nfralick
Tue, 08/13/2024 - 22:59
Edited Text
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
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