Processing Trauma Through Art Therapy Infused Dungeons & Dragons Jessica A. Laudicina Pennsylvania Western University, College of Social Science & Human Service Department of Counseling & Art Therapy COUN 7550-400: Intro to Research in Art Therapy Dr. Carolyn Brown Treadon, ATR-BC, ATCS April 25th, 2024 Purpose There is a need for effective and innovative treatments for CPTSD and sexual trauma. However, there is limited research on the use of D&D for therapeutic purposes, and even less on its use for treating this disorder. This research seeks to develop an art therapy framework for using D&D in a therapeutic setting for clients with this diagnosis. PTSD vs. CPTSD PTSD CPTSD Typically one specific traumatic event Prolonged or recurrent exposure re-experiencing the event in the present re-experiencing the event in the present avoidance of triggers of re-experiencing avoidance of triggers of re-experiencing persistent heightened perceptions of threats persistent heightened perceptions of threats difficulties with emotional regulation negative perception of self and others difficulties in maintaining relationships additional symptoms that cause significant impairment in important areas of functioning (e.g. psychosis, dysphoria, dissociation, social withdrawal, obsessive compulsions, somatic complaints) Justification 4% Prevalence Of CPTSD in the USA 4% Suicides Are contributed to PTSD or CPTSD 2016 57,329 Children were victims of sexual abuse 46% Fibromyalgia Patients also have been diagnosed with PTSD or CPTSD What is D&D TTRPG Table Top Role Playing Game Created in 1974, currently one of the best selling games of all time with a 50 million player base In the Field Some practices have started using it in therapeutic ways such as Hero Journey Club and Geek Therapeutics for peer support Theoretical Underpinnings Narrative Trauma-Informed CBT Art Therapy Psychodrama Literature Review Trauma-Informed - Shifts “what is wrong” to “what happened”, turning victim into a survivor - Core Principles Safety Trustworthiness & Transparency Peer Support Collaboration & Mutuality Empowerment, Voice & Choice Cultural Competence Literature Review Cognitive Behavioral Therapy - Problem-oriented therapeutic model - Delves into how thoughts, feelings, behaviors and perception all influence each other - Addresses maladaptive thought patterns, dysfunctional assumptions and negative automatic thoughts Literature Review Narrative Therapy - Stories are used to “make sense of and construct meanings” in experiences and relationships - Key Principles Externalizing; mapping the impact Re-Authoring; grieving, processing and empowerment - Pairs well with other practices such as exposure and reprocessing therapies Literature Review Psychodrama - Form of group therapy where they act our unscripted moments in a member’s life as they had experienced it - Underlying Principles “As if”; symbolic thinking, representation and projection of mental state Catharsis; “experience of release” - Psychodrama and D&D both encourage reflection of the characters through sharing and use guided fantasy. Literature Review Art Therapy - Offers an alternative to talk-based therapies - Focuses on creative expression as a tool for therapeutic processing - Reasons why art therapy is effective for treating trauma Bypasses verbalization Distancing from traumatic experience Boosts access to emotions and boosts positive ones The Mythos Campaign Story In Greek mythology, our heroes help a new goddess during recovery Characters Temples Clients create unique characters and will roleplay as them Visiting temples will provide interventions that will give players the skills needed to face bosses Bosses Face bosses that symbolically represent the symptoms of CPTSD Campaign Features Locations NPCs Interventions 43 distinct locations including temples, markets and more Over 100 unique NPCs and 18 random monster encounters 13 temples all including a therapeutic intervention and 9 specialized bosses Therapeutic Process - 1 year, biweekly 3 hour sessions In-person preferred, online possible - Session format… - Session 0 Check-in & Recap Gameplay Discussion Open Journaling Boundaries Group Ice-Breakers Create Characters Establish Goals & Character Creation Race 8 choices, may reveal what the player wants to be more like Stats Will effect gameplay and how the player interacts with the world Class 8 options, may reveal what the player is comfortable doing Backstory Should relate to character and have a clear goal to guide them Interventions - Self-Reflection; Journaling - Relationships; Totem sculpture - Mindfulness; Bilateral body scans - Finding your voice; Blackout poetry - Self determination; Jellyfish bracelets - Telling your story; Narrative trees - Identity; Masks - Letting go; Disappearing paper - Hope & values; Keeper boxes - Reframing trauma; Kintsugi - Finding positivity; Sand mandalas - Anxiety regulation; Worry pets - Neuro-regulation; Somatic practices Bosses - Negative self-worth - Recklessness - Emotional regulation - Detachment - Hypervigilance - Avoidance - Re-living Moving Forward - What is next? - Development of certain elements - Two trial groups - Future publishing Moving Forward - Limitations & Future Research… - Controlled trials to evaluate efficacy - Investigate use of D&D in conjunction with other therapies - Explore how D&D may benefit other conditions - Further research into CPTSD treatments Questions & Discussion Resources ● American Art Therapy Association. (2023, January 18). About Art Therapy. American Art Therapy Association. https://arttherapy.org/about-art-therapy ● American Psychological Association. (2017, July 31). Cognitive Behavioral Therapy (CBT). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. https://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy ● Bayes, J. (2022). Narrative Therapy in Trauma Care. Dulwich Centre Australia. https://research.ebsco.com/c/356ple/viewer/pdf/bk4fn26tzf ● Butera-Prinzi, F., Charles, N., & Story, K. (2022). Bearing witness, externalizing & re-authoring: A response to Joanna Bayes’ ‘Narrative therapy in trauma care.’ Dulwich Centre. https://connect.ebsco.com/s/article/Reading-EBSCOhost-PDFs-with-Adobe-Reader?language=en_US Resources ● Campbell, M., Decker, K. P., Kruk, K., & Deaver, S. P. (2016, October 20). Art therapy and cognitive processing therapy for combat-related PTSD: A Randomized Controlled Trial. Taylor & Francis Online.www.tandfonline.com/doi/full/10.1080/07421656.2016.1226643 ● Connell, M., & Atanasio, J. (2023, August 15). The Certified Therapeutic Game Master Program. Therapeutic Game Master. https://therapeuticgamemaster.com ● Diamond, A. (2022, May 21). Who’s playing Dungeons & Dragons these days? the usual fans, and then some. The New York Times. https://www.nytimes.com/2022/05/21/style/dungeons-and-dragons.html ● Ellis, M. E. (2022, June 24). The role art therapy can play in healing PTSD. BrightQuest Treatment Centers. https://www.brightquest.com/blog/the-role-art-therapy-can-play-in-healing-ptsd Resources ● Giacomucci, S. (2021, February 24). Psychodrama and social work theory. SpringerLink. https://link.springer.com/chapter/10.1007/978-981-33-6342-7_6#ref-CR18 ● Lechner, B. (2023, February 6). Psychodrama und Drachen: Die Verwendung von Pen & Paper- Rollenspielen in der Psychodrama-Psychotherapie mit Jugendlichen und jungen Erwachsenen. Springer Fachmedien Wiesbaden. ● Littlejohn, G., & Guymer, E. (2018, December 13). Central processes underlying fibromyalgia. European Medical Journal. https://www.emjreviews.com/rheumatology/article/central-processes-underlyingfibromyalgia ● Panina-Beard, N., & Vadeboncoeur, J. A. (2022). Narrative therapy. In Salem Press Encyclopedia Research Starters. Salem Press. Retrieved September 6, 2023, from https://research.ebsco.com/c/356ple/viewer/html/rhs5eoh6jj Resources ● Rape, Abuse & Incest National Network. (2020). Children and Teens: Statistics. RAINN. https://www.rainn.org/statistics/children-and-teens ● Sidhu, P., & Carter, M. (2006). Pivotal Play: Rethinking Meaningful Play in Games Through Death in Dungeons & Dragons. The University of Sydney. https://research.ebsco.com/c/356ple/viewer/pdf/f4gcsfu5tb ● Tomic, M., Veljkovic, J., & Djuric, Z. (2006). Psychodrama - A beginners guide. Jessica Kingsley Publishers. ● Trauma Institute & Child Trauma Institute. (2023, February 15). Types of trauma therapy. TICTI. https://www.ticti.org/treatment/types-of-trauma-therapy Resources ● U.S. Department of Health and Human Services. (2014, October 3). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD. https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf ● U.S. Department of Veterans Affairs. (2019, January 1). Complex PTSD. PTSD: National Center for PTSD. https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp ● Wizards of the Coast LLC. (2023). What is D&D: Dungeons & Dragons. D&D Official. https://D&D.wizards.com/start-playing-D&D