Dungeons, Dragons, and Jobs to Be Done in teen mental health


Jan 10, 2023

Teen mental health has reached a crisis point. Before the pandemic, the CDC reported increased rates of persistent sadness, hopelessness, and suicidal ideation in teenagers, and stressed social connectedness as a key factor in addressing teen mental health. COVID-19, which only served to increase social isolation in teens, exacerbated existing mental health problems and created new ones. 

With the teen mental health crisis in the US continuing to worsen, it may be time to look outside our usual medical toolkit for solutions beyond traditional therapy. One popular example from abroad is social prescribing.

Social prescribing to address patients’ Jobs to Be Done

Back in 2018, we wrote how social prescribing—where doctors prescribe social activities such as hiking and knitting classes—could improve health in a way that factors in patient interests and non-medical needs. While we previously covered social prescribing for chronically ill senior citizens, prescribing non-medical care to address health concerns can be applied to other ages and health issues. An example of this is doctors prescribing farmers’ markets to help patients manage diabetes and other nutrition concerns.

Social prescribing addresses patients’ personal needs, wants, and desires alongside their health concerns, providing context to the progress a patient seeks for themselves. The progress one wants to make in their life at a particular point in time within a particular context is called their Job to Be Done, or simply their “job”. Knowing patients’ jobs helps health professionals define solutions that patients want to embrace given their unique circumstances, values, and aspirations.

For mental health providers, social prescribing can provide an innovative way to address concerns and reach young patients. A potential example of using social prescribing to address the jobs of teens experiencing mental health crises is prescribing tabletop role-playing games (TTRPGs) as a therapeutic activity.

TTRPGs as social prescribing for mental health

TTRPGs are games where the narrative unfolds through storytelling. The most famous of these types of games is Dungeons & Dragons (D&D), which reached a new surge in popularity in part thanks to online series such as Critical Role and Dimension 20. Led by a Dungeon Master, players develop their own characters and act as a group through a series of puzzles, battles, and other encounters to solve problems and achieve an end goal.  

TTRPG therapy has proven beneficial for patients who struggle socially, have experienced trauma, or are exploring their identity, by providing a safe space for players to process their lives and practice skills to help them overcome personal challenges. One study showed struggling teens who play D&D experience all five stages of the Psychological Recovery Model, a tool used to assess a patient’s potential for recovery. According to Dr. Megan Connell, a clinical psychologist in North Carolina, the core skills used in playing D&D, such as telling stories, being creative, and practicing math and reading, are beneficial for someone struggling with their mental health. 

This is an excellent application of social prescribing, particularly as role-playing games may better address players’ jobs than traditional therapy. Character development empowers players to create a persona that embodies their personal goals and desires; gameplay creates the ability to tackle challenges that mirror the ones players may be facing in real life. TTRPG therapy is especially positive for those with an existing interest in games, as it approaches treatment in a way that patients already value.

Below are examples of potential jobs a teen may have in seeking mental health care, and how TTRPGs can address them effectively. 

How TTRPGs may address teens’ jobs better than traditional therapy

The universe of jobs is infinite. The following are a few examples of potential jobs related to mental health, and the role of TTRPGs in helping teens serve these jobs. 

1. Help me overcome trauma in a safe way, so I can develop coping mechanisms to feel happier.

Role playing allows individuals to work through real-life experiences in a “safe space” that’s slightly removed from reality. Players can be the hero of their own tale in a way that mirrors their own experiences, while still remaining outside of the real world. 

As I highlighted before, social connection is key to improving teen mental health. TTRPGs provide an excellent structure to foster social connection because they are group-based games that allow players to connect around a common interest and collaborate to achieve a common goal.  

2. Help me overcome social anxiety, so I can make and sustain friendships.

A benefit of TTRPG therapy is how it addresses social anxiety and issues individuals have in identifying social cues. Players can develop characters whose power is rooted in charisma, where finding confidence in public speaking plays a major role in someone’s success. Additionally, they can practice navigating social interactions and communicating with others. Role playing games are also shown to help people become more empathetic, which is key in emotional growth.

3. Help me avoid the stigma and challenge of therapy, so I can address my mental health in a comfortable way.

From the outside looking in, TTRPG therapy looks like playing a game. For those who may feel embarrassed or afraid to participate in traditional therapy, a game such as D&D provides the chance to tackle their concerns without the added stress and stigma of a more traditional therapy setting. 

Companies like Geek Therapeutics and Game to Grow are seeing role-playing games’ benefits in addressing mental health concerns, and they are training therapists to incorporate games into their work. Therapists looking to improve the mental health of their teen clients could benefit from looking at the benefits of prescribing TTRPGs. The social prescribing of games like D&D can enable therapists to further support their patients’ goals—because, as popular D&D player Aabria Iyengar said, “D&D isn’t therapy, but it is therapeutic.”

Jessica is a research associate at the Clayton Christensen Institute for Disruptive Innovation, where she focuses on business model innovation in health care, including new approaches to population health management and person-centered care delivery.