Evaluating Long-Term Impacts of TTRPG Participation on Mental Health Among Veterans and First Responders

Abstract

Tabletop role-playing games (TTRPGs) have emerged as valuable tools for fostering social connections and reducing stress in communities facing post-traumatic stress disorder (PTSD). This article explores methods for assessing the sustained benefits of TTRPG participation, including pre- and post-session surveys to measure anxiety levels. Drawing from longitudinal studies in therapeutic gaming programs, it highlights evidence-based insights into long-term improvements in mental health. With a focus on programs like Roll2Heal, which supports veterans, first responders, and healthcare professionals through safe TTRPG environments, the discussion emphasizes community-driven approaches to PTSD relief and social engagement. 

Photo Courtesy : R2H Columbus OH Chapter

INTRODUCTION

In high-stress professions such as military service, emergency response, and healthcare, individuals often encounter traumatic experiences that contribute to conditions like PTSD, characterized by heightened anxiety, social isolation, and emotional distress. Programs utilizing TTRPGs offer a unique avenue for addressing these challenges by promoting collaborative storytelling and group interaction. Roll2Heal, a community initiative dedicated to providing veterans, first responders, and healthcare professionals with a supportive space for TTRPGs, aligns with this approach. Its purpose centers on using these games as recreational and therapeutic tools to enhance social bonds, encourage relationship building, and mitigate PTSD-related stress without formal therapeutic intervention, as members are not licensed therapists.

Insights from literature, such as Sebastian Junger's Tribe, underscore the importance of communal belonging in alleviating PTSD symptoms. Junger argues that the disconnection from close-knit groups upon returning to civilian life exacerbates mental health issues among veterans, suggesting that rebuilding tribal-like connections can foster resilience. This perspective ties directly into TTRPG programs, where participants form ongoing groups that simulate supportive communities. Roll2Heal incorporates safety measures like the Deck of Player Safety to ensure sessions remain comfortable and inclusive, allowing players to signal content boundaries effectively.

Evaluating the long-term impacts of such participation is essential for refining these programs. This article delves into practical methods for tracking benefits, such as changes in anxiety levels, and integrates findings from longitudinal studies in similar therapeutic gaming contexts. By focusing on sustained outcomes, it aims to inform community leaders and participants on optimizing TTRPGs for mental health support.

METHODS FOR TRACKING SUSTAINED BENEFITS

To assess the enduring effects of TTRPG involvement, programs can employ structured evaluation techniques that prioritize participant feedback and measurable indicators. One effective approach for some TA-RPGS involve pre- and post-session surveys, which capture immediate shifts in anxiety levels using standardized scales like the Generalized Anxiety Disorder 7-item (GAD-7) questionnaire. These surveys, administered before and after each game session, allow for tracking short-term changes, such as reduced tension or improved mood, while repeated over time to reveal patterns.

For long-term monitoring, longitudinal tracking extends these surveys across months or years, incorporating follow-up assessments at intervals like three, six, and twelve months post-participation. This method enables the observation of sustained benefits, including enhanced social connectedness and stress resilience. In community settings like Roll2Heal, anonymous digital surveys can be distributed via platforms such as the organization's Discord server, encouraging honest responses without pressure.

Additional tools are being used by some TA-RPGs  include qualitative journals where participants log personal reflections on social engagement and emotional growth, complemented by group debriefs focused on shared experiences. Safety protocols, such as the Deck of Player Safety used in Roll2Heal, integrate seamlessly into evaluations by noting how these tools contribute to a secure environment that supports ongoing participation. Programs should ensure ethical data handling, obtaining consent and anonymizing information to maintain trust.

INSIGHTS FROM LONGITUDINAL STUDIES

Longitudinal research on therapeutic gaming provides compelling evidence for the lasting advantages of TTRPGs in mental health contexts. A scoping review of TTRPG applications highlighted their role in enhancing cognitive and psychosocial skills while intervening in issues like stress and anxiety, with benefits observed over extended periods in group settings. One-year intervention studies demonstrated that regular TTRPG sessions improved social connectedness among adults, reducing isolation often associated with PTSD.

Further investigations, including theses on resilience building, revealed that participants perceived TTRPGs as aiding emotional processing and self-efficacy, with effects persisting beyond initial involvement. Surveys of TTRPG players indicated that a significant majority experienced trauma processing and personal growth, attributing these to the communal aspects of gameplay. In contexts similar to Roll2Heal, studies on modified TTRPGs for cognitive behavioral support showed reductions in general and social anxiety, aligning with the program's emphasis on community-driven stress relief.

These findings echo themes in Tribe, where Junger links PTSD recovery to restored communal ties, suggesting that TTRPG groups mimic tribal structures to combat feelings of disconnection. Roll2Heal's blog discussions on frame theory in TTRPGs further illustrate how layered storytelling promotes emotional safety, contributing to long-term PTSD management.

DISCUSSION

The methods and insights outlined demonstrate that TTRPG participation can yield measurable, long-term benefits for mental health, particularly in reducing anxiety and fostering social ties among veterans, first responders, and healthcare professionals. By implementing pre- and post-session surveys alongside longitudinal tracking such as decreased PTSD symptoms through consistent community engagement. This aligns with Junger's observations in Tribe that rebuilding a sense of belonging is key to recovery, as TTRPGs create ongoing, supportive networks.

Roll2Heal exemplifies this by offering a safe space where TTRPGs serve as bridges for relationship building and stress alleviation, reinforced by tools like the Deck of Player Safety. Participants are encouraged to join the community via https://discord.gg/q7HAsxb4Rt to experience these benefits firsthand. In conclusion, therapeutic gaming programs hold promise for sustained mental health support, with evidence from studies reinforcing their value in PTSD contexts.

References

Abbott, M. S., Stauss, K. A., & Burnett, A. F. (2022). Table-top role-playing games as a therapeutic intervention with adults to increase social connectedness. Occupational Therapy in Mental Health, 38(1), 16-31. https://doi.org/10.1080/0164212X.2021.1916623

Davis, K., & Washburn, M. (2024). A scoping review of tabletop role-playing game (TTRPG) interventions in allied health and education: An overview of applications and impact. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1439930

Junger, S. (2016). Tribe: On homecoming and belonging. Twelve.

Roll2Heal. (n.d.). The magic of frame theory in TTRPG therapy for PTSD relief. Retrieved from https://roll2heal.org/blog

Roll2Heal. (n.d.). The therapeutic potential of tabletop role-playing games for PTSD among veterans, first responders, and healthcare professionals. Retrieved from https://roll2heal.org/blog

Wright, J. C. (2021). Tabletop roleplaying games, and depression, and social anxiety (Honors thesis). University of Maine.