EMDR Therapy and the Hero’s Journey: Using Tabletop Role-Playing Games like Dungeons & Dragons in Trauma Treatment

EMDR Therapy and the Hero’s Journey: Using Tabletop Role-Playing Games like Dungeons & Dragons in Trauma Treatment Guest Blog Post by Kate Mostyn, LCPC, LCAT (formerly Kate Shannon) You find yourself in a dark, wet, and cold cave surrounded by the bones of lost adventurers. You feel frozen and, at the same time, feel the energy in your body screaming “Run!!” or “Fight!” You look down at yourself and realize you have no shoes on. Just the comfortable clothing you fell asleep in. No shield, no sword, no healing potions, no backpack of random items that would help you in a bind. And then, you hear it. A roar so deep that it shakes the cave and your insides at the same time. Your fear itches something primal. At that moment, you realize, “I’ve been here before.” You scan the bones at your feet again, and that’s when the flashes begin. You’ve been here before. Many times. You realize ever so slowly…the bones are yours. In trauma treatment, there is often a saying that the individual who is engaging in therapy is on “The Hero’s Journey.” The highly researched approach for trauma therapy called Eye Movement Desensitization and Reprocessing (EMDR) gives us a structured outline, also known as the 8-phase protocol, giving us an adaptable and effective treatment model. What is powerful about the EMDR 8 phase treatment model is that it is highly adaptable, well-researched, and offers striking parallels to tabletop role-playing games (TTRPGs), for example, Dungeons and Dragons, for individual clients. What is a tabletop role-playing game (TTRPG)? Traditional TTRPGs are cooperative games where a group of players act as unique characters and collaborate to tell an interactive, imaginative story. One person, the Dungeon Master or Game master (DM/GM), acts as narrator and facilitator, while players explore a fantasy world, battling monsters and solving puzzles using dice to determine success. There are many different types and styles of TTRPG’s with varying levels of complexity. The most popular is called Dungeons and Dragons (D&D), which includes a wide range of mechanics and an expansive fantasy lore system. TTRPG therapy (Kilmer et al., 2023) takes this a step further, describing a collaborative storytelling experience where players control a character of their choice. This character explores, roleplays, and engages in combat in a fictional and somewhat structured environment with the support of a licensed therapist to achieve mental health goals. TTRPGs can also be played individually, either by oneself or with a single player and a single Game Master. Sometimes known as “solo questing”, this is where the blending of EMDR trauma treatment and TTRPG’s can be used with practice and skill. Blending EMDR and TTRPG Blending EMDR therapy and TTRPGs incorporates theoretical approaches like play therapy, creative arts therapy, narrative therapy, and playful EMDR. Although basic training in EMDR provides a trainee with a structured and script-heavy approach, advanced training in playful EMDR approaches allows clinicians more freedom to adapt the scripts and phases while maintaining authenticity to the protocol to meet the needs of children, teens, adults, and neurodivergent individuals who may need a more flexible approach. The integration of EMDR and TTRPGs is essentially narrative roleplay acting as a container for adaptive reprocessing. While the vehicle may appear to be “dice and dragons,” the true clinical foundation lies in the use of aesthetic distance, embodiment, projection, nervous system rehearsal, agency, symbolic confrontation, and experiential learning. Whether you are trained in EMDR therapy or not, it is easy to see the parallels between a TTRPG hero’s journey and the trauma treatment phases. Below is a chart that integrates the 8 classic phases of EMDR therapy and parallels the hero’s journey through EMDR & TTRPGs. Benefits of integrating TTRPG in EMDR therapy So why turn something fun like a table-top game into a trauma treatment approach? Let’s look at some grounding … ready your dice!! Aesthetic Distance: Aesthetic distance refers to the engagement of difficult emotional material through metaphor, story, symbolism, or imaginative projection rather than direct exposure. Just like the narrative at the beginning of this article, we know that trauma memories can pull people into the past through flashbacks, dreams, and even dissociation. Using approaches that provide aesthetic distance (e.g., creative arts therapy, play therapy, IFS/parts work) allows clients to engage with material without becoming flooded. This can create more tolerance in the moment and continued motivation over time to engage in the treatment process. Adapting Trauma Treatment: Recent research (Fisher, 2023) highlights the importance of adaptations and neuro-affirming variations of the traditional EMDR protocol to fully support neurodivergent individuals. Creatively blending EMDR and TTRPG’s can be an effective integration of motivating gaming material blended with traditional protocols to uniquely adapt the treatment process to each individual’s needs. Kids and Teens: Trauma treatment for children and teens is most successful when embedded with play (it’s how kids learn and process!). Teens and older kids (thanks to shows like “Stranger Things” and a general resurgence of TTRPGs) are much more familiar with TTRPG games and, therefore, may be more likely to “buy into” the therapy process. Additionally, being able to literally sword fight your way through processing traumatic material brings the concept of being a hero to life, which can be more motivating, inspiring, and engaging. Adaptive Bilateral Stimulation (BLS): Depending on client needs, bilateral stimulation may be integrated through traditional eye movements, tapping, rhythmic swordplay, drumming, marching in place, movement-based bilateral activities, or other playful EMDR adaptations. These adaptations provide the flexibility many clients need while also maintaining phase 4 (reprocessing) principles of dual attention and BLS. Immersion: Blending EMDR and TTRPG’s allows for full immersion for skill building and exposure-based therapy. With trauma treatment, we are always dancing the fine line of exposing the client incrementally and safely — TTRPGs allow for a safer aesthetic distance but also provide a rich world that can be created and adapted on the fly. Additionally, for coping skills and resourcing — the full immersion you get from having a cleric throw you a healing potion to regain some hit points feels real! There are loads of somatic, cognitive, and embodied moments within the game that can re-teach a nervous system and pave the way for strong resourcing and processing. Impact and empowerment: Trauma therapy is hard work. It can be exhausting. It is tiring. Blending the work within the narrative framework of TTRPGs allows individual agency over the trauma story in a tangible way that is impactful and can increase commitment to the therapeutic process. There are many variables that make this approach highly individualized. Depending upon the profile of the client, immersion into the game varies as well for client success. For example, children, teens and tweens will often engage with the use of sword play (using pool noodles ) during Phase 4, titrating the traumatic experience with bilateral stimulation using a playful EMDR approach. Adults may require a bit more direct “hopping” out of the immersion of the game to do BLS during phase 4 and then checking back into the story to see how the narrative has changed (if it has). To gain a deeper understanding, we can take a look at this hypothetical example: A teenager who experienced bullying at school became shut down whenever the events were discussed directly. Using a TTRPG framework, she first gathered “coping spell scrolls” and recruited a protective party member to build resourcing and empowerment. She spent time practicing with her resource figure who would engage in protective combat “drills” to build felt experiences of safety. She then entered the “Dungeon of Silence” to confront the “Echoing Wraith,” a creature that mimicked her bullies’ taunts. Through the encounter, she was able to vocalize anger, practice protective responses, and reprocess the experience in a way that felt contained and empowering. After reprocessing, the client engaged with finding “the loot” to integrate the installation of the Positive Cognition (PC). As part of the installation, she chose a powerful amulet as her ‘loot,’ one that whispered, ‘I can speak my mind.’ All in all, using TTRPGs to engage clients with the difficult and often exhausting journey of trauma treatment can provide a host of benefits depending upon the client. TTRPG’s offer an incredibly rich and adaptable world for therapists to create an individualized and supportive modality for engagement while still maintaining authenticity to protocol-driven trauma treatments. ****A note that this model is not for all clients. This integrated approach of EMDR therapy and TTRPG requires EMDR training, and playful EMDR training would be highly encouraged, as this is an advanced approach that still requires adherence to the EMDR protocol with play-based treatment integration. Kate Mostyn, (formerly Kate Shannon), LCPC, LCAT, MT-BC is a Licensed Clinical Professional Counselor, Licensed Creative Arts Therapist, and Board Certified Music Therapist. Kate specializes in working with children, tweens, teens, and adults with anxiety, relational stress, and trauma. She uses expressive modalities, nerd therapy, EMDR, parts work, and mindfulness-based approaches. She also provides consultation for EMDR and clinicians looking to find creative and authentic ways to support their clients . References Association for Play Therapy. (2019). Association for Play Therapy. https://www.a4pt.org/ Bages, C., Hoareau, N., & Guerrien , A. (2020). Play to reduce bullying! Role-playing games are a useful tool for therapists and teachers. Journal of Research in Childhood Education, 35 (4), 631-641. https://doi.org/10.1080/02568543.2020.1810834 Baker, I. S., Turner, I. J., & Kotera, Y. (2023). Role-playing games (RPGs) for mental health (why not?): Roll for initiative. 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Journal of Humanistic Psychology, 60 (1), 99-129. https://doi.org/10.1177/0022167816686263 Back to Focal Point Blog Homepage Additional Resources If you are a therapist interested in the EMDR training: Learn more about EMDR therapy at the EMDRIA Library Learn more about EMDR Training Search for an EMDR Training Provider Check out our EMDR Training FAQ If you are EMDR trained: Check out the EMDRIA Let’s Talk EMDR Podcast Check out the EMDRIA Focal Point Blog Learn more about EMDRIA membership Search for EMDR Continuing Education opportunities If you are an EMDRIA™ Member: Learn more about EMDR Consultation Find clinical practice articles in the EMDRIA Go With That Magazine® Search for articles in Journal of EMDR Practice and Research in the EMDRIA Library