Minnesota veterans get help through Dungeons & Dragons role-playing therapy

Allison Battles' group therapy at the Minneapolis VA Medical Center is never boring. On a recent Wednesday, she led four adventurers through ancient ruins and on a descent into a crystalline cave.

The quest was make-believe: they were playing the classic role-playing game Dungeons & Dragons. But the communication among the veterans was real.

And that, of course, was the point.

Battles and fellow VA psychologist Thomas Quinlan created one of the first group therapies using D&D, as it's popularly known, to give veterans with depression, post-traumatic stress and other disorders practice with social skills that can be barriers in real life. Veterans prone to aggression can practice patience, while those with anxiety can express themselves or test personality traits through the game's mythical characters.

"We are hiding therapy with a spoonful of sugar," Battles said. "It makes therapy fun and shows that growth, recovery and healing doesn't always have to be focused on the darkness of the problem or the challenge."

Battles' Roll for Recovery program gained acclaim last year when she and Quinlan presented outcomes from their first group to the American Psychological Association. Veterans after 12 weeks of game play reported reductions in depressive and anxiety symptoms, aggression and social avoidance.

Role-playing games (RPGs) work as adjuncts to traditional therapy because they foster teamwork, compared to games that pit players against one another, Quinlan said. Decisions and dice rolls determine their fate.

"From a therapy standpoint, there is a lot of value to that, talking about failure at something when the dice are just against you that day," he said. Participants also "see differences between themselves and a character they may play."

Battles served as Dungeon Master — the narrator and referee — and Quinlan acted out non-player characters during a session of their fifth D&D group last month.

The game resumed with the company of four returning from the cave, where they had killed some giant spiders and chased off others before glowing crystals sapped their energy and forced a retreat. They were hired by an academic who wanted the cave cleared so he could search for the ruins of a magical library. He was not pleased at their report.

"I'm confused," Quinlan said in character, "because it sounds like you came back out with spiders still there. The idea was I would be able to go in and find out if this library exists!"

Christopher Swanson, one of the veterans, was annoyed — both in real life and in character as a female half-elf named Pim.

"The spiders are gone," Swanson retorted, "and I'm pretty sure that was our job. Our job wasn't to find a library!"

Battles made a note to discuss this conflict later in the session, which was split into 90 minutes of play and 30 minutes of review.

D&D is more than a professional tool for Battles, who has become a prolific researcher and published studies on the moral injuries that occur when soldiers' duties and beliefs conflict. But she was a late bloomer.

Playing D&D with friends helped her endure graduate school, and they still play virtually every Thursday. Her first character was a warrior who righted wrongs.

"D&D allowed me to literally take up the sword of my own life," Battles said.

She found a willing colleague in Quinlan, who enjoyed the card game Magic: The Gathering. It turned out they found an ideal target group in veterans, some of whom were kids when they played D&D, which was first published in 1974. But D&D also proved popular aboard ships and on deployments, because it doesn't require many pieces or electronics.

Eleven of 18 veterans in the first VA group completed the game, and those who stuck with it participated almost all the time — blowing away typical group therapy attendance rates.

One veteran in the latest group is a biochemical executive who served as a project manager in the Air Force on a missile warning system. D&D helps him confront depression and practice listening rather than always taking charge, said the veteran, who discussed the therapy on condition of anonymity.

"I am working on trying out a different approach," he said, "and it's consistent with my character" — Jiggs, a portly but helpful dwarven sorcerer — "to be comfortable just going with the whims of the group."

The quest continued with the group rappelling back into the cave. A low dice roll meant that Jiggs tripped and fell in, but a high roll meant that another character, Azural the barbarian, caught him.

Swanson wanted Pim to descend with flair, and a good roll allowed the character to shimmy down the rope head-first before flipping to land on her feet.

"Nice catch," Pim said to Azural.

Battles continued her narration, describing a gray light billowing from a crevasse. Dead spiders lay among the stalagmites and crystals, along with carcasses of a squirrel and wolf.

"Alrighty," she said, "what do you all do?"

Swanson's Pim wanted a forensic analysis of the cave, noting that the dead wolf seemed out of place. The veteran playing Jiggs was impatient; the group had played for an hour with nary a fight or action.

"The most interesting thing is that gray light over there," he said. "What do you say we go toward that and try to see who's chanting? Maybe they're friendly."

Decisions are key therapeutic moments. Some veterans always choose to fight in D&D, but Battles steers them to challenges that can't be solved through force. One group had to solve a riddle about a box, which frustrated one veteran.

" 'I'm just going to smash the box. We're just going to get through it,' " Battles recalled him saying. "As he said that, he had a look on his face and he was like, 'Oh, I'm doing that again.' The frustration, felt in character, mirrored his own life."

Therapeutic benefits of D&D were recognized as far back as the 1980s, but rumors of the game's Satanic underpinnings scared off research funding, said Megan Connell, a North Carolina psychologist who trains people to run RPG groups and wrote a book on this form of therapy. Role-playing invites people to experiment with personalities, she said.

"That little bit of social distance gives you permission to try things out, and if it doesn't go well, it was your character at fault" rather than you, Connell said.

In a discussion following last month's game, veteran Brian Spencer said he was like his character, the fiery barbarian Azural, in the way he fulfilled duties. Education, military service, work and family created so many obligations.

"It's nonstop running," he said.

Swanson was upset about the argument during the game. Quinlan's academic character had asked them to get rid of spiders and then demanded more. It paralleled expectations Swanson experienced during service on a nuclear submarine and at work. The pressure stokes anxiety, and Swanson said it's good to role-play Pim, a character who sticks up for herself.

"It's not going to change things overnight, obviously," Swanson told the group, "because I've been dealing with it for 45 years. But it is helpful."