CBT-infused therapeutically applied game of Dungeons and Dragons for social anxiety and depression: a waitlist-controlled trial

Background: People that access community mental health services in New South Wales (NSW) Australia, present with a complex mix of mental health issues. While the most common presentations include schizophrenia and bi-polar disorder, symptoms of social anxiety and depression are common amongst this cohort. Given the drop-out rates associated with Cognitive Behavioural Therapy, there is a growing interest in using therapeutically applied role-playing games (TA-RPGs) as an alternative. Given the current evidence for this treatment is in its infancy, there is a need to investigate the effectiveness of TA-RPGS. Objective: To evaluate the effectiveness of a cognitive behavioural therapy-infused, therapeutically applied role-playing game (Dungeons and Dragons) for consumers of two community mental health services in Sydney, Australia. Methods: In total, 33 consumers of community mental health services were quasi-randomised to either the TA-RPG 8-week intervention group or a waitlist control group receiving treatment-as-usual. The TA-RPG consisted of a specially designed game of Dungeons and Dragons that was infused with elements of cognitive behavioural therapy. All participants received treatment as usual. Primary outcome measures were changes in self-reported social anxiety and PTSD symptoms. Secondary outcome measures were changes in self-reported depression and self-esteem. Results: After 8 weeks, participants in the TA-RPG group experienced a significant reduction in self-reported symptoms of social anxiety and depression, relative to baseline. A significant increase in global self-esteem was also reported. These changes were not experienced by participants in the waitlist control group. No change in either group was observed for PTSD symptoms. Dropout rates were 17% for the intervention group. Conclusion: A CBT infused, therapeutically applied role-playing game group intervention was effective at reducing self-reported symptoms of anxiety and depression for consumers of adult community mental health services in Sydney, Australia.