements of CBT embedded throughout) reduced self-reported symptoms of social anxiety, depression and improved self-esteem. The current study therefore extends this work, using a more robust experimental design. Methods: The authors propose a two-group randomised controlled trial testing the efficacy of a CBT-infused, therapeutically applied, 8-week Dungeons and Dragons group program. An active control group will play board games for a comparable amount of time. Outcome measures will be collected before and after participation in both groups, with the intervention group also completing outcome measures at 12 month follow up. Conclusion: The results will determine the effectiveness of providing a TA-RPG group in a community mental health service. Trial registration: The trial was registered on the Australian New Zealand Clinical Trials Registry on 14/4/25; reference number ACTRN12625000296437