From Play to Praxis: Translating Tabletop Role-Playing Games into Evidence-Based Clinical Interventions

Tabletop role-playing games (TTRPGs), such as Dungeons & Dragons, Pathfinder, and Call of Cthulhu, are increasingly being adapted for clinical use, yet the field remains limited by inconsistent terminology, variable intervention models, and a nascent empirical literature. Collaborative Role-Playing Integrative Therapy (CRIT) distinguishes therapist-led, clinically intentional TTRPG interventions from recreational play. This article conceptualizes CRIT as a flexible group therapy approach in which well-supported psychotherapy mechanisms may be instantiated. The paper focuses on three such CRIT-compatible mechanisms: therapeutic alliance, exposure, and behavioral activation. Each mechanism is translated into CRIT-specific clinical applications. Clinical implications are considered regarding gameplay design, ethics/safety, and multicultural factors.