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DISSERTATION ON DUNGEON & DRAGONS                                                               1               The World of Dungeons and Dragons as a Therapeutic Approach to Complex Trauma  Dava R. Wilson, MPA, MSSA, LCSW-BACS Department of Community Care and Counseling, Liberty University  A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Education   School of Behavioral Sciences Liberty University-Lynchburg Virginia 2023   DISSERTATION ON DUNGEON & DRAGONS                                                               2             The World of Dungeons and Dragons as a Therapeutic Approach to Complex Trauma     Dava R. Wilson, MPA, MSSA, LCSW-BACS  A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Education   School of Behavioral Sciences Liberty University, Lynchburg, VA 2023  Approved by:  Dr. Thomas Vail, PhD., Committee Chair  Dr. Ralph Fox, PhD., Committee Member DISSERTATION ON DUNGEON & DRAGONS                                                               3           Abstract This qualitative dissertation delves into the therapeutic potential of Dungeons and Dragons (D&D) as an intervention for individuals coping with trauma and related mental health challenges. Drawing from a diverse sample of participants with varying gender identities, age groups, and D&D experience levels, this study employs a grounded theory approach to unravel the intricate interplay between D&D engagement and mental health outcomes. The study identifies several key implications, including the importance of creating inclusive therapeutic spaces, the lifespan relevance of D&D interventions, the potential for tailored interventions addressing relationship dynamics, and the accessibility of D&D as a therapeutic tool. Delimitations highlight the contextual specificity, limited generalizability, sample characteristics, subjective perceptions, therapeutic emphasis, temporal constraints, and cultural considerations inherent to this research. Keywords: Dungeons and Dragons, D&D therapy, qualitative research, therapeutic intervention, coping mechanisms, trauma processing, conflict resolution, mental health, stress reduction, grounded theory, gender identity, age-specific benefits, relationship dynamics, inclusivity, accessibility.     DISSERTATION ON DUNGEON & DRAGONS                                                               4           Dedication  This paper is dedicated to my family, both biological and chosen, whose love and support have led me to this completion. To my daughters and grandbabies, this is to show that we as women can move beyond our trauma and thrive. Most of all I want to thank my best friend and husband, Rhynos Wilson, Jr. one of God’s biggest gifts to me, who has always been my biggest cheerleader and believed in me even when I failed to do so myself.              DISSERTATION ON DUNGEON & DRAGONS                                                               5                                                                  Acknowledgments  To Dr. Thomas C. Vail for his dedication, motivation, and support throughout the dissertation. To those who made the decision to allow me into their community of D&D and to learn so much from you, I thank you! I could not complete this journey without acknowledging a man who inspired me to become a professor and to seek my doctoral degree, Dr. Peter Bacho. You have impacted my life so profoundly, and I will forever be grateful for you being in my life. “Vote your interest and not your ignorance.”             DISSERTATION ON DUNGEON & DRAGONS                                                               6           Table of Contents Abstract ............................................................................................................................................3 Dedication ........................................................................................................................................4Acknowledgments............................................................................................................................5 Table of Contents .............................................................................................................................6 List of Tables .................................................................................................................................12 List of Abbreviations .....................................................................................................................13 Chapter One: Introduction .............................................................................................................14 Overview ............................................................................................................................14 Background ........................................................................................................................14 Situation to Self..................................................................................................................19 Problem Statement .............................................................................................................20 Purpose Statement ..............................................................................................................20 Significance of the Study ...................................................................................................21 Research Questions ............................................................................................................24 Summary ............................................................................................................................24 Chapter Two: Literature Review ...................................................................................................26 Overview ............................................................................................................................26 Theoretical Framework ......................................................................................................26 Related Literature...............................................................................................................29 Alternative Interventions .......................................................................................44 History of Dungeons and Dragons .........................................................................59 DISSERTATION ON DUNGEON & DRAGONS                                                               7           Characters of Dungeons and Dragons ....................................................................62 Classes........................................................................................................63 Species (formerly called Races) .................................................................68 Basic Rules.................................................................................................70 Dungeon Master (DM) ...............................................................................71 What is an NPC? ........................................................................................71 The Dice .....................................................................................................71 The D20 .....................................................................................................72 The D12 .....................................................................................................72 The D10 .....................................................................................................72 The D8 .......................................................................................................73 The D6 .......................................................................................................73 The D4 .......................................................................................................74 Session Zero ...............................................................................................74 Homebrew ..................................................................................................74 Weapons .....................................................................................................75 Summary ............................................................................................................................75 Chapter Three: Methods ................................................................................................................78 Overview ............................................................................................................................78 Design ................................................................................................................................79 Research Questions ............................................................................................................79 Setting ................................................................................................................................80 DISSERTATION ON DUNGEON & DRAGONS                                                               8           Participants .........................................................................................................................82 Procedures ..........................................................................................................................83 The Researcher's Role ........................................................................................................85 Data Collection ..................................................................................................................87 Interviews ...........................................................................................................................88 Surveys ...................................................................................................................92 Document Analysis ................................................................................................97 Observations ..........................................................................................................98 Data Analysis .....................................................................................................................99 Case Selection ........................................................................................................99 Documents ...........................................................................................................100 Reflective Journal ................................................................................................100 Data Analysis .......................................................................................................100 Trustworthiness ................................................................................................................101 Credibility ............................................................................................................101 Dependability and Confirmability .......................................................................103 Transferability ..................................................................................................................104 Ethical Considerations .....................................................................................................104 Summary ..........................................................................................................................105 Chapter Four: Findings ................................................................................................................107 Overview ..........................................................................................................................107 Relationship Between Research Questions and Theoretical Frameworks ......................108 DISSERTATION ON DUNGEON & DRAGONS                                                               9           Theory of Planned Behavior and Social Information Processing………….…..110 Incorporating Social Theory ................................................................................110 Incorporating Decision Theory............................................................................110 Incorporating Instinct Theory of Aggression, Frustration-Aggression Theory...110 Applying Social Learning Theory ........................................................................111 Applying Theory of Planned Behavior and Social Information Processing ........111 Applying Strategy of Conflict Theory and Fictitious Play Theory ......................111 Strategy of Conflict Theory and Fictitious Play Theory ......................................111 Participant Responses and Theoretical Linkage to Themes ............................................112 Synthesis and Reflection ..............................................................................................................123 Participants .......................................................................................................................124 CS101 ...................................................................................................................124 CS102 ...................................................................................................................126 CS103 ...................................................................................................................127 CS104 ...................................................................................................................128 CS105 ...................................................................................................................129 CS107 ...................................................................................................................131 CS110 ...................................................................................................................132 CS111 ...................................................................................................................134 CS113 ...................................................................................................................136 CS114 ...................................................................................................................137 CS115 ...................................................................................................................138 DISSERTATION ON DUNGEON & DRAGONS                                                               10           CS116 ...................................................................................................................139 CS117 ...................................................................................................................141 CS118 ...................................................................................................................142 CS119 ...................................................................................................................144 CS120 ...................................................................................................................146 CS122 ...................................................................................................................147 CS124 ...................................................................................................................149 CS126 ...................................................................................................................150 Results ............................................................................................................................151 Themes ...........................................................................................................................152 Theme Development ..........................................................................................181 Research Question Responses ............................................................................183 Summary ........................................................................................................................188 Chapter Five: Conclusion ............................................................................................................190 Overview ..........................................................................................................................190 Summary of Findings .......................................................................................................191 Discussion ........................................................................................................................193 Implications......................................................................................................................196 Incorporating a Christian Worldview Perspective ...........................................................198 Delimitations and Limitations ..........................................................................................199 Recommendations for Future Research ...........................................................................203 Summary ..........................................................................................................................204 DISSERTATION ON DUNGEON & DRAGONS                                                               11           References ........................................................................................................................206 Appendices .......................................................................................................................230 DISSERTATION ON DUNGEON & DRAGONS                                                               12           List of Tables Table 1 .......................................................................................................................................... 84 Table 2 ........................................................................................................................................ 153 Table 3 ........................................................................................................................................ 166 Table 4 ........................................................................................................................................ 175 Table 5 ........................................................................................................................................ 178                DISSERTATION ON DUNGEON & DRAGONS                                                               13           List of Abbreviations Adverse Childhood Experiences (ACEs) Attention-Deficit/Hyperactivity Disorder (ADHD) Autism Spectrum Disorder (ASD) Dungeon Master (DM) Dungeons & Dragons (D&D) Female-to-Male (used in the context of transgender identity) (FTM) Generalized Anxiety Disorder (GAD) Lesbian, Gay, Bisexual, Transgender, Queer, and more (LGBTQ+) Major Depressive Disorder (MDD) Male-to-Female (used in the context of transgender identity) (MTF) Non-Player Character (NPC) Obsessive-Compulsive Disorder (OCD) Oppositional Defiant Disorder (ODD) Post-Traumatic Stress Disorder (PTSD) Role Playing Game (RPG)      DISSERTATION ON DUNGEON & DRAGONS                                                               14           Chapter One: Introduction Overview  This research aims to explore both the need for and the efficacy of alternative role-playing interventions, such as Dungeons and Dragons, to process complex trauma safely. Mental health diagnoses have increased due to post-pandemics, poverty, unemployment, isolation, social skills loss, and exposure to traumatic environments. Due to these unexpected changes in today's world, clinicians and clients need access to outside-the-box intervention options to meet the needs of these clients. Background Mental illness is an illness that does not discriminate. According to The National Institute of Mental Health (NIMH), mental illness affects tens of millions yearly in the United States. In 2020, 52.9 million, 1 in 5, Americans reported having some form of mental illness (www.nimh.nih.gov, 2020). Many with mental illness fail to seek treatment due to stigmas, fear, or other factors such as access to care and financial constraints. However, NIMH found that in 2020, young adults ages 18-25 reported more serious mental illness (SMI) than their older adult counterparts. This definition is pertinent information when identifying treatment approaches for this population. Many recent events (war, deployment, post-pandemic, death, isolation) have increased the need for mental health professionals to treat varying mental health issues, such as depression and anxiety. However, an increasing number of clients are suffering from complex traumas such as post-traumatic stress disorder (PTSD) and sexual trauma. Millions of Americans experience DISSERTATION ON DUNGEON & DRAGONS                                                               15           complex trauma, including sexual assault and post-traumatic stress disorder (PTSD). According to the National Sexual Violence Resource Center (NSVRC), 1 in 5 women (18.3%) and 1 in 71 men (1.4%) in the United States have been raped at some time in their lives, including completed forced penetration, attempted forced penetration, or alcohol/drug-facilitated completed penetration (nsvrc.org, 2010). The National Center for PTSD reported that about seven or eight out of every 100 people would experience PTSD at some point. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others (nimh.nih.org, 2019). According to the Mental Health America's (MHA) annual survey (2021), 1.5 million more Americans live with mental illness than the 2020 report. According to MHA, the numbers continue to rise as isolation, loneliness, and grief increase weekly across the country due to the current post-pandemic (mhanational.org, 2021). Isolation and loneliness have recently become prevalent factors in people's overall mental health, increasing symptomology of those already suffering from certain mental illnesses and initiating new symptoms for those unaware of issues. Several recent studies provide compelling evidence for adverse mental health effects of isolation and quarantine, particularly depression, anxiety, stress-related disorders, and anger (Henssler, 2021). A study completed in China (Gong et al., 2021), the suspected origin of the COVID-19 virus, reported that those who did quarantine due to medical issues (i.e., COVID-19 positive or high risk of issues due to preexisting conditions) reported a substantial increase in depression, anxiety, and stress than those who self-quarantined as a precautionary measure (Gong et al., 2021). DISSERTATION ON DUNGEON & DRAGONS                                                               16           Urbanization and poverty are other documented contributing factors to the increase in mental health concerns. More people are moving to urban areas from rural areas and experiencing psychological distress related to adjusting to new environmental stimuli (Sadaf et al., 2021). Some of these environmental stimuli causing negative impacts on the mental health of those participating in the studies are lack of trees, social deprivation, overstimulation (lights, billboards, excessive noise), and overpopulation (Sadaf et al., 2021). These contributors reported at a higher rate during the peak of COVID-19 and quarantine. Another collateral damage from the post-pandemic was the loss of hundreds of thousands of jobs and increased poverty levels. Forty percent of Americans live one paycheck away from homelessness, according to a study (Mello, 2019) focusing on wage disparity based on gender during the post-pandemic.  Worries about homelessness, food, bills, finances, and overall quality of life trigger anxiety and depression. Adolescents and young children are more susceptible to the adverse effects of poverty than their parents, who have learned coping strategies to manage their stressors (Dashiff et al., 2009; Yoshikawa et al., 2012).  These influencing factors also affect people continuously throughout their lives when left untreated, as evidenced by the adverse childhood experiences (ACEs) model. Steele et al. (2016) researched how poverty and mental illness, when left untreated in children, will affect their ability to parent in a healthy way as an adult, therefore continuing a cycle of maladaptive behaviors that can lead to severe mental illness (SMI) or substance and physical abuse. Their findings revealed that this cycle is preventable when teachers, nurses, and counselors recognize the signs of adverse childhood experiences (ACE) components in a child, coupled with continued communication with parents offering resources and other assistance (Steele et al., 2016). This DISSERTATION ON DUNGEON & DRAGONS                                                               17           need is increased with the post-pandemic and subsequent isolation and quarantine, as many professionals no longer have eyes on the child directly.  There are obstacles to mandated reporting. Mandated reporters are defined "as a person who has regular contact with vulnerable people and is therefore legally required to ensure a report when abuse is observed or suspected. Specific details vary across areas—the abuse reported may include neglect or financial, physical, sexual, or other types of abuse. Mandated reporters may include paid or unpaid people who have assumed full or intermittent responsibility for caring for a child, dependent adult, or senior citizen" (NASW Code of Ethics, 2021). These scenarios become a concern in a time of increased mental illness, isolation, and other outliers such as job loss, poverty, and substance abuse as self-medication (Stockwell et al., 2021;2020) due to the lack of "eyes" on vulnerable populations, particularly during a post-pandemic. Home is not always a safe place to live; for adults and children living in domestic and intimate partner violence, home is often where most abuse occurs (Stockwell et al., 2021;2020). The home can be where power and control over those they abuse, often without influence or input from anyone "outside" the couple or the family unit.  In the COVID-19 crisis, the encouragement has been to "stay at home" (Stockwell et al., 2021;2020), which has significant implications for those adults and children already living with someone abusive or controlling. Strict and enforced restrictions on movement shut off escape choices, ability to seek help, and ways of coping for victims/survivors. Restrictive measures are also methods of power for people who abuse through tactics of control, surveillance, and threats. These tactics are because what goes in within people's homes takes place "behind closed doors" and out of the literal view of other people. An unintentional consequence of the lockdown DISSERTATION ON DUNGEON & DRAGONS                                                               18           measures may have granted those who abuse greater freedom to act without witnesses or consequences (Bradbury-Jones & Isham, 2020). With the increase in mental health cases, domestic violence, substance abuse, and the recent post-pandemic, clinicians and clients need to find ways to connect in safe and beneficial ways to the client's needs. Teletherapy is one of those tools which has allowed the connection between clinician and client, providing accessibility advantages for consumers, including rural, disabled, and housebound clients, have been advertised (US Department of Health and Human Services, 2016), and has led to increased access to care for military veterans (Mott et al., 2014). Teletherapy has also provided the much-needed eye on vulnerable populations to discreetly assess and screen for potential abuse. Some reported constraints using teletherapy, such as lousy internet connections, home environment, pets, and lack of ritualistic behaviors (getting ready to leave for an appointment) are just a few. Additional constraints are that many traditional therapeutic intervention methods fail to translate across online video conferences (Burgoyne & Cohn, 2020). This statement is especially true for clients on the autism spectrum or with SMI (Romney & Garcia, 2021). Stigma and cultural influences contribute to the lack of care sought for mental illness in certain cultures, and technology-based treatment may be a struggle for elderly clients.  Alternative and outside-the-box thinking for treatment modalities before this post-pandemic, and numerous studies show their efficacy in treating certain mental illnesses. There are several evidence-based treatment approaches for the treatment of these traumas, including Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization Reprocessing (EMDR), Gestalt Therapy, and Prolonged Exposure Therapy (Schneider et al., 2013). These treatment DISSERTATION ON DUNGEON & DRAGONS                                                               19           approaches are evidence-based and studied within the parameters of in-person engagement; therefore, they do not always translate across the screen in video sessions (Burgoyne & Cohn, 2020). Recently, however, newer approaches have shown promise in mental illnesses such as depression and anxiety, which involve role-playing games (RPG) (Corsini, 2017), avatar therapy, video games, and virtual reality. Gestalt therapy is an effective and popular therapeutic method incorporating role-playing in treatment planning. Some research shows improvement in PTSD symptoms for those with exposure therapy using virtual reality technology (Smith, 2020). Situation to Self  In my pursuit of a doctorate in community care and counseling with an emphasis in traumatology from Liberty University, I came to the research domain with a rich background in clinical practice and an enduring commitment to the welfare of individuals who have experienced trauma. With over a decade of professional experience as a licensed clinical social worker and therapist, I have worked with diverse populations in various settings, and this firsthand clinical knowledge deeply informs my research perspective. My academic journey, which began in 2009, has been marked by acquiring an associate degree in human services, a master's degree in public administration, and another master's degree in social work, where I had the privilege of completing a thesis. This extensive educational background and my clinical expertise enable me to approach research with a unique and holistic viewpoint, bridging the gap between theory and practice.   DISSERTATION ON DUNGEON & DRAGONS                                                               20           Problem Statement Clinicians need more tools to meet the needs of the rising number of clients with mental health needs post-post-pandemic, many of whom are frustrated by the traditional approaches used to treat their symptoms (Aboujaoude et al., 2020). Introducing more modern and current versions of these approaches, which originate from evidence-based practices, can assist clinicians in treating complex trauma in a less invasive manner. According to a study conducted by the Pew Research Center (2008), four out of five young adults play some version of a video game, either in person or online, and 21% of them report playing daily. This information speaks to adjusting approaches based on the client's needs to gain buy-in for treating mental illness. Dungeons and Dragons (D&D) is one of these modernized approaches to complex trauma, which can be processed through character development and role-playing in themed worlds and played in person or online, which is essential given the current post-pandemic. Purpose Statement Qualitative research aims to understand and explain participant meaning (Morrow & Smith, 2000). More specifically, Creswell (1998) defines qualitative research as an inquiry process of understanding based on distinct methodological traditions of inquiry that explore a social or human problem. The researcher builds a complex, holistic picture, analyzes words, reports detailed informants' views, and conducts the study naturally (Creswell, 1998, p.15). Thus, using a qualitative methodology allowed the researcher to study the phenomenon of D&D as a therapeutic intervention in its naturalistic setting. Morrow, Rakhsha, and Castaneda (2001, p.582-583) provide assorted reasons for using qualitative research to study multicultural issues. For example: It includes context as an essential component of the research. It addresses the DISSERTATION ON DUNGEON & DRAGONS                                                               21           researcher's process of self-awareness and self-reflection. It can uniquely capture the meanings made by participants of their experiences. Scholars in multicultural counseling and psychology have called for expanded methodological possibilities to address questions that traditional methods cannot answer. Its methods allow voices previously silenced to be heard and marginalized lives brought to the center. Significance of the Study This qualitative study case study is essential and needed for several reasons. First, a gap exists in the research regarding alternative therapeutic ways to use role-playing games as a processing and healing tool for complex trauma. The available literature focuses on RPGs within the context of depression and anxiety, while others look at virtual reality to treat PTSD. There is no research on using Dungeons and Dragons (D&D) as a therapeutic intervention outside of its use for mild anxiety and developmental disabilities. Thus, the second goal of this study is to focus on qualitative findings to gain an in-depth understanding of how D&D is a role-playing therapeutic technique to process complex trauma such as PTSD and sexual trauma with its use of character creations and themed worlds. Third, this study is needed to provide clinicians with an alternative intervention to meet the client's needs by acknowledging their comfort with gaming and merging this strength with an intervention tool. Fourth, this study will add new knowledge to this neglected area. However, it also provides information to social scientists, health care providers, mental health professionals, educators, and policymakers to better understand the non-traditional needs of a growing population of those with mental health needs to be increased by the post-pandemic. Fifth, the D&D as an intervention study will use samples from actual game participants who have reported experiencing various levels of mental health concerns. This study DISSERTATION ON DUNGEON & DRAGONS                                                               22           will be conducted online during live D&D games on sites like Twitch and YouTube. Finally, this study will provide information for future researchers who wish to study alternate possibilities for mental health interventions that address complex trauma and other mental health issues. Experts fear COVID-19 significantly impacted mental health, becoming post-pandemic (Parrish, 2020). The mental health effects of physical illness can be significant under the best circumstances. However, there is collateral damage to the isolation we experienced away from support systems and loved ones, which contributed to an increase in mental health needs by even those who did not previously experience mental health symptomology (Lieberman & Olfson, 2020). Moreover, in families who lost loved ones to COVID-19, substantial distress and extended grieving process continue past the post-pandemic timeline. Interventions to improve mood, create positive attitudes to facilitate recovery, and support conversations about mental health are some of the essential pieces of the post-pandemic puzzle that could play a significant role in the comprehensive approach to patients who are mentally and physically recovering from this virus (Franchi, 2022). As we enter the fourth year of this post-pandemic, the need for alternative methods and interventions that allow both the clinician's and client's safety and flourishing mental health outcomes is imperative to reduce this increasing mental health need. These suggestions are mere surface-level ideations. Several studies have looked outside the box and produce innovative alternative mental health interventions to assist in this post-pandemic situation (Parrish, 2020). One of the studies looked at the positive effects of natural green space. Greenspace is defined as natural vegetation such as grass, plants, or trees and built green structures such as parks. The thought is that greenspace can have restorative effects from stress relief and mood enhancement, DISSERTATION ON DUNGEON & DRAGONS                                                               23           increase physical activities, promote neighborhood social cohesion (e.g., social contact) and allow for reduced exposure to environmental hazards such as air pollution and noise. Physical activity mediates the relationship between exposure to green space and mental health.  Additionally, viewing nature can trigger positive emotions, relieve stress (i.e., stress reduction theory), and function as a positive distraction from the post-pandemic's dim reality, helping reduce mental fatigue and stress (Heo et al., 2021). Another study out of Japan researched how access to a view of this green space positively affects mental health. Findings reported significant policy implications, suggesting that nature, even in urban areas, has excellent potential to be used as a "nature-based solution" for improved public health (Soga et al., 2020, p.134). There is extensive evidence from disease epidemics of the past that show frontline workers are at a higher risk of developing both short- and long-term mental health effects stemming from the stressors related to the disease itself and related outliers (Pollack et al., 2020).  There is also growing evidence that socioeconomic status may increase the chance of developing mental health problems (WHO, 2014). So, with these factors in mind, clinicians, as essential and frontline workers, as experts in mental health, must be aware of the effects and the potential financial challenges that face those affected by the post-pandemic. With financial challenges contributing to increased depression, including increased self-harm and suicidal ideations (Elbogen et al., 2021), it is essential to find budget-friendly alternatives to processing mental health struggles, which can be accessed online if needed.   DISSERTATION ON DUNGEON & DRAGONS                                                               24           Research Questions This study aimed to answer the central research question: How do players of D&D describe the relationship between character development and their diagnosed mental illness? This study will also address the following research questions: 1.       How do these players view their mental illness? 2.       What are the qualities and characteristics of characters used to process mental illness symptomology? 3.       How do players identify their choices of themed worlds within the game? Is it player-centered? 4.       How would players describe this experience as an intervention technique? Summary            This dissertation consists of five chapters and an appendix section. In the first chapter, we will briefly introduce mental illness, complex trauma, and interventions. We will also explain the rationale for conducting this study and the reasons for employing qualitative research methods, and we will present the problem statement along with the research questions. Chapter two will present a comprehensive review of the literature. The third chapter will describe the research methods, including how cases will be selected, the forms of data collection, how data will be analyzed, the validation strategies used to increase the validity and reliability of the study, potential ethical issues, and the role and background of the researcher. Chapter four will present and highlight the results of the case-by-case analysis. This chapter describes cases in detail, DISSERTATION ON DUNGEON & DRAGONS                                                               25           along with the themes that emerged from each case. Themes are presented and accompanied by quotes. The last chapter will discuss the results of the study, the implications for theory development, practice, public policy, future research, the strengths and limitations of the study, a conclusion, and a section on lessons learned, as well as the references used in all the chapters of this dissertation. There will also be an appendix section that includes copies of the internal review board approval, the informed consent forms, interview protocols, the demographic questionnaire, the observation protocol, and the written permissions from the Dungeon Master (DM) to observe and interview players.            DISSERTATION ON DUNGEON & DRAGONS                                                               26           Chapter Two: Literature Review Overview The National Commission wrote the Belmont Report for the Protection of Human Subjects of Biomedical and Behavioral Research, also referred to as The Commission, as a result and response to The National Research Act of 1974. The report from hhs.gov (2016) identified basic ethical principles to guide biomedical and behavioral research on human subjects. This research was conducted based on the guidelines from this report. The chapter is in three sections. The first section describes the phenomenon of mental illness. This section highlights (1) national statistics on the population (s) most affected by mental illness and complex trauma, (2) theoretical models and methods describing the evidence-based theoretical models and approaches, and (3) current evidence-based models used traditionally with complex trauma, and (4) the changing needs during a post-pandemic. The second section of this chapter focuses on how the post-pandemic has affected mental illness. The third section of this chapter focuses on the available literature on alternate mental health interventions (games, RPGs, Board games, VR), highlighting the limited available research on this topic as related to complex trauma and the need for continued exploration in this area of study. Theoretical Framework Mental health and well-being experts draw from other areas to inform their perspectives on what clinicians and practitioners call an integrated approach. They also review a person's mental health within cultural competence. For example, an act could be psychopathological in DISSERTATION ON DUNGEON & DRAGONS                                                               27           one cultural context but not another. The primary areas in which counselors, psychologists, and psychiatrists understand mental health are spiritual, statistical, disease/medical/biological, psychological, social, psychosocial, biopsychosocial, and individual, group, and family therapies (Dasgupta, 2013). The spiritual approach explains who we are in the world and how we act in the form of morals and value systems. This approach explains what we perceive happens after death based on our choices and actions. The spiritual perspective discusses good and evil as they relate to distress. A moral character's perspective suggests that there are virtues a person needs to learn, allowing the individual to live a better life free from mental illness. Based on mathematics, statistics seek to define 'normal' or 'average' for populations. Anyone falling outside of the "norm" is considered abnormal. The disease/medical/biological (genetics, neuroimaging, and neurobiology) approach explains mental health as it relates to chemical and physical changes in the brain. The Psychological (psychodynamic, behavioral, cognitive-behavioral, existential/humanistic) approach states that mental health develops along a projected path. People try to adjust to their environment to survive within it. Problems arise when a person learns maladaptive strategies to respond to new situations (trauma responses).            The social approach refers to biology, psychology, and society equally affecting a person's mental health. The influence of societal norms is essential to the adaptive or maladaptive behavior of the individual (Dasgupta, 2013). The psychosocial (Social learning model) is what researchers and academics study the relationship between a person's thoughts (psychological) and their social behavior. According to Bandura, people learn through observation and modeling DISSERTATION ON DUNGEON & DRAGONS                                                               28           other people's behavior (McLeod, 2016). Included in the perceived priority a person gives to their psychological processes.            The biopsychosocial combines biological, psychological, and social factors that explain mental illness, emphasizing the person and their environment. Each stresses confidentiality and creates a safe space for people to share. Individual counseling is a one-on-one session with a trained counselor. Depending on the type of therapy used, these sessions can continue for months or years versus group counseling, where people with similar challenges work with a licensed counselor. The goals are to discuss issues and share knowledge and solutions among peers. Finally, family therapy is a method that involves helping a family improve their communication. Through the facilitation of a licensed therapist, they learn conflict resolution techniques, which are often short-term (Dasgupta, 2013). There are several evidence-based treatment approaches for the treatment of complex traumas, including Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization Reprocessing (EMDR), Gestalt Therapy, and Prolonged Exposure Therapy (Schneider et al., 2013). However, newer approaches have shown promise in mental illnesses such as depression and anxiety, which involve role-playing games (RPG) (Corsini, 2017), avatar therapy, video games, and virtual reality. Some research shows improvement in PTSD symptoms for those with exposure therapy using virtual reality technology (Smith, 2020). Gestalt therapy is a popular therapeutic method incorporating role-playing in treatment planning. Gestalt therapy, such as the "empty chair" technique, can be effective in diverse settings. One of the primary features of the Gestalt techniques is the designation of psychodrama and role-playing. Originating in Germany in the 1930s, Fritz and Laura Perls were clinicians who provided psychoanalysis, which differed DISSERTATION ON DUNGEON & DRAGONS                                                               29           from the famous views of Sigmund Freud, and this became a breakaway opportunity to create their discipline. Related Literature In German, Gestalt Therapy means "whole" (Perls et al., 1994, p.14). By explicitly focusing on helping clients "become who they truly are," Perls denied his part in shaping what parts of themselves clients felt free to express in the therapy (Perls et al., 1994, p.14). These "parts" are related to the efficacy of role-playing to be part of themselves through character creation, who feels empowered to process trauma.  Cognitive-behavioral therapy (CBT) is also a theoretical framework for processing trauma. The gold-standard CBT for psychosis and negative thinking patterns brought on by trauma offers, at best, modest effects. With advances in technology, virtual reality (VR) therapies for auditory-visual hallucinations (AVH), such as avatar therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects (Dellazizzo et al., 2021). CBT is an evidence-based treatment founded on the premise that our thoughts control our emotions and behavior (Gautam et al., 2020). It is a short-term, purposeful therapy that examines the link between thoughts, emotions, and behavior. In CBT sessions, clients will learn to recognize cognitive distortions or "thinking traps," such as all-or-nothing thinking, catastrophizing, and faulty assumptions. With the negative thought patterns identified, clients practice more rational and positive ways of viewing situations and experiences. Most CBT practitioners include homework so clients can practice identifying and changing thoughts in real-life personal situations (Gautam et DISSERTATION ON DUNGEON & DRAGONS                                                               30           al., 2020). Some clinicians have found that the characters created in role-playing games such as Dungeons and Dragons (D &D) also assist their clients in processing complex trauma and anxiety through their characters in a theme related to their struggles (Abbott et al., 2021). Many trauma-related models help guide clinicians to treatment options that may prove helpful for their clients. The transtheoretical model, for example, references the stages of change that are important when speaking about mental health and readiness for change from current mental health to improved mental health (Prochaska et al., 1992). (See Table 1). The stages include pre-contemplation, contemplation, preparation, action, and maintenance. Depending upon where a client or, in this case, a player of D&D is at in this process will determine whether their character will truly assist them in processing their trauma. Therefore, it is essential to ascertain where in this model they identify, preferably in the action stage, for best results (Prochaska et al., 1992). The cognitive model, created by Aaron Beck (1979), is the person's perception of themselves and of an initiating event that causes mental illness and impacts their future self. (See Table 2). By following this model, players of D&D can reframe their perception of themselves through character design, which will also challenge the thoughts of their trauma in initiating or triggering events. In addressing specific triggers, worlds, and scenes are chosen and create a safe space for the player to not only process the trauma through the character but also engage in new, healthier thoughts, leading to healthier behaviors. The internal family systems model (IFS), created by Richard C. Schwartz in the early 1990s, is based on the Family Systems Theory. This theory states that individuals cannot understand in isolation from the family unit but through developing techniques and strategies to DISSERTATION ON DUNGEON & DRAGONS                                                               31           effectively address issues within a person's internal community or family. This evidence-based approach (Swartz, 1999) assumes everyone possesses a variety of sub-personalities, or "parts." It attempts to get to know each of these parts better to achieve healing (Schwartz, 1999, p.4). These parts are called Self, Managers, Firefighters, and the Exiles. (See Table 3). This evidence-based theory states that our inner parts contain valuable qualities, and our core self knows how to heal, allowing us to become whole and integrated with our parts (Schwartz, 1999). Looking at IFS with relationship to D&D character development for processing complex trauma, one could identify with one of the parts to gain the healing powers from the core self.  Theoretical models such as Foa's Associative Network Theory have influenced how clinicians "see" PTSD and understand how it affects the brain and behaviors often simultaneously. Foa and her colleagues (Foa & Kozak, 1986; O'Sullivan, 1999; Foa et al., 1989) have put forward an information-processing theory of PTSD that centers on forming a so-called fear network in long-term memory. This fear network encompasses trigger information about the traumatic event, cognitive, behavioral, and physiological reactions to the trauma, and stimuli produced within an organism, especially in the gastrointestinal system and other internal organs, which links these stimulus and response elements.  Activation of the trauma-related fear network by triggering stimuli (i.e., reminders of the trauma), according to Foa et al. (1989), causes information in the network to enter conscious awareness, which is the intrusion symptoms of PTSD. Attempts to avoid and suppress such network activation led to the avoidance symptoms of PTSD. Foa et al. (1989) argue that successful trauma resolution can only occur by integrating the fear network with existing memory. Such assimilation requires, first, the activation of the fear network to become accessible DISSERTATION ON DUNGEON & DRAGONS                                                               32           for modification and, second, assessing whether the availability of information is incompatible with the fear network so that the overall memory can be modified. One way to activate the trauma is through role play in a themed virtual world, such as in D&D, where the character provides a safe place to integrate the fear network and assess the memory for modification to promote healing.  Similarly, Ehlers & Clark's cognitive model of PTSD suggests that negative appraisals, disjointed trauma memories, and unhelpful coping strategies maintain PTSD. These are influenced by cognitive processing during trauma (Beierl et al., 2020). Like other cognitive models, it looks at complex trauma such as sexual assaults or severe traffic collisions. Within this model, if the survivor of complex trauma, such as the ones focused on in the model, can reframe the negative memory and overall appraisal of the trauma through healthy strategies, such as RPG, they will be able to process the trauma more healthily and positively which will allow them to become less disjointed in their daily functioning.  Game theory is a theoretical framework for conceiving social situations among competing players; game theory is the science of strategy, or at least the optimal decision-making of independent and competing actors in a strategic setting. (Hayes, 2022). This work, created by mathematician John von Neumann and economist Oskar Morgenstern in the 1940s (Neumann & Morgenstern, 2021), was later extended to real-world use by mathematician John Nash, best known for the movie A Beautiful Mind (Howard, 2001). The main fundamental base of game theory is that one player's payoff is contingent on the strategy implemented by the other player. The game identifies the players' identities, preferences, and available strategies and how these strategies affect the outcome. Depending on the model, various other requirements or DISSERTATION ON DUNGEON & DRAGONS                                                               33           assumptions may be necessary. Game theory has various applications, including psychology, evolutionary biology, war, politics, economics, and business (Hayes, 2022). According to game theory, the participants' actions and choices affect each outcome. Assuming the players within the game are rational and will strive to maximize their payoffs (Stanford University, 2019).  Although the game theory is most often used in the "game" of 'rationality' in economic strategy, one firm (executive role) competes for power over another (executive role). One could argue, however, that its foundational essence could also be practical in RPGs where characters used to compete within the game's safety to assume power over something such as complex trauma. The importation of game theory into humanistic disciplines provides a dense and intricate web of connections associated with 'rationality' in the Western cultural tradition. The word has normatively marginalized specific characteristics as ordinary and vital as emotion, femininity, and empathy (Stanford University, 2019).  At its origin, Neumann & Morgenstern asked that those who interpret game theory in terms of Revealed Preference Theory (RPT) (Samuelson, 1938) should not think of game theory as in any way a practical account of the motivations of some human actors (such as actual people). Instead, they should regard the game theory as part of the body of mathematics used to model those entities (with or without literal existence) who consistently select elements from mutually exclusive action sets, resulting in patterns of choices that allow for some haphazard and noise, is statistically modeled as the max application of utility functions (2019). Game theory is also a formalized study of strategy and psychological principles, which has been used quantitatively for years and has now found its way into qualitative research methods (Camerer, 2003). DISSERTATION ON DUNGEON & DRAGONS                                                               34           People use game theory to describe and model how human populations behave. Some believe they can predict how actual human populations will behave when confronted with situations comparable to the studied game. Critics often criticize this view of game theory because game theorists often violate the assumptions made. The assumption was that players always act to maximize their wins when this is not always true directly. Altruistic and philanthropic behavior would not fit this model (Duffy, 2010). Using humanistic application within social sciences, one could apply the fundamentals of Game theory with human actors playing in the form of a fictional character, using mutually exclusive themes, resulting in patterns of choices, allowing for some discomfort in a safe space. Additionally, it is a barrier to processing complex trauma and builds upon a qualitative outcome measure of its use (Gamson, 1965). Behavioral game theory is the application mentioned above, allowing real-life factors to influence real-life decisions and circumstances (Colman, 2003). Behavioral game theory uses empirical models to explain how social preferences, such as ideals of fairness, efficiency, or equity, influence human decisions and strategic reasoning (Golman, 2020). In a special issue research report (Golman, 2020), Behavioral game theory was explored based on whether fairness (Seier, 2020) in strategic games, such as D&D, is driven by intuitive or deliberate responses to outside influences. Additionally, it examined how people are willing to incur selfish costs in the name of fairness, even to punish those not deemed fair. Seier (2020) found that those driven by fairness also sought social utility or strengthened contact with others in society as a fundamental characteristic of strategic gaming. This finding is like social theory, which studies phenomena related to human activity and society (Seidman, 2016). DISSERTATION ON DUNGEON & DRAGONS                                                               35           As far back as 1965, Martin Shubik gathered relevant publications in print referring to Game theory, which was in four sections. The fourth section is most relevant to this work because it concerns gaming, the unique methodology of working out the consequences of situations with humans acting in simulated environments, and "games" constructed to be parallel to defined social situations (Anderson, 1965, p. 195). It was this section that social scientists and social anthropologists used to gain a deeper understanding of using Game theory in complex social behavior in society, such as antisocial, malevolence, deception, manipulation, and misbehaviors (1965). In continuing this section's point of view, we can assume that this research can be continued and be applicable today within the D&D player's world to gain a deeper understanding and process of complex trauma from social misbehavior.  Camerer (2003) identified three primary ingredients in behavioral game theory. These ingredients are (1.) Mathematical theories of how moral obligation and vengeance affect the way people bargain and trust each other; (2.) a theory of how limits in the brain constrain the number of steps of "I think he thinks …" reasoning people naturally do, and (3.) a theory of how people learn from experience to make better strategic decisions. Behavioral game theory explains strategic interactions that include bargaining, bluffing games in sports and poker, strikes, how conventions help coordinate a joint activity, price competition, patent races, and building up reputations for trustworthiness or ruthlessness in business or life.  Gleaning from the second ingredient, Camerer (2003) mentioned that D&D relies heavily on characteristics in social psychology (Seidman, 2016) and game theories to draw in players and keep them engaged. The strategic choices within role-playing and character-building aspects of the game not only overcome issues that arise in social settings in the real world, but they also DISSERTATION ON DUNGEON & DRAGONS                                                               36           must accomplish this while playing the role of unrelated characters at the same time, with their personalities, traumas, flaws, social abilities, ex Cetera. While the players of D &D may not be thinking of it while doing so, they are participating in a complex interconnecting series of social psychological exercises with every decision they make, both in the game as characters and at the table as players (Whitten, 2019). Another important aspect of playing D&D is character development and choices. Decision Theory, "an analytic and systematic approach to the study of decision making," is another theoretical model related to game theory. One of the most important decisions to make in D&D is which class the character will be in, and it allows others to gain insight into how someone will interact in the game. For example, if someone creates a Dwarf character, they are untrusting, as in the first ingredient mentioned above (Camerer, 2003). Barbarians are straightforward fighting styles chosen by players who are passive in real life and want to process with rage. As mentioned in the second ingredient (2003), they are also easily overwhelmed by options.  Fighters like to evaluate the waters before deciding, like in the third ingredient (2003). The paladin class is those who are hopeless romantics and believe in the social behaviors of chivalry and making the world a better place. They are fighters for social justice and live out the proverbial knight in shining armor persona, the third ingredient (2003). Monks, rarely chosen first, are steeped deeply in tradition and experience in the game. Rangers have secret pasts and struggle with the game's longevity; however, they are adventurous and creative, allowing for some strategic processing. Rogues are one of the more popular classes for those who desire to play out revenge plots. Rogues are where criminal acts can occur without actual consequences DISSERTATION ON DUNGEON & DRAGONS                                                               37           but may be necessary to move forward from trauma. Wizards, Warlocks, and Sorcerers are deeply committed to the rules and the magic, while clerics are competitive and want to win. Bards are for those who need the theatrical part of the strategy, and druids are empathetic and helpers. Classes are imperative for classes to choose to create a strategic playing area for the best possible processing (Spurlin, 2021). Recently, there has been an increased number of violent acts regarding our nation's schools and other public areas as well as online. Most recently, there was a mass shooting at a black grocery store in Buffalo, New York, and a massive school shooting in Uvalde, Texas. Experts say that in all cases of these horrendous crimes, the main component is the perpetrator coming from a dysfunctional home. Researchers have looked deeply into this as of late and have produced the theory that other contributing factors to the dysfunction in the homes are the decline of the family (Bennett, 2022) and parents not "parenting their children." At the center of the lack of parenting is technology. Electronic devices and video games babysit children so their parents can go on with the daily tasks they wish to do without interruption. Researchers have delved into the content of these games and any potential effects of said content.  Psychologists have three main theories of aggression that explain why we become aggressive and whether that behavior can be changed. More theories proposed that these three have stood the test of time and are crucial to understanding where aggression originates (Thudium, 2022). These theories include the instinct theory of aggression, frustration-aggression theory, and social learning theory (2022).  The first one, the instinct theory of aggression, is from Freudian influence when he realized that instinct alone could not explain all of life's urges and behaviors. He wrote these DISSERTATION ON DUNGEON & DRAGONS                                                               38           thoughts in Beyond the Pleasure Principle (Freud, 1922) and introduced Thanatos, a name he gave to the death instinct. The death instinct helped explain why humans become aggressive, engage in harmful behaviors, or seek to recreate past traumas. Freud believed that these two instincts exist in every human mind and that all behaviors stem from the balance of these two instincts. These instincts explain why we take anger out on others. Even if this anger or aggression is initially directed inward, Eros (the life instinct) overpowers Thanatos.  Aggression will project outward with the instinct to keep ourselves alive (Freud, 1922). Freud did not explain these behaviors; instead, he believed there was little use in subduing aggression when it comes from an innate instinct deeply embedded in the human mind. He focused more on structuring society in a way that kept communities small. To protect the community, people devised strategies for focusing aggressive behaviors outside the community, thus protecting all members (1922). In Freud's example, he describes Eros and Thanatos as two "characters" in the human brain. One represents life, the other death, which in D&D is prevalent. If a player of D&D wishes to process a complex trauma, based on Freud's writings, they may wish to tap into their Thanatos to recreate their trauma in a safe space within the realm of the D&D world. Freud also mentioned focusing on small communities as a protective factor. D&D players are a community within themselves; although violence is part of the game of D&D, it is within the game as a safeguard for the players.  Frustration-aggression theory is the intertwining of two common emotions: frustration and anger. These emotions can stop us from attaining our goals. The frustration-aggression theory states that aggression stems from frustration. Frustration is likely to turn into aggression, DISSERTATION ON DUNGEON & DRAGONS                                                               39           but it does not have to be if a person has higher levels of self-awareness or self-control (Thudium, 2022). One early study researching this theory involved children in front of a wire screen. Toys were on the other side. While the children could see the toys, the toys were just out of reach. The children who wanted to play with the toy became frustrated. By removing the barrier, the children could play with the toys; researchers noted that their play was much more aggressive than when the barrier had not been in place initially (Barker et al., 1941; Thudium, 2022). The last aggression theory comes from one of the most famous experiments of all time—the Social Learning Theory proposed by Albert Bandura (1969, 1971, 1986). Bandura is most known for his Bobo Doll experiment, which attempted to explain how children learn aggression from an early age. He proposed that aggression is a learned behavior. Children exert aggression simply because they imitate what they have observed (Bandura, 1969).  An adult placed children in a room with some and a large Bobo Doll. (A Bobo Doll is one of those inflatable clowns that bounces back up when you hit it.) Half the children sat in the room with the adults as they gently played with the toys, displaying little aggression. The other half sat in the room with the adult as the adult aggressively hit or kicked the Bobo Doll. Some of these adults used explicit language or even hit the Bobo Doll over the head with a mallet (Bandura, 1969, 1971, 1986). The children were then separated from the adults and placed in a room with more toys. After a few minutes, someone took away the toys, causing distress to the children. Someone then led them to a third room containing another Bobo Doll. The children who had witnessed the aggressive adults started exhibiting aggressive behavior themselves. They imitated and modeled aggressive actions, such as kicking, hitting, or being aggressive toward the DISSERTATION ON DUNGEON & DRAGONS                                                               40           Bobo doll. Based on this experiment, Bandura proposed that individuals frequently learn aggression through positive or negative reinforcement and indirect observational learning (Bandura, 1969). These initial introductions to what influence aggression led to modern-day research involving "screen time." An eye-opening study in 2018 will follow children for a decade after an MRI brain scan to monitor screen time's effect on a child's brain and if it continues to produce effects years later (Cooper, 2018). The first wave of data from brain scans of 4,500 participants (9 and 10-year-olds) is in, and Dr. Dowling of the National Institute of Health (NIH) and other scientists are intrigued. The MRIs found significant differences in the brains of some kids who use smartphones, tablets, and video games more than seven hours a day (Cooper, 2018). In the scans, there were assorted colors. The colors show differences in the nine and ten-year-olds’ brains. The red color represents premature cortex thinning, typically in older children, as a part of the maturation process. The wrinkly outermost layer of the brain processes information from the five senses. The researchers hypothesize that screen time is the effect of this and may have severe long-term effects on the child's ability to use the five senses and increase aggression (Cooper, 2018).  Aggression is one of the effects researchers are saying can come from video games with violent content. The General Aggression Model (GAM) is a comprehensive, integrative framework for understanding aggression. It studies the role of social, cognitive, personality, developmental, and biological factors in aggression. Proximate (immediate) processes of GAM feature how person and situation factors influence cognitions, feelings, and arousal, which affect appraisal and decision processes and influence aggressive or non-aggressive behavioral DISSERTATION ON DUNGEON & DRAGONS                                                               41           outcomes. These are like the factors within the cognitive-behavioral therapy (CBT) modality, where a triggering event creates a thought or feeling that influences behavior. The proximate processes serve as a learning trial that affects the development and accessibility of aggressiveness. Distal (learned) processes of GAM detail how biological and persistent environmental factors can influence personality through changes in knowledge structures. GAM is applied to understand aggression in many contexts, including media violence, domestic violence, intergroup violence, temperature effects, pain effects, and the effects of global climate change (Allen et al., 2017; Anderson & Bushman, 2020). The theory of planned behavior (Ajzen, 1991) and the general aggression model (Anderson & Bushman, 2020) are the two dominant social psychological theories applied to the study of cyberbullying perpetration to explain the variables and processes engaged in this form of antisocial behavior. Because of how cyberbullying perpetration measurement occurs, both theories analyze the distal (learned) mechanisms that outline cyberbullying perpetration, and both can provide similar predictions, albeit through various levels of processing. For example, both theories detail the importance of cyberbullying attitudes in predicting cyberbullying perpetration; however, the routes from attitudes to behavior differ. For instance, GAM posits that attitudes are one of several learned knowledge structures that form and become automatized after learning aggression schemas that form one's aggressive personality to predict (individually or interactively) aggression. In contrast, the Theory of Planned Behavior suggests that attitudes do not directly predict cyberbullying but do so indirectly through intentions (Barlett, 2019). The general criticism in applying these theories to the study of cyberbullying is that they need to adequately offer predictions unique to the online world to add efficacy and validity DISSERTATION ON DUNGEON & DRAGONS                                                               42           beyond predicting traditional bullying perpetration. That does not suggest that these theories are invalid or cannot be applied to predict cyberbullying. However, the theoretical processes relevant to both theories are different from the online world through which bullying occurs. Interventions that reduce cyberbullying use a curriculum borrowed from these theories (Barlett, 2019). One could have made the same assumption when predicting adverse outcomes from online games like D&D, as online games. The theory of planned behavior (Ajzen, 1991) looks at the intentions to perform behaviors of various kinds as being predictable with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control. These behavioral control intentions and perceptions account for considerable variance in actual behavior. Research has demonstrated that attitudes, subjective norms, and perceived behavioral control are associated with relevant sets of significant beliefs regarding behavior, norms, and control. However, the exact nature of these relations remains unclear (1991). Looking at this theory concerning D&D, one could use it to assist them in strategic planning to predict their opponents' next moves. However, this same theory could also be relevant in predicting how one could process one's trauma by creating a perfect theme storyline for the player.             The social-ecology theory from Bronfenbrenner (1977) hypothesized that shaping one's behavior might be influenced by many classes of closely interrelated structures, which he referred to as the ecological environment, which consists of the micro-system mesosystem, exo-system, macro-system, and chrono-system. Individual behavior, he concluded, is predicted by the strength and power that each system has on the person. The closer the system is to the person, the more direct and immediate influence countless variables will have on their behavior (Barlett, DISSERTATION ON DUNGEON & DRAGONS                                                               43           2019). According to Bronfenbrenner (1977), the micro-system consists of various interactions between the person and their immediate environment with specific physical and sequential features. Variables in the micro-system exist outside the individual but play an essential role in determining social behaviors. For instance, Wright (2016) proposed that micro-system variables often include parent, peer, and school factors. Experts fear that the COVID-19 pandemic created an even more significant impact on mental health post-pandemic (Parrish, 2020). Interventions to improve mood, create positive attitudes to facilitate recovery, and support conversations about mental health are some of the essential pieces of the post-post-pandemic puzzle that could play a significant role in the integrated approach to patients who are mentally and physically recovering from this virus (Franchi. 2022). These suggestions are mere surface-level ideations; as we enter the new standard post-pandemic, alternative methods and interventions that allow both the clinician's and client's safety and flourishing mental health outcomes are imperative to reduce this increasing mental ill-health need. Several studies have explored innovative alternative interventions for mental health to assist in this post-post-pandemic situation (Parrish, 2020). One of the studies looked at the positive effects of natural green space, defined as natural vegetation such as grass, plants, or trees, and built green structures such as parks, which can have restorative effects from stress relief and mood enhancement. It reported that increased physical activity promotes neighborhood social cohesion (e.g., social contact) and reduces exposure to environmental hazards such as air pollution and noise—physical activity is a tool to mediate the relationship between exposure to greenspace and mental health. Additionally, viewing nature can trigger positive emotions, relieve DISSERTATION ON DUNGEON & DRAGONS                                                               44           stress (i.e., stress reduction theory), and function as a positive distraction from the post-pandemic's dim reality, helping reduce mental fatigue and stress (Heo et al., 2021). Another study from Japan investigated the positive impact of having access to green spaces on mental health. The findings indicate significant policy implications, highlighting that nature, even within urban areas, holds enormous potential as a "nature-based solution" for enhancing mental health (Soga et al., 2020, p. 2). There is extensive evidence from disease epidemics of the past that show frontline workers are at a higher risk of developing both short- and long-term mental health effects stemming from the stressors related to the disease itself and related outliers (Pollack et al., 2020). There is also growing evidence that socioeconomic status may increase the chance of developing mental health problems (WHO, 2014). So, with these factors in mind, clinicians, as essential and frontline workers, as experts in mental health, must be aware of the effects and the potential financial challenges that face those affected by the post-pandemic. With financial challenges contributing to increased depression, including increased self-harm and suicidal ideations (Elbogen et al., 2021), finding budget-friendly alternatives to processing mental health struggles accessed from anywhere is imperative.  Alternative Interventions   Dungeons and Dragons (D&D) is an immersive fantasy role-playing game (RPG) that allows players to fulfill real-world social and mental health needs through interaction during imaginative play using characters/personas. Although much has changed since the first edition, the overall dynamics have remained faithful to the original. Players meet in small groups of three to eight individuals and work under a guiding set of rules to accomplish imaginary tasks, DISSERTATION ON DUNGEON & DRAGONS                                                               45           maneuvering throughout the game as created characters or personas. The facilitator/leader is called the Dungeon Master (DM), and it is her or his duty to create the story structure (theme), enforce rules, and describe actions. Although the DM guides the story, the theme development, and enactment depend on the players' creativity. Thus, D&D functions as a "group-related, organized, controlled, waking fantasy" where players feel safe and heard (Blackmon, 1994, p. 629).  There are many studies regarding the use of tools such as role-playing games (RPG), virtual reality (VR), and other role-play environments by which clients process post-traumatic stress disorder (PTSD) and anxiety (Kramer et al., 2010; Reger et al., 2016; Franklin et al., 2017; Mishkind et al., 2017; Rizzo & Shilling, 2017; Robitaille et al., 2017; McNamara et al., 2018; Ramirez & LaBarge, 2018; Beidel et al., 2019; Hoffman et al., 2019; Lowell & Alshammari, 2019; Rizzo et al., 2019; Sherill, 2019; Cieślik et al., 2020; Roquet, 2020; Abbott et al., 2021; DiBacco & Gaynor, 2021; Teng et al., 2021; Blake et al., 2021). In these studies, there is an evidenced-based argument for the efficacy these tools offer in a therapeutic setting, both group and individual.  Games have the potential to fulfill genuine human needs, engage learners, and unite people in unprecedented ways (McGonigal, 2011). Play therapy games are adequate for teaching children self-concept, behavioral changes, cognitive abilities, and social skills and reduce the effects of bullying and anxiety management (Bagès et al., 2020). Additional research was completed on the efficacy of avatars, video games, and board games in processing mental health struggles (Asselbergs et al., 2018).  DISSERTATION ON DUNGEON & DRAGONS                                                               46             Gaps in the research exist concerning a newer phenomenon: Dungeons and Dragons (D&D), a role-playing game played online and on a tabletop. Players use this game to process complex trauma, including cases of sexual assault, PTSD, and severe anxiety/depression (Abbott et al., 2021). This qualitative study will examine the efficacy of D&D as a therapeutic tool to process mental illness through observational studies, surveys of past and present players, and interviews. (Asselbergs et al., 2018).   Studies have explored D&D and related AT use with anxiety treatments, treatment-resistant schizophrenia patients, and other similar diagnoses (Blackmon, 1994; Beaudoin et al., 2021; Dellazizzo et al., 2021). Blackmon (1994) investigated the use of fantasy RPGs, such as D&D, to utilize with a suicidal schizoid male who was severely isolated. In the research, they used D&D as a safe guide for this young man to express his feelings and inner self safely, which was unreachable in traditional ways. He later matured into other therapeutic modalities. Even in the 1990s, practitioners recognized the therapeutic benefit of using RPG as a treatment strategy. The research delves into the theoretical foundations of this process, examining it dynamically and in terms of the biological connection and the equivalence of dreams and waking fantasies in schizoid patients. It has demonstrated the game's effectiveness in treating specific individuals with positive outcomes (Blackmon, 1994). Tabletop versions of RPGs like D&D have also proven beneficial for individuals with social anxiety (Abbott et al., 2021). Given the declining social connectedness in a post-pandemic world, the resulting health crisis characterized by increased loneliness, anxiety, and depression (Abbott et al., 2021). Participants who were introduced in a small group for safety reasons due to the post-pandemic reported that playing the tabletop version of D&D provided the social DISSERTATION ON DUNGEON & DRAGONS                                                               47           interaction they were lacking, boosted their self-confidence in social situations, and lessened their anxiety about missing critical social cues (Abbott et al., 2021). Another researcher who explored how players fulfill social needs through group communication during D&D tabletop role-plays reported that group members' real-world needs met through the symbolic in-game interactions evidenced by communicative indicators (Adams, 2013). Avatar therapy (AT) is also a similar experience to virtual D&D in that you create a persona on screen.; Rather than being the character, one utilizes the avatar inside the theme of the game and as a virtual extension of the actual player to process trauma, severe mental illness, and substance abuse and assist in treatment for some personality disorders, where trauma is at the epicenter (Garety et al., n.d.; Gordon et al., 2017; Falconer et al., 2017; Ward et al., 2020). Additionally, technological advances have allowed virtual spaces for people with trauma, and their avatars, who represent themselves in a virtual world, can meet online to process feelings and build friendships (Fong & Mar 2015). In recent years, researchers have incorporated AT into treatment for severe mental illnesses such as schizophrenia, who suffer from persecutory auditory hallucinations. The therapists in the studied scenarios encouraged the client to enter a dialogue with the avatar, which can be changed via the client's control through a game like a computer system, adjusting their perception of the auditory hallucination's influence on abuse to social engagements with the avatar (Allen, n.d.; Leff et al., 2013; Rodger, 2013; Mayor, 2017; Olivet et al., 2019; Smith, 2020; Ward et al., 2020). Avatars created for processing trauma in the D&D world as the player would control the virtual version of the person who experienced the trauma and, therefore, be able to adjust their perceptions of the trauma in a safe and virtual space.  DISSERTATION ON DUNGEON & DRAGONS                                                               48            In a study by Lucas et al., 2014, therapists used avatars to represent the human client to complete in-depth clinical interviews, where clients in the human form were apprehensive and guarded. They found that by using the avatar, clients opened and reported feeling safe to do so as an avatar rather than their authentic selves. D&D players often hypothesize to experience the same concept when using this virtual world as a safe space to process trauma (Smith, 2020; Rus-Calafell, 2021). Virtual reality (VR) dates to 1987, when Jaron Lanier coined the term. His research and engineering contributions significantly influenced the VR industry (The Franklin Institute, 2019). The idea behind VR was to create an illusion of seeming reality. It assists those involved in feeling present in an artificial environment. It was not always computer-generated imitations either. Artists from the 19th century created panoramic paintings or 360° murals. This artwork filled the entire visual field encompassed by human eyes (The Franklin Institute, 2019). More recently, VR has been used for post-traumatic stress disorder (PTSD) in active duty and combat veterans and to treat executive dysfunction (Robitaille et al., 2017; Tielman et al., 2017; Sherrill et al., 2019). In addition, researchers have also discovered that those who create and evaluate the VR scenarios gain a more profound sense of empathy for those struggling with PTSD and anxiety (Roquet, 2020). Clinical findings supported the rationale for using VR as a VR application to deliver prolonged exposure (PE) for treating active duty and combat veterans with combat- and sexual assault-related PTSD (Rizzo & Shilling, 2017). Research provides comprehensive insights into early efforts to develop virtual human agent systems. These systems serve multiple roles, including acting as virtual patients for training the next generation of clinical providers, serving DISSERTATION ON DUNGEON & DRAGONS                                                               49           as healthcare guides to support anonymous access to trauma-relevant behavioral healthcare information, and acting as clinical interviewers with the capability to perform automated behavior analysis of users to infer psychological states (Rizzo & Shilling, 2017; Rizzo et al., 2019).    Prolonged exposure (PE) is an evidence-based psychotherapy for PTSD, but there was limited research on active-duty military populations. Reger et al., 2016 compiled research around the efficacy of VR therapy with this population and discovered that PE in VR form is an efficacious treatment for active-duty Army soldiers with PTSD on active duty or from deployments to Iraq or Afghanistan. One could suggest that virtual-form PE effectively treats complex trauma such as PTSD and sexual-related PTSD. D&D is a virtual reality (world) that allows for creating any scenario to include wartime themes.  These studies only go with the need for caution. Ramirez and LaBarge (2018) advocate for the need to proceed with caution as it is an innovative technology in this discipline. As with any newer applications of treatment modalities, participants are part of a larger control group, which can continue the value of the results of previous research. Applying D&D as a virtual process tool exemplifies continuing this value. It supports a cost-effective method for complex trauma treatment and alternative treatments for other clinical applications (Mishkind et al., 2019).  Other clinical treatment modalities, which have been researched and shown to be effective in processing trauma, serve as a bridge to the efficacy of D&D as a clinical treatment technique for adults and children. Studies inclusive of expressive arts discuss the integration of expressive arts techniques within trauma-focused cognitive-behavioral therapy (TF-CBT) for DISSERTATION ON DUNGEON & DRAGONS                                                               50           child survivors of trauma. The TF-CBT approach is flexible and adaptable, making it well-suited for integrating expressive arts techniques (Wymer et al., 2020). Drama therapy, also a form of expressive art, includes sensory play, body games, sounds, stories, role-playing, and improvisation by embedding techniques within dramatic activities to process trauma in children (Walker & Wilson, 2018; Wu et al., 2020).  Psychodrama and meditation are other alternatives for processing trauma, as evidenced by a study to help students elaborate on their feelings of traumatic grief due to a car accident and the suicide of two of their classmates (Testoni et al., 2021). Self-transcendence shows a direct, positive correlation with the development of resilience. Those who can expand their boundaries in unconventional ways exhibit enhanced skills in restoring their psychological balance after experiencing traumatic or challenging events (Thomson, 2011; Testoni et al., 2021). D&D is also a vehicle to transcend and expand personal boundaries in a non-traditional manner by processing traumatic or difficult events using psychodramatic tools in person or virtually. Theorists have evaluated the idea of psychodrama in group settings. Psychodrama could assist in exposure to social engagement for those with social anxiety and feeling supported by peers, and due to the efficacy, studies have proven group modality to be. Even as early as 1969, J.L. Moreno saw the need for psychodrama in a therapeutic setting. Moreno wrote, "The human brain is the vehicle of the imagination. Psychodrama can train the imagination and overcome the differences that hinder communication between the sexes, races, generations, the sick and the healthy, people and animals, people and objects, and the living and the dead. The simple methods of psychodrama give us courage, return our lost unity with the universe, and re-establish the continuity of life" (1969). Moreno described the basic concepts of psychodrama in a DISSERTATION ON DUNGEON & DRAGONS                                                               51           therapeutic group setting as follows: 1. The warm-up, preparing for an act; 2. Spontaneity and creativity; 3. The encounter; 4. Simulation; 5. Concretization and acting out. 6. The mirror; 7. The double; 8. Sensitivity training; 9. Role-playing and role reversal; and 10. Surplus reality (1969). These basic concepts are upon which D&D gameplay, particularly virtual, is based and, therefore, according to Moreno, would be effective as a group processing trauma.  With PTSD being one of the results of complex trauma, we as clinicians also need to address the precursor to PTSD, known as acute stress. We cannot officially diagnose someone with PTSD without six months of observing the presenting symptoms (DSM IV, 2000). Therefore, acute stress serves as a placeholder for the ability to treat and observe the client while ascertaining their PTSD symptomology. Hospitalization frequently occurs because symptoms significantly affect individuals' daily functioning. Psychodrama group therapy has been crucial in treating acute stress and reducing feelings of loneliness and distress among psychiatric inpatients (Ron, 2018). This approach follows a broader trend of psychodrama practitioners and specialists in the mental health field who prefer a more holistic, experience-based approach as an alternative to the labeling language of psychology (Ron, 2018). A preliminary look at the makeup of D&D players also shows that those who experienced trauma are socially limited and use the platform to engage in a safe space (Abbott et al., 2021). Doing this in a group modality allows patients/clients to learn other social skills they can transfer back into daily functioning, which has been negatively affected by trauma.  Art therapy is an evidence-based therapeutic strategy that has demonstrated its benefits in trauma treatment. Therapeutic doll-making serves various functions for clients in therapy, DISSERTATION ON DUNGEON & DRAGONS                                                               52           particularly for those addressing complex trauma histories. Recent literature on treating complex trauma suggests that talking treatments have limitations, necessitating supplementary therapeutic approaches emphasizing holistic and body-oriented processes. These approaches encompass art therapy and various expressive modalities, including doll-making (Stace, 2014). Extensive literature describes how doll-making can be a valuable tool for facilitating the processing of complex trauma. Using prefabricated dolls has aided adolescents and adults in this process. This same approach can be virtually adapted or through immersion in role-playing games like D&D. Another dress-up type technique used in processing trauma is cosplay. Cosplay, a combination of "costume play," is an activity and performance art in which cosplayers wear costumes and fashion accessories to represent a specific character. Cosplayers often interact to create a subculture, like the themed playgroups in D&D. A broader use of "cosplay" applies to any costumed role-playing in venues apart from the stage. My favorite sources include anime, cartoons, comic books, manga, television series, and video games (Gn, 2011; Birkedal, 2019). The cosplayer can express and experience behaviors and emotions ordinarily unavailable in their "real-life" scenarios. These enable a radical, empathetic form of identity exploration, wherein the cosplayer can express and develop an understanding of their own and others' experiences through characterization (Birkedal, 2019), much like D&D experience. Some theorists argue that this engagement makes participants more vulnerable to pathological dissociation. However, others would employ participants who would experience less dissociative strategies, which is an area to address in observation and self-reporting measures (Thomson, 2011). As mentioned previously, cosplay characters can be developed from comic books and therefore prompted research into the comic book realm to discern whether comic books, also DISSERTATION ON DUNGEON & DRAGONS                                                               53           known as graphic novels, were developed by the creators as their means to process some trauma. In the Uncanny X-men #236, titled 'Busting Loose,' the primary female character Carol Danvers, also known as Ms. Marvel, is raped. The creator and author, Chris Claremont, has post-traumatic dissociation followed by reclamation of power, supportive community, and disclosure, allowing the Carol character to redress address the problematic historical removal of trauma from superhero narratives that deal with sexual violence. Within this framework, Carol could achieve disassociation from her traumatized self, confront her trauma, and regain inner peace, facilitating her return to her "real-world" persona (Deman, 2020, p. 412). Researchers have also proposed these interventions as practical within a D&D game context. The players disconnect from the trauma and find healing by confronting it through a character based on themselves.  Trauma affects every aspect of our daily functioning and the role of emotion and trauma in international politics and leads to the interdisciplinary nature of work (Auchter, 2019). Like cosplay and psychodrama techniques, narrative storytelling provides narration of trauma (Auchter, 2019). The ability to narrate the words, first on paper and then aloud, has been shown as a positive way for trauma survivors to share their experiences while coping healthily. Communities are a "feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals" (Merriam-Webster, 2020, n.d.). With this definition in mind, trauma survivors who come together for narrative healing can be considered a community without much societal resistance. Like cosplay and psychodrama techniques, narrative storytelling provides narration of trauma (Auchter, 2019). The ability to narrate the words, first on paper and then aloud, has been shown as a positive way for trauma survivors to share their experiences while coping healthily. DISSERTATION ON DUNGEON & DRAGONS                                                               54           Trauma affects every aspect of our daily functioning and the role of emotion and trauma in international politics and leads to the interdisciplinary nature of work (Auchter, 2019). Communities are "feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals" (Merriam-Webster, 2020, para b). With this definition in mind, trauma survivors who come together for narrative healing can be considered a community without much societal resistance. Researchers surmise that storytelling is a lost art and needs reincarnation in trauma survivor communities. Storytelling has been used for centuries in many parts of the world to pass on cultural knowledge and, therefore, today, can be used to create a space based on truth to engage with peers and share and heal (Auchter, 2019). Similarly, one could stretch this further and identify a community of trauma survivors who join an RPG such as D&D, where they narrate through created characters/personas to share and communally process their trauma. This approach is equally practical for children who do not know how to verbalize their trauma and can provide a way to express their feelings using safe characters (Mendoza & Bradley, 2021).   There are gaps in the research with regards to a newer phenomenon, which includes the use of Dungeons and Dragons (D&D), a role-playing game played both online and tabletop, which recently has been used to process complex trauma such as sexual assault, PTSD, and severe anxiety/depression (Abbott et al., 2021). Community storytelling is a therapeutic way to bridge this divide (Mamon et al., 2017). Narrative storytelling has had significant implications on the Veterans' perceptions of their recovery and the civilian community, providing a place for both these communities to join and bridge the gap created by PTSD and combat trauma. Another community addressed previously is veterans, who, through no fault of their own, feel a DISSERTATION ON DUNGEON & DRAGONS                                                               55           disconnect between themselves and the civilian population based solely on their combat experiences. These same individuals could benefit from RPGs like D&D, as other research has shown success overall in VR settings (Tielman et al., 2017). This qualitative study will examine the efficacy of D&D as a therapeutic tool to process mental illness through observational studies, surveys of past and present players, and interviews. (Asselbergs et al., 2018). All the above research promotes a space for the adaptations of the current techniques to be used within the parameters of D&D as a formidable technique for the processing of complex trauma using character/personas as versions of the players to provide a safe space to engage, connect, build community, create a narrative, and bridge gaps in research. Research has shown that role-playing and game-like techniques have been influential in the processing and healing of survivors of complex trauma and other mental illnesses such as schizophrenia and anxiety/depression. Research also looks explicitly at D &D as a therapeutic technique for anxiety. Current literature avoids discussing the efficacy of D &D with more complex issues such as post-traumatic stress disorder (PTSD) and sexual trauma. The plethora of research mentioned above provides a solid foundation by which there is evidence of D&D personas being an effective method to process complex trauma. This research will grant those in the mental health field a more in-depth look at the availability and efficacy of D&D for processing and treating complex traumas. The meso-system includes variables that modify the social structures that are imperative for the micro-system, and, as Bronfenbrenner (1977) noted, the meso-system consists of a plethora of other micro-system interactions. In other words, the mesosystem would include statistical-based interactions between peers, parents, teachers, and other influences on DISSERTATION ON DUNGEON & DRAGONS                                                               56           maladaptive behaviors (such as bullying, cyberbullying, and school shootings). Other influential social structures inside the micro-system interactions exist in the eco-system, and, per Bronfenbrenner (1977), the types of social structures at this level of analysis include mass media and various laws and policies. Bronfenbrenner (1977) argues that the macro-system differs from the previous levels of analysis in that the variables that fit into the macro-system represent cultural beliefs recognized across various institutions and entities. In other words, cultural beliefs surpass parenting, peer and teacher interactions, and mass media and laws. From a social-psychological point of view, researchers have often classified cultures as independent or interdependent (Barlett, 2019). The first defined culture focuses on the self, whereas the alternative focuses on the collective group. Finally, the chrono-system addresses temporal changes that influence the other variables in each other system (Wright, 2016). As it pertains to maladaptive behavior perpetration, access to technology, access to the Internet, the cost of a home computer or cellular phone, et cetera, have all changed over time, becoming more accessible. Massive changes within other societal-level changes predicted by the chrono-system have pronounced impacted the other systems within the social-ecological theory (Barlett, 2019). Looking at D&D as a part of the micro-system, one may hypothesize that the other influential social structures inside the micro-system interactions exist in the eco-system and, per Bronfenbrenner (1977), the types of social structures at this level of analysis include mass media and various laws and policies. Therefore, influence (adaptive and maladaptive) in the D&D world could be substantial in the form of the game's rules and player policies as the game is resurfacing in popularity due to the influence of mass media in shows such as Stranger Things (2016). DISSERTATION ON DUNGEON & DRAGONS                                                               57           According to the GAM, based on how individuals experience their environments and move through their life experiences, they develop different scripts and knowledge structures. Scripts allow individuals to organize information about proper behavior in certain situations. For example, a restaurant script may include ordering from a menu, waiting for food to come to the table, and paying after a meal (DeWall & Anderson, 2011; Pedersen & Miller, 2004; Wiedeman et al., 2015). Script behavior can also be proper in how a DM creates a script within the game of D&D to create a safe space for characters created by players to process complex trauma. The D&D script may include information about the players in the trauma of the scene, how they wish to process it (writing a no-send letter, screaming in an empty field, breaking objects, killing another character who represents the trauma), waiting for the scene to happen, complete the scene, and debrief. These scripts and knowledge structures impact an individual's perceptions of the world. (Anderson & Bushman, 2002; DeWall & Anderson, 2011). In any scenario, an individual's characteristics, environment, and the scripts or life lessons they have acquired influence their current behavior: this interaction and subsequent internal state impact how the individual responds to the current situation. A response may be thoughtful, critical, impulsive, and maladaptive (DeWall & Anderson, 2011; Miller, 2004). Using established scripts and knowledge structures may become automatic responses associated with an individual's mood (Anderson & Bushman, 2002). This experience and situation will continue influencing future knowledge (life lessons), interactions, perceptions, and decisions (Wiedeman et al., 2015). Researchers found that children were more likely to be hostile after viewing media violence, demonstrating behaviors such as hitting and punching and how DISSERTATION ON DUNGEON & DRAGONS                                                               58           situational inputs (aggressive shows, games, environmental violence) affect an individual's response and internal state (Bushman & Anderson, 2001). There has long been concern surrounding the effects of media influences, such as violence in television or film, and video games have increased aggressive behavior in individuals who watch those programs. Some studies support these concerns in children through longitudinal data (Huesmann et al., 2003). On the contrary, another study (Krahé et al., 2011) examined the links between desensitization to violent media stimuli and habitual media violence exposure as a predictor and aggressive cognitions and behavior as outcome variables. The researchers in the study by Krahé et al. (2011) found no connections between habitual media violence viewing and arousal in response to sad and funny film clips. Furthermore, arousal triggered by the sad and funny clips did not serve as a predictor for aggressive cognitions or aggressive behavior in the laboratory task. It is essential to differentiate between aggression, aggressive behavior, and violence (Liu, 2004). They define aggression as the visible manifestation of anger intended to cause harm or pain. Aggressive behavior and violence are not the same, nor are they interchangeable. Violence is a form of physical assault, whereas aggressive behavior is a broader concept that includes physical, verbal, psychological, and other means of causing harm, i.e., violence is but one form of aggressive behavior (2004). Aggressive behavior does not always present a physical component. This critical distinction is vital because, although understanding aggressive behavior as a gateway to violence is informative, non-violent aggressive behavior can still lead to adverse outcomes and needs equal attention (2004). DISSERTATION ON DUNGEON & DRAGONS                                                               59           Numerous theories have postulated explanations for the emergence of aggressive behavior in childhood, seeking to account for such behavior in adolescents and adults. The social learning theory suggests that individuals acquire aggressive behavior by observing the actions of others. This theory may provide insight into aggressive behavior in children and various age groups. By observing aggressive behavior and its effect on obtaining a potential reward, an individual may use similar behavior when confronted with a similar problem in young children, supported by evidence that children who experience familial violence are often linked to displays of aggressive behavior by children within that family dynamic and beyond (Herrera & McCloskey, 2003). Another model, the social information processing (SIP) theory, suggests that people develop aggressive behavior after repeated exposure to specific social stimuli. For example, continual aggression may occur after a reward following aggressive behavior, such as a toddler tantrum for candy and receiving candy to stop the behavior (Liu, 2004). There is no absolute certainty that violent video games equal violent children/adults. The point is that many models are about aggression and how it links to violent media and environmental stimuli. These models have been proven and disproven over the years. D&D is a game involving much violence. However, no studies are tying D&D to violent behavior from its players.  History of Dungeons and Dragons Dungeons and Dragons (D&D) is a role-playing game created in the 1970s by Gary Gygax and Dave Arneson (Appendix A & B). It began as a tabletop game where players could DISSERTATION ON DUNGEON & DRAGONS                                                               60           create their characters and backstories. These players could be anything from an elf to a sorcerer. It is a collaborative game that occurs over many sessions, also called campaigns, which explores fantasy worlds with the help of the "all-knowing "narrator, the Dungeon Master (DM). The DM creates puzzles, battles, themes, and adventures for the players. Gygax reported he created the game for those who had not found their place in this world, which he identified. "You have to start there with knowledgeable people, but people who also feel like they are not part of the fabric [of America] and maybe are not going anywhere" (Riggs, 2022, pp. 10-11). Gygax and Arenson were considered social outcasts; in fact, the creation of D&D came after Gygax lost his job, yet another experience where he felt discarded. Before the creation of D&D, Gygax was into war reenactment games and created a game called Chainmail (Appendix C), which never became popularized. This game failure created his headspace to create the D&D game, along with inspiration from the book Conan the Barbarian (Howard, 1932). Gygax and Arenson met at a convention in 1969, and Arenson was a fan of the war-themed game Chainmail, which prompted him to explore a similar game rich in fantasy. Gygax and Arenson's collaboration began with dungeon-riddled castle Blackmoor (Appendix D) in 1971.  Gygax spent the next few months expanding the information shared by Arneson into a D&D prototype (Appendix E). As he prepared the game for publication, Gygax assessed it on his children. According to Gygax's son Ernie, however, the initial run-through "took place after school on a weekday, and it was two boys and one girl exploring a scorpion nest" and fighting a band of reptilian humanoids known as kobolds (Appendix F) (Riggs, 2022, p. 13). Upon completing the initial manuscript, Gygax and Arenson encountered challenges finding a publisher who shared and understood their vision. In 1973, Gygax collaborated with fellow self-DISSERTATION ON DUNGEON & DRAGONS                                                               61           proclaimed geek Don Kaye to establish Tactical Studies Rules (TSR) (Appendix G), along with investor Brian Blume. TSR ran an initial 1,000 copies of D&D, assembling them in Gygax's basement. The game went on sale in a mail-order format in January 1974. The game began to gain momentum by 1975, with the third edition selling out in months versus the first edition taking a year (Appendix H & I). Sadly, the bond that created the friendship of Gygax and Arenson soon became animosity, and a long-standing feud replaced the friendship. Arenson and Gygax never repaired the relationship, and Arenson attempted to steal D&D from Gygax, even taking him to court. Gygax prevailed, as Arenson was not a dependable partner for the court. Arenson died in 2009, and Gygax in 2010 (Riggs, 2022). He changed immensely in the initial years of TSR prior to Gygax's death. He became a millionaire, abandoned his faith as a devout Jehovah's Witness, separated from his wife, moved from Illinois to California, and lived alcohol, womanizing, and mansion living (Riggs, 2022). In the late 1970s and early 1980s, D&D created a moral panic in the church community. The religious leaders claimed that the game badly influenced youth and taught them devil worship—the controversy initiated by the disappearance of 16-year-old James Dallas Egbert III in August 1979. A student at Michigan State University with a history of depression and an affinity for role-playing games, Egbert left behind a suicide note before disappearing. The detective investigating the case's theory was that Egbert had entered the school's underground steam tunnels as part of a D&D game. However, Egbert disputed this explanation when he reappeared a month later, his subsequent suicide in August 1980, and the detective's continued claims of a connection. The game was also to blame for a Virginia high school student's 1982 suicide and DISSERTATION ON DUNGEON & DRAGONS                                                               62           the 1984 murder of a Missouri teenager by two D&D-playing peers (Riggs, 2022). Researchers have continuously debunked the false connection between D&D and violence, and the game's rebirth began with Clyde Haberman's New York Times article in 2016. TSR began to experience financial hardship from the religious crusade and had to lay off most of its workforce. In 1984, Gygax hired Lorraine Williams, whose family owned the Buck Rogers comic character copyright, to help steer TSR, Inc. back to prosperity. The two had a falling out, but Williams liked the company and its staff, so she completed a secret buy-out of TSR's partners. In an unexpected board meeting on October 22, 1985, TSR's board voted Gygax out as president and CEO and replaced him with Williams. In turn, she served as the leader of TSR until 1997, when Wizards of the Coast (WOC), the company behind Magic: The Gathering, acquired it (Riggs, 2022). Under William's leadership, D&D expanded to novels based on the rulebooks to continue to gain profit and buy-in from players after the game book was purchased. Because of the success of the novel department, all the artists, designers, editors, illustrators, and cartographers feared for their job security. These things did not happen when WOC acquired D&D. They expanded the franchise to five editions of the game spanning five decades and counting.  Characters of Dungeons and Dragons   Within the game of D&D, there are races and classes. However, the language is now removing the word race and replacing it with species to be more culturally sensitive to fantasy and real-world implications (Wizards of the Coast, 2020). It is essential to understand all levels of the game itself to have the capacity to see it in a therapeutic light as an intervention.   DISSERTATION ON DUNGEON & DRAGONS                                                               63           Classes Classes are often chosen first in creating characters, then species are adopted. In looking at the classes, one also would consider their specific classifications; these are listed along with the identity of the various classes of the basic rules of the D&D game, as there are now additional additions to them based on campaigns. However, for the sake of this research, the basic rules of D&D will be outlined. It is also essential to understand that this list does not include the plethora of sub-classes derived from these base classes. 1. Barbarians are fierce warriors who can enter battle with rage (Appendix J). 1. Armor: Light armor, medium armor, shields 2. Weapons: Simple weapons, martial weapons 3. Tools: None 4. Saving Throws: Strength, Constitution 5. Skills: Choose two from Animal Handling: Athletics, Intimidation, Nature, Perception, and Survival. 2. Bards are inspiring and charismatic magicians whose power is that of musical creation (Appendix K).  1. Armor: Light armor 2. Weapons: Simple weapons, hand crossbows, longswords, rapiers, shortswords 3. Tools: Three musical instruments of the player's choice DISSERTATION ON DUNGEON & DRAGONS                                                               64           4. Saving Throws: Dexterity, Charisma 5. Skills: Choose any three 3. Clerics are priestly champions who possess divine magical healing powers in service of a higher power (Appendix L).      1. Armor: Light armor, medium armor, shields 2. Weapons: Simple weapons 3. Tools: None 4. Saving Throws: Wisdom, Charisma 5. Skills: Choose two from History, Insight, Medicine, Persuasion, and Religion. 4. Druids are priests of the Old Faith who have the powers of nature and adopt animal forms (Appendix M). 1. Armor: Light armor, medium armor, shields (druids will not wear armor or use shields made of metal) 2. Weapons: Clubs, daggers, darts, javelins, maces, quarterstaffs, scimitars, sickles, slings, spears 3. Tools: Herbalism kit 4. Saving Throws: Intelligence, Wisdom 5. Skills: Choose two from Arcana: Animal Handling, Insight, Medicine, Nature, Perception, Religion, and Survival. DISSERTATION ON DUNGEON & DRAGONS                                                               65           5. Fighters are masters of martial arts and are skilled in multiple weapons and armor (Appendix N).  1. Armor: All armor, shields 2. Weapons: Simple weapons, martial weapons 3. Tools: None 4. Saving Throws: Strength, Constitution 5. Skills: Choose two skills from Acrobatics, Animal Handling, Athletics, History, Insight, Intimidation, Perception, and Survival. 6. Monks are masters of the martial arts, harnessing their powerful bodies in pursuit of physical and spiritual perfection (Appendix O).  1. Armor: None 2. Weapons: Simple weapons, shortswords 3. Tools: Choose one type of artisan's tools or one musical instrument 4. Saving Throws: Strength, Dexterity 5. Skills: Choose two from Acrobatics, Athletics, History, Insight, Religion, and Stealth. 7. Paladins are holy warriors bound by a secret oath (Appendix P).  1. Armor: All armor, shields DISSERTATION ON DUNGEON & DRAGONS                                                               66           2. Weapons: Simple weapons, martial weapons 3. Tools: None 4. Saving Throws: Wisdom, Charisma 5. Skills: Choose two from Athletics, Insight, Intimidation, Medicine, Persuasion, and Religion. 8. Rangers are those who combat threats towards the edges of civilizations (Appendix Q). 1. Armor: Light armor, medium armor, shields 2. Weapons: Simple weapons, martial weapons 3. Tools: None 4. Saving Throws: Strength, Dexterity 5. Skills: Choose three from Animal Handling, Athletics, Insight, Investigation, Nature, Perception, Stealth, and Survival. 9. Rogues are scoundrels who use stealth and trickery to overcome presented obstacles and their enemies (Appendix R).  1. Armor: Light armor 2. Weapons: Simple weapons, hand crossbows, longswords, rapiers, shortswords 3. Tools: Thieves' tools 4. Saving Throws: Dexterity, Intelligence DISSERTATION ON DUNGEON & DRAGONS                                                               67           5. Skills: Choose four from Acrobatics, Athletics, Deception, Insight, Intimidation, Investigation, Perception, Performance, Persuasion, Sleight of Hand, and Stealth. 10. The sorcerer is a spellcaster who draws on its inherited magic from gifts or bloodlines (Appendix S).  1. Armor: None 2. Weapons: Daggers, darts, slings, quarterstaffs, light crossbows 3. Tools: None 4. Saving Throws: Constitution, Charisma 5. Skills: Choose two from Arcana: Deception, Insight, Intimidation, Persuasion, and Religion. 11. Warlocks are the wielders of magic from a bargain made by an extraplanar entity (Appendix T). 1. Armor: Light armor 2. Weapons: Simple weapons 3. Tools: None 4. Saving Throws: Wisdom, Charisma 5. Skills: Choose two skills from Arcana: Deception, History, Intimidation, Investigation, Nature, and Religion.  DISSERTATION ON DUNGEON & DRAGONS                                                               68           12. Wizards have scholarly magic and can manipulate the structures of reality (Appendix U).  1. Armor: None 2. Weapons: Daggers, darts, slings, quarterstaffs, light crossbows 3. Tools: None 4. Saving Throws: Intelligence, Wisdom 5. Skills: Choose two from Arcana: History, Insight, Investigation, Medicine, and Religion. Species (formerly called Races) Each species has racial traits that one must know when adopting or creating a character so the character can meet the player's specific need/goal within the game. The following will describe the species and their specific racial traits in depth. 1. Humans (Appendix V) are the youngest of the standard races, late to arrive on the world scene, and short-lived compared to dwarves, elves, and dragons. Whatever drives them, humans are the innovators, the achievers, and the pioneers of the world—racial traits: +1 to all ability scores and extra language. 2. Dragonborns (Appendix W) look like dragons but stand erect like humans and lack the wings or tails of dragons—racial traits: +2 Strength, +1 charisma, draconic ancestry, breath weapon, and damage resistance. DISSERTATION ON DUNGEON & DRAGONS                                                               69           3. Dwarves (Appendix X) are bold, hardy, skilled warriors, miners, and stone and metal workers—racial traits: +2 Constitution, dark vision, dwarven resilience, dwarven combat training, and stonecutting. 4. Elves (Appendix Y) are magical people with otherworldly grace, living in the world but not entirely a part of it—racial traits: +2 dexterity, dark vision, keen senses, fey ancestry, and trance. 5. Gnomes (Appendix Z) are full of energy and enthusiasm for life, shining through their tiny bodies—racial trait: +2 intelligence, dark vision, and cunning. 6. Half-Elf (Appendix AA) are combinations of the best qualities of elves and humans. The racial traits are charisma, +1 to two other ability scores, dark vision, fey ancestry, and skill versatility.  7. Halflings (Appendix BB) survive the world of more giant creatures by avoiding notice or offense—racial traits: +2 dexterity, luck, bravery, and halfling nimbleness. 8. Half-Orc (Appendix CC) are proud leaders of the orc community. They may venture into the world to prove their worth. They often become adventurers, achieve greatness, or do mighty deeds. Racial traits are +2 strength, +1 constitution, dark vision, menacing, relentless endurance, and savage attacks. 9. Tieflings (Appendix DD) are greeted with stares or whispers, suffer violence in public, are mistrusted by most, and are mistreated in society—racial traits: +2 charisma, +1 intelligence, dark vision, hellish resistance, and infernal legacy.  DISSERTATION ON DUNGEON & DRAGONS                                                               70           Basic Rules The Basic Rules (Appendix EE) run from levels 1 to 20 and cover the cleric, fighter, rogue, and wizard, presenting what we view as the essential subclass for each. It also provides the dwarf, elf, halfling, and human as race options; in addition, the rules contain 120 spells, five backgrounds, and character sheets. But the best part? The Basic Rules is a free PDF. Anyone can download it from our website. We want to put D&D in as many hands as possible, and a free digital file is the best way to do that. The Basic Rules document has four parts: • Part 1 is about creating a character, providing the rules and guidance you need to make the character you will play in the game. It includes information on the various races, classes, backgrounds, equipment, and other customization options players can choose. Many rules in part 1 rely on material in parts 2 and 3. • Part 2 details the rules for playing the game beyond the basics described in this introduction. This part covers the kinds of die rolls players make to determine success or failure at the tasks the player's character attempts and describes the three broad categories of activity: exploration, interaction, and combat. • Part 3 is all about magic. It covers the nature of magic in the worlds of D&D, the rules for spellcasting, and a selection of typical spells available to magic-using characters (and monsters) in the game. DISSERTATION ON DUNGEON & DRAGONS                                                               71           • Part 4 is about tools for Dungeon Masters. It includes information and stat blocks for monsters, advice for building combat encounters, and magic items" (D&D.wizards.com/what-is-D&D/basic-rules, 2018). Dungeon Master (DM) The Dungeon Master plays a vital role in the D&D table. Although players will bring their characters to the game, the DM will provide everything else. In simple terms, the primary responsibilities of the DM are to narrate the adventure, control the monsters during combat, role-play any nonplayer characters (NPCs) that the players' characters may encounter, and help move the story (campaign). What is an NPC? Non-Playing Characters (NPCs) refer to any characters in the story(campaign) that the players do not portray. Including any random character players may encounter that helps their game. An excellent selection of NPCs is a significant first step to enhancing the player's fantasy world. Keeping notes about them and having a few ready for players to encounter is about strategy. The Dice            A Dungeons and Dragons dice set made up of seven dice. There is the 20-sided die, or D20; the 12-sided die, or D12; the 10-sided die, or D10; the 8-sided die, or D8; the six-sided die, or D6 and the 4-sided die or D4. Most sets will include two D10s for percentage rolls.  DISSERTATION ON DUNGEON & DRAGONS                                                               72           The D20 The D20 (Appendix FF) is essential to D&D gameplay. It is the most used die in the game. It determines who strikes first and how accurate their strike is. For example, a player encounters an evil living tree that blocks their path. The player then rolls a 15 on the D20. The Dungeon Master (DM) rolls on behalf of the evil tree as an NPC and gets a 13. In this case, the player has the initiative and strikes first. The living tree's tough bark gives it an armor class of 14. To damage it, the player must roll a 14 or higher on the D20 to do any damage to the tree. There are simplified explanations and many other contributing factors which come into play. For instance, a player might have a magical sword that adds +1 to their attack roll. Therefore, a player must roll a 13 or higher to hit the tree. Once the player hits the opponent, the player still needs to determine the extent of damage done, which is when the other dice come into play. The D12 The D12 die determines battle damage. Players and monsters in Dungeons and Dragons only have so many hit points or "life points.” The player or the monster is dead when the hit points go to zero. If the player can hit the enemy as determined by the D20, then the player finds out how much damage happened. Some of the most significant weapons (and some spells) make 1 to 12 points of damage determined by the D12. Players roll and get an 8. The orc players were fighting and only had five hit points left. That orc is now dead! The D10 Much like the D12, the D10 is primarily used to determine damage from specific weapons or spells. Additionally, players can use two D10s when the Dungeon Master determines DISSERTATION ON DUNGEON & DRAGONS                                                               73           that something has a percentage chance of succeeding. Usually, in a set, the two D10s will be assorted colors. Players will determine the color of the first number and the second. For instance, a player makes the green die first, and the blue die second. The player rolls: green is a six, and blue is a four. The player just rolled a 64 or a 64%. The player must come to a very narrow stone bridge in the game. The player is wearing heavy armor, but the player decides to try to cross the bridge. Factoring in other aspects of the player's attributes, the DM determines the player has a 34% chance of falling off the bridge while crossing. As the player begins to cross, they roll. Roll a thirty-four or above, and the player safely crosses the bridge. Roll thirty-three or lower, the player falls into that raging river below. Other dice rolls and skill sets will determine whether the player drowns. The D8 Like the D12 and D10, the D8 is used for determining damage done. The damage factor assigned to weapons that can be wielded in one hand, which means the other hand is free to use a shield. Carrying a sword and shield is a popular choice for the warrior classes especially, and they tend to move toward weapons that can do the most damage while still allowing added shield protection. Those weapons often cause 1 to 8 points of damage, requiring the D8. The D6 The D6 will be most familiar to people. It is shaped exactly like the dice used for many other games. However, a D6 in Dungeons and Dragons, like all other D&D dice, uses traditional numbers rather than the dots seen on conventional game-playing dice. Like the others mentioned, the D6 determines the damage of spells and weapons. DISSERTATION ON DUNGEON & DRAGONS                                                               74           The D4 The D4 determines damage for the most miniature weapons found in Dungeons and Dragons. It is one of the more unique dice available because it has several numbers on each side. When rolling a D4, the result is by the number along the die's bottom edge. Turning the die, players will see the number on all three sides. It will also be the only number that appears right-side up rather than at an angle. The player only needs to look at one side of the four-sided die to determine the numerical outcome, as that number will be the same on the other two sides (Appendix GG). (D&Dbeyond.com/Dice, n.d.). Session Zero Session Zero allows players and DMs to get on the same page before a campaign begins. D&D works best when everyone at the table agrees on the kind of story players all want to tell. It also allows for a space to identify any potential triggers for players and a place to choose whether they can participate in the storyline or can create a character specific to facing the trigger.  Homebrew A homebrew campaign is a complete adventuring module that a Dungeon Master (DM) would put together for a party of players and their characters. It is a dungeon crawl, a type of scenario in fantasy role-playing games in which heroes navigate a labyrinth environment (a "dungeon"), battling various monsters, avoiding traps, solving puzzles, and looting any treasure they may find (D&Dbeyond.com, 2022, para 3), and rescue, or the acquisition of a precious DISSERTATION ON DUNGEON & DRAGONS                                                               75           artifact, set within an official D&D module or in yet another homebrew that the DM has crafted using similar resources (D&Dbeyond/homebrew.com, n.d.). Weapons The payer's class determines which weapon they are naturally proficient in using. Proficiency in using a weapon is the difference between life and death. Each weapon falls into melee and ranged categories. A melee weapon attacks a target within five feet of a player, whereas a ranged weapon attacks a target at a distance (https://www.D&Dbeyond.com/sources/basic-rules/equipment#Weapons, n.d.). Summary            The review of the literature section delves into the current state of research and knowledge regarding the use of alternative interventions, including Dungeons and Dragons (D&D), in the context of mental health support and trauma processing. It explores existing studies and highlights the therapeutic potential of such interventions. The post-pandemic scenario, particularly in the context of COVID-19, has emphasized the pressing need for effective mental health interventions. Researchers have noted that the pandemic's aftermath has significantly impacted mental health, making exploring novel approaches to address the increasing mental health challenges imperative. Several studies have investigated alternative methods and interventions to promote mental well-being (Parrish, 2020; Franchi, 2022). For example, research has examined the positive effects of natural green spaces and their role in stress reduction, mood enhancement, and social cohesion (Heo et al., 2021). DISSERTATION ON DUNGEON & DRAGONS                                                               76           Such studies have suggested that exposure to nature can be a valuable tool for improving mental health, even in urban settings (Soga et al., 2020). Frontline workers, including clinicians, are at higher risk of experiencing mental health issues, often linked to the stressors related to their work (Pollack et al., 2020). Socioeconomic status also plays a significant role in determining mental health outcomes (WHO, 2014). Given these challenges, it is crucial for clinicians to be aware of the potential mental health implications for those affected by the post-pandemic, especially concerning financial difficulties contributing to depression and self-harm (Elbogen et al., 2021). The literature suggests alternative interventions can provide accessible and cost-effective ways to address mental health struggles. In recent years, studies have explored the use of role-playing games (RPGs) and virtual reality (VR) in processing post-traumatic stress disorder (PTSD) and anxiety (Kramer et al., 2010; Reger et al., 2016; Franklin et al., 2017; Rizzo & Shilling, 2017). These studies present evidence of the effectiveness of these tools in therapeutic settings, both in group and individual contexts (Beidel et al., 2019). Furthermore, games, such as D&D, have the potential to fulfill essential human needs, engage learners, and foster social connections (McGonigal, 2011). Play therapy games have effectively taught children self-concept, behavioral changes, cognitive abilities, and social skills while reducing the effects of bullying and managing anxiety (Bagès et al., 2020). However, a gap in research exists concerning the use of D&D in processing complex trauma, such as sexual assault, PTSD, and severe anxiety/depression (Abbott et al., 2021). DISSERTATION ON DUNGEON & DRAGONS                                                               77           The literature indicates that virtual and tabletop RPGs, like D&D, have shown promise in aiding individuals with social anxiety (Abbott et al., 2021). Particularly, when social connectedness has decreased due to factors like the post-pandemic, playing D&D has been shown to provide social interaction and boost self-confidence, thus lessening anxiety (Abbott et al., 2021; Adams, 2013). This research supports using RPGs to process trauma and build social skills. Similar experiences to D&D include avatar therapy (AT), which allows individuals to create and control avatars in a virtual world for trauma processing (Garety et al., n.d.; Gordon et al., 2017). These avatars represent individuals and help them confront their trauma in a safe and virtual space (Lucas et al., 2014). AT has shown efficacy in treating severe mental illnesses like schizophrenia, offering a virtual space for processing trauma and building resilience (Ward et al., 2020). VR therapy has also effectively treated PTSD in veterans (Rizzo & Shilling, 2017). Narrative storytelling explores share and process trauma (Auchter, 2019). Storytelling allows trauma survivors to narrate their experiences and find healing in shared narratives. Similarly, communities of trauma survivors who engage in RPGs, such as D&D, can find a supportive environment to process their trauma (Mendoza & Bradley, 2021). This literature review sets the stage for the present research, which aims to examine the efficacy of D&D as a therapeutic tool for processing mental illness and trauma. The existing literature provides a solid foundation for exploring the potential benefits of using alternative interventions like D&D to address mental health challenges and complex trauma. It is evident that these interventions offer valuable ways to support individuals in their journey toward healing and well-being. DISSERTATION ON DUNGEON & DRAGONS                                                               78           Chapter Three: Methods Overview  Chapter Three is a crucial component of this research study, aiming to provide a comprehensive and detailed account of the research procedures, design, and analysis. This chapter is structured into several subsections to facilitate a thorough understanding of the research process. This research explores the necessity and effectiveness of alternative role-playing interventions, explicitly focusing on Dungeons and Dragons (D&D) as a safe method for processing complex trauma. Given the substantial increase in mental health diagnoses attributed to post-pandemic circumstances, such as poverty, unemployment, heightened isolation, loss of social skills, and greater exposure to traumatic environments, it has become essential to investigate innovative interventions to address the evolving needs of clients and clinicians. The key subsections within Chapter Three include design, research question, setting, participants, procedures, researcher's role, data collection, data analysis, trustworthiness, transferability, ethical considerations, and summary. Chapter 3 of this qualitative case study dissertation focuses on the methodology and research framework employed to explore the efficacy of alternative role-playing interventions, particularly Dungeons and Dragons (D&D), to process complex trauma safely.  By presenting this detailed overview in Chapter Three, this research seeks to facilitate a thorough understanding of the research process and to ensure that the study's execution is both transparent and replicable. The research design and methodologies are selected with the aim of addressing the critical need for alternative interventions in a rapidly changing world with evolving mental health challenges. By presenting this detailed overview in Chapter Three, this DISSERTATION ON DUNGEON & DRAGONS                                                               79           research seeks to facilitate a thorough understanding of the research process and to ensure that the study's execution is both transparent and replicable. We select the research design and methodologies to address the critical need for alternative interventions in a rapidly changing world with evolving mental health challenges. Design            This study will utilize a multiple-case study design. Case studies are "a strategy of inquiry in which the researcher explores a program, event, activity, process, or one or more individuals in depth is an exploration of a 'bounded system' of a case or multiple cases over time through detail, in-depth data collection involving multiple sources of information-rich in context" (Creswell, 2013, p. 13). Stake (1995) explains that researchers investigate case studies because they are interested in their uniqueness and commonality. The researcher wants to hear the subject's stories and open honest conversations about questions both sides may have. The researcher will have the opportunity to see how the participants function in their ordinary pursuits and milieus and with a willingness to put aside any preconceived notions while we learn. "The multiple case study design or collective case study investigates several cases to gain insight into a central phenomenon" (Creswell, 2013; Stake, 2006; Yin, 2003).  Research Questions  The central research question that this study aimed to answer is, how do players of D&D describe the relationship between character development and their diagnosed mental illness? This study will also address the following research sub-questions: 1.       How do these players view their mental illness? DISSERTATION ON DUNGEON & DRAGONS                                                               80           2.       What are the qualities and/or characteristics of characters used to process mental illness symptomology? 3.       How do players identify their choices of themed worlds within the game? Is it player-centered? 4.       How would players describe this experience as an intervention technique? Setting  The choice of Microsoft Teams as the primary setting for this qualitative case study dissertation goes beyond mere convenience; it is a deliberate and strategic decision to enhance the research process. Utilizing Microsoft Teams as the research setting offers several distinct advantages that align with the study's core objectives. Primarily, this digital platform enables a global reach, including participants from various locations worldwide. This extensive reach is crucial as it provides diverse perspectives on the effectiveness of alternative role-playing interventions, particularly Dungeons and Dragons (D&D), in processing complex trauma. In today's interconnected world, the global impact of mental health and trauma issues is undeniable, emphasizing the need to gather insights and experiences from a wide range of cultural and geographical contexts. Furthermore, Microsoft Teams' digital infrastructure transcends geographical boundaries, fostering inclusivity and accessibility. It accommodates participants from diverse backgrounds, ensuring that the research captures a broad spectrum of experiences, not constrained by the limitations of physical proximity. In trauma and mental health, it is paramount to recognize that the nuances and expressions of these issues can vary significantly across diverse cultures and DISSERTATION ON DUNGEON & DRAGONS                                                               81           regions. Microsoft Teams offers a unique vantage point to explore these variations comprehensively. In addition, Microsoft Teams' digital environment promotes a sense of safety and anonymity that may be particularly conducive for research involving sensitive topics like complex trauma. Participants can engage in discussions and share their experiences with a degree of privacy and security, potentially leading to more candid and authentic responses. This setting minimizes potential barriers that could deter individuals from sharing their personal stories openly, thus enhancing the depth and authenticity of the research data. Finally, the utilization of Microsoft Teams aligns with the contemporary context, considering the impact of the COVID-19 pandemic on research methodologies. In an era marked by social distancing measures and the need for remote communication, this platform offers a practical solution to connect with participants and gather data while adhering to necessary health guidelines. In sum, the decision to employ Microsoft Teams as the setting for this qualitative case study dissertation is rooted in its capacity to transcend geographical limitations, foster inclusivity, ensure participant privacy and safety, and adapt to the demands of the current global landscape. These factors collectively contribute to research setting that is dynamic, diverse, and ideally suited to explore the multifaceted nature of processing complex trauma through alternative role-playing interventions, with a particular emphasis on D&D, across the country and the world.  DISSERTATION ON DUNGEON & DRAGONS                                                               82           Participants  The study's participants consist of nineteen individuals, each assigned a pseudonym (CS101, CS102, CS103, CS104, CS105, CS107, CS110, CS111, CS113, CS114, CS115, CS116, CS117, CS118, CS119, CS120, CS122, CS124, and CS126). These participants' narratives, gathered through recorded interviews, and their cognitive interpretations form the context and stories from which the study's data came. First, the study provides a group description to highlight the commonalities among the participants. Then, individual demographics are presented, including age, gender, marital status, employment status, and the duration of their engagement with the game. It is essential to acknowledge that, despite my efforts to maintain objectivity throughout the study, it is impossible to interact with the participants with complete impartiality. Therefore, I have included an Excel sheet of the results (see Appendix 1) to offer transparency regarding the potential influence of my subjective perspectives and experiences on the research process and the development of themes and sub-themes. The researcher recruited the study's participants through Facebook D&D group posts and referrals from group members. Furthermore, the initial participant, CS101, referred to two additional participants (CS119 and CS120). The table below presents both the commonalities and individual characteristics of the participants. The participant group comprised eleven males, seven females, and one individual who identified as non-binary. To be eligible for the study, participants had to meet specific criteria, including being at least 18 years old, having experience as a D&D player, and receiving a mental DISSERTATION ON DUNGEON & DRAGONS                                                               83           health diagnosis at some point. Each participant completed a screening and demographic survey (see Appendix 2) on Survey Monkey. The researcher screened and approved twenty-two participants but only conducted interviews with twenty. After the interview, one participant opted to withdraw from the study, resulting in nineteen participants. The following participant overviews are thematic and relevant to the study. 1. Protected Identity: Participants come from diverse backgrounds, including different genders and gender identities, which highlights the inclusivity of D&D as a therapeutic tool. 2. Age: Participants range in age from their twenties to their fifties, indicating that D&D-based interventions may be relevant and practical across various life stages. 3. Relationship Status: Participants have different relationship statuses, including single, married, divorced, engaged, and in domestic partnerships. The different statuses imply that D&D interventions tailor their approach to address various relationship statuses' distinct challenges and needs. 4. D&D Experience (Years): Participants have varying levels of experience with D&D, ranging from 1 year to 45 years. This diversity in experience levels highlights the accessibility of D&D as a therapeutic intervention, even for individuals with limited prior exposure to the game. Procedures Following the initial IRB application, we administered a demographic screening survey to assess participants' eligibility for research participation. To be eligible, participants needed to DISSERTATION ON DUNGEON & DRAGONS                                                               84           be at least 18 years old, have received a mental health diagnosis (either previous or current), and have experience as a D&D player. Upon confirming eligibility, we sent the participant an informed consent form (see Appendix). After the participant signed the form and returned it to us, we scheduled an interview and assigned a pseudonym to each participant. The interviews were conducted on Microsoft Teams and were recorded with the participant's consent, as outlined in the informed consent form. This recording allowed for the creation of interview transcripts, reviewed during the data analysis process. The interviews followed a predetermined set of questions. Occasionally, the researcher asked additional questions not covered in the script to ensure clarity and a smooth flow of information. The researcher is the only one who can access all video recordings and transcripts securely stored on a private, password-protected computer. Table 1   Demographics of Participants Gender/Marital Status/Years Playing D&D Age Female 7 Divorced 1 2 Years 1 Engaged 1 1 year 1 Married 4 10 Years 2 18 Years 1 4 Years 1 Single 1 Male 1 Divorced 11      19 Years 3 33 Years 1 34 Years 1 Domestic Partnership 1 DISSERTATION ON DUNGEON & DRAGONS                                                               85                 9 Months in therapy/ 20 Years  1 Married 1      25 Years 4 30 Years 1 34 Years 1 45 Years 1  Single 1      30 Years 3 5 Years 1 6 Years 1 Non-Binary 1 Single 1         15 Years 1 Grand Total 19  The participants were made up of eleven males, seven females, and one identified as non-binary who met requirements for the study being at least 18 years old, a player of D&D, and having a mental health diagnosis at some point in their life. Each participant completed a screening and demographic survey (Appendix 2) on Survey Monkey, and although twenty-two participants were screened and approved, only twenty were interviewed, one of whom decided to drop out after the interview excluding her information from the findings, leaving nineteen participants.  The Researcher’s Role  As I contemplated my role as a researcher for my dissertation, I recognized the pressing need for innovative interventions, especially considering the profound impact of the post-pandemic landscape on individuals seeking therapeutic support. Drawing from my prior experience conducting research for my master's thesis, I am eager to contribute my personal and professional insights to understanding the manifestation of complex trauma in individuals with DISSERTATION ON DUNGEON & DRAGONS                                                               86           intricate trauma histories. Moreover, being both a clinician and a researcher, I am acutely aware of the controversies and stigmas surrounding this subject in various professional and community settings. To address these concerns, it is imperative to conduct meticulous research in this critical area. I hold a particular stance on this topic from fellow researchers' perspectives. However, my actual position is one of awareness regarding my own biases and preconceptions about complex trauma and therapeutic approaches. I bring to this study a comprehensive understanding of the issues at hand, having worked with diverse populations in a wide range of clinical settings. While my background may facilitate my study of this topic, I also remain conscious of my emotional triggers and how they might influence my data analysis. In response, I am committed to seeking input from peer reviewers and employing validation strategies to minimize any undue influence on this research. As someone deeply enthusiastic about being a clinician and educator, I have diligently pursued coursework in research methods, social policy, assessments, theoretical interventions, and statistics throughout my academic journey, and my undergraduate years exposed me to various research projects, encompassing quantitative and qualitative research methodologies focusing on social justice and addressing societal issues. Furthermore, my master 's-level thesis was dedicated to the mandatory treatment interventions for domestic violence perpetrators, reflecting my commitment to addressing pressing societal challenges. As I continue my graduate education, my passion for making a meaningful difference in individuals' lives grows, alongside refining my skills. I am a doctoral candidate at Liberty University, specializing in community care and counseling with a focus on traumatology. DISSERTATION ON DUNGEON & DRAGONS                                                               87           My experiences as a licensed clinician and my role as an adjunct faculty member at a local university have afforded me a multifaceted perspective. These roles have allowed me to work with diverse populations, including children, adolescents, and adults, across a spectrum of care settings, from schools to residential facilities private practice to crisis stabilization units. Regardless of the setting, I have consistently observed trauma as a common thread connecting the individuals I serve. This observation has been the driving force behind my pursuit of a doctoral degree emphasizing traumatology. Upon completing this doctoral program, I aim to transition into a full-time role as a master's-level professor while continuing my private practice.  In this capacity, I aspire to mentor and shape new social workers, sharing the knowledge and experiences I have gained throughout my career. Many opportunities have enriched my life and career, and I am compelled by a deep-seated desire to give back to the community and the field, thereby paying forward the blessings I have received. Data Collection For this study, data collected is unstructured interviews, non-participant observation, collection of documents, anonymous surveys, and a reflective journal. The players took an initial survey where they identified any current or previous mental health diagnoses, such as PTSD, anxiety, or depression. For those who report a diagnosis, additional questions included ones regarding their D&D gameplay related to their diagnosis. In qualitative research, gatekeepers assist the researcher in "gaining access to study participants at research sites" (Creswell, 2013, p. 90). This access often involves writing a letter that lays out the study's parameters, including the potential impact and outcomes of the research. The gatekeeper, who serves as the Dungeon Master (DM) of the games, will have a conversation with the researcher about the necessity of DISSERTATION ON DUNGEON & DRAGONS                                                               88           this study. The gatekeeper will contact the players that met the criteria via an anonymous survey and ask them if they would be interested in participating in the study. The gatekeeper maintained the DM position during the data collection phases of the study. Interviews Participant observation, collection of documents, anonymous surveys, and a reflective journal gathered data for this study. A gatekeeper will assist in identifying the players. After that, players will complete an initial survey to identify any current or previous mental health diagnoses, such as PTSD, anxiety, or depression. If a participant reported a diagnosis, we then asked them additional questions about their D&D gameplay about their diagnoses. In qualitative research, gatekeepers assist the researcher in gaining access to study participants at research sites (Creswell, 2013, p. 90). The gatekeeper, who serves as the Dungeon Master (DM) of the games, will have a conversation with the researcher about the necessity of this study. Subsequently, the gatekeeper will contact the players who meet the criteria via an anonymous survey and inquire if they would be interested in participating in the study. The gatekeeper will stay within the DM position during the data collection phases of the study. The interview questions are as follows: 1. Why did you decide to participate in this study? 2. Do you mind sharing what factors played a role in this decision?  3. What interested you in the D&D game? 4. How long have you played D&D? DISSERTATION ON DUNGEON & DRAGONS                                                               89           5. Would you mind telling me your favorite D&D moment?  6. Have you created more than one character? 7. Describe your favorite character and why they were such a favorite. 8. Do you see D&D as a safe space to process difficult feelings and experiences for yourself? 9. Help me understand how you came to choose D&D as a tool related to your mental health? 10. What is your selection process for character building? 11. What characteristics did you choose for your characters and why? 12. Do you yourself feel you have some of these same characteristics or are they ones you wish you possessed? 13. How are these characteristics meaningful to you? 14. Does your mental health diagnosis influence your gameplay? Or does your character influence the diagnoses in either a healthy or harmful way? 15. Did you take your mental health diagnoses into consideration when developing this character? Have you in the past if not with this one? 16. Does this character affect your feelings (positively or negatively)? 17. If so, how do you experience those feelings inside the game and in your real life? 18. Do you feel that your character helps you process your trauma? How does this occur? DISSERTATION ON DUNGEON & DRAGONS                                                               90           19. Can you tell me about the process of choosing a particular D&D group that meets your goals for the game? 20. Is the DM an important element of this choice? If so, why? 21. Have you had DMs who created themes based on goals to process mental health? 22. Are you currently or have you ever been to traditional therapy? 23. If so, what was that experience like for you? 24. If not, do you mind sharing the reason for making this choice? 25. If a therapist offered a D&D experience as part of your therapeutic intervention, would you be interested in it? Why or why not? 26. Is there anything else you would like to share that would benefit this research? Developing a comprehensive set of interview questions for this qualitative dissertation is crucial to ensure the validity and reliability of the data collected. Each question specifically investigates the research objectives and lays the foundation for discussing findings in Chapter Five. In line with Creswell's qualitative research criteria (Creswell, 2018, pp.192-193), the interview questions for this study have been developed with precision to align with the qualitative research objectives. Here is an elaboration of how each question adheres to these criteria: Question one aligns with Creswell's criterion of addressing "the central phenomenon or concept" (Creswell & Creswell, 2018, p. 192). It directly targets participants' motivations to DISSERTATION ON DUNGEON & DRAGONS                                                               91           engage with the central phenomenon, which is the use of D&D for processing complex trauma. Question two follows Creswell's emphasis on exploring "the context of the research" (Creswell & Creswell, 2018, p. 192); this question encourages participants to provide context for their motivations, enabling a deeper understanding of their decision to participate. Question three supports the criterion of gaining "a rich understanding of the phenomenon" (Creswell & Creswell, 2018, p. 192). It seeks to uncover the specific aspects of D&D that participants find intriguing or engaging. Question four follows Creswell's principle of "understanding the participants," this question captures the extent of participants' experience with D&D, which is fundamental to understanding their perspectives (Creswell & Creswell, 2018, p. 193). Question five adheres to Creswell's principle of "developing a complete story" (Creswell & Creswell, 2018, p. 193). It prompts participants to share personal stories, providing a more comprehensive understanding of their experiences. Question six is consistent with Creswell's recommendation to "delve deeply" (Creswell & Creswell, 2018, p. 193). It explores the depth of participants' engagement with character creation, uncovering whether they have multiple experiences.  Question seven is under Creswell's focus on "intensive analysis" (Creswell & Creswell, 2018, pp. 257-258); this question encourages participants to provide detailed descriptions of their favorite characters, enabling an in-depth analysis. Questions eight and nine address Creswell's criterion of "personal bias" (Creswell & Creswell, 2018, p. 193) as it probes participants about their perception of D&D as a secure space for emotional processing. DISSERTATION ON DUNGEON & DRAGONS                                                               92           Questions ten and eleven adhere to Creswell's principle of "developing themes" (Creswell & Creswell, 2018, p. 273) by exploring the recurring theme of character building and the decision-making process. Question twelve explores the participants' self-perception, aligning with Creswell's focus on understanding the participants' views and experiences (Creswell & Creswell, 2018, p. 193). Question thirteen aligns with Creswell's criterion of "studying the phenomenon as a whole" (Creswell & Creswell, 2018, pp. 274-275); this question investigates the holistic meaning of chosen characteristics in the context of the participants' experiences. These questions have been thoughtfully crafted to address Creswell's qualitative research criteria and are vital tools for gaining a deep and comprehensive understanding of the research phenomenon. Top of Form Surveys  The survey (Appendix II) used was created by the researcher and posted on Survey Monkey and was purely for demographic purposes. The questions included in the online survey were: 1.Do you want to participate in this study and are 18+? (Required.) 1. Yes 2. No 2.Have you been diagnosed with any mental health diagnoses? (Required.) 1. Yes No DISSERTATION ON DUNGEON & DRAGONS                                                               93           3.Do you play D&D? (Required.) a) Yes 2. No 4.What is your identified gender? 5. What is your age? (Required.) 1. 18-24 2. 25-34 3. 35-44 4. 45-54 5. 55+ 6.How would you describe yourself? (Required.) 1. American Indian or Alaskan Native 2. Asian 3. African American or Black 4. Native Hawaiian or Pacific Islander 5. White 6. Two or More Races 7.What is your current employment status? (Required.) DISSERTATION ON DUNGEON & DRAGONS                                                               94           1. Employed Full-Time (40 or more hours per week) 2. Employed Part-Time (up to 39 hours (about 1 and a half days) per week) 3. Unemployed or Currently Looking for Work. 4. Unemployed and Not Looking for Work. 5. Student 6. Retired 7. Homemaker 8. Self-employed. 9. Unable to Work/Disabled 8.What is your educational background? (Required.) 1. Less than a High School Diploma 2. High School Degree or Equivalent (GED) 3. Some College, No Degree 4. Associate Degree (e.g., AA, AS) 5. Bachelor's Degree (e.g., BA, BS) 6. Master's Degree (e.g., MA, MS, MEd) 7. Professional Degree (e.g., MD, DDS, DVM) 8. Doctorate (e.g., PhD, EdD) DISSERTATION ON DUNGEON & DRAGONS                                                               95           9. What is your marital status? (Required.) 1. Single, Never Married 2. Single, Divorced 3. Married, or in a Domestic Partnership 4. Widowed 5. Divorced 6. Separated 1. What is your annual household income? (Required.) 1. Less than $20,000 a year 2. $20,000-$34,999 3. $35,000-$49,999 4. $50,000-$74,999 5. $75,000-$99,999 6. $100,000+ The importance of a demographics survey, like the one made on Survey Monkey for this study is essential to ensure the trustworthiness and precision of the information gathered (Creswell & Creswell 2018 p. 257). Adhering to Creswell's research design principles, these surveys primarily center around details and whether participants meet the study's criteria for DISSERTATION ON DUNGEON & DRAGONS                                                               96           inclusion (Creswell & Creswell 2018 p. 265). Implementing a straightforward 'Yes/No' format for questions such as age, mental health diagnoses and involvement in D&D reflects Creswell's notion of face validity – assessing whether the survey measures what it aims to measure at glance (Creswell & Creswell 2018 p. 267). Furthermore, the survey offers multiple choice selections for factors like gender, employment situation, educational background, marital status, and income level; this structured approach aids in collecting comprehensive demographic information in accordance with Creswell's emphasis, on crafting a cohesive narrative (Creswell & Creswell 2018 pp. 262 263). Ensuring that participants meet criteria for the research is important as it aligns with Creswell's idea of understanding the participants (Creswell & Creswell 2018 pp. 198 199). The accuracy and honesty of responses play a role in determining the survey's credibility. To improve construct validity, which refers to how the survey measures what it intends to measure it is essential for the questions to reflect the research objectives and hypotheses discussed in sections. follows Creswell's principle of connecting the research questions (Creswell & Creswell, 2018, pp. 133-136). To further ensure the survey's validity, it is vital to test it with a small sample, consistent with Creswell's approach, to assess clarity and comprehension of the questions before its full-scale deployment (Creswell & Creswell, 2018, pp. 199-200, 208-209). This process will aid in refining the survey and enhance the accuracy and trustworthiness of the data collected, thus adhering to Creswell's emphasis on trustworthiness. Additionally, the research team can analyze whether the survey's demographic data aligns with the research objectives and can adjust, if necessary, thereby enhancing the overall validity of the instrument (Creswell & Creswell, 2018, pp. 199-200, 208-209). The validity of the survey, as guided by Creswell's DISSERTATION ON DUNGEON & DRAGONS                                                               97           qualitative research principles, is crucial in ensuring the accuracy and credibility of the data collected for this qualitative dissertation. Document Analysis In the data analysis section of this qualitative dissertation, we use document analysis to extract valuable insights from a range of carefully chosen documents. These documents provide a comprehensive understanding of the research topic, specifically focusing on the efficacy of alternative role-playing interventions, such as Dungeons and Dragons (D&D), in processing complex trauma safely. The specific documents collected for analysis include: Initial Screening Survey: The initial screening survey serves as a critical document as it acts as a gatekeeper, ensuring that the participants in the study meet the predefined criteria. By collecting and analyzing these surveys, we can determine the eligibility of the participants, specifically regarding their age, mental health diagnoses, and participation in D&D. This document aids in selecting a suitable sample that aligns with the research objectives. Demographic Survey on Survey Monkey: The demographic survey conducted via Survey Monkey is essential to gather comprehensive background information about the participants. This document encompasses gender, age, educational background, employment status, and annual household income. The rationale for selecting this document is to provide a contextual understanding of the participants, allowing for a rich exploration of their demographic diversity and its potential influence on their experiences with D&D as a therapeutic tool. Informed Consent Form (Appendix II): The informed consent form signed by each participant is a critical ethical document. It outlines the participants' voluntary agreement to DISSERTATION ON DUNGEON & DRAGONS                                                               98           participate in the research and their understanding of the study's purpose and procedures. The rationale for including this document is to establish the ethical foundation of the research and ensure that participants willingly share their experiences. Recorded Interview Answers with Transcripts: The audio-recorded interviews and their transcripts serve as the core source of data for this qualitative analysis. These documents contain rich narratives and responses from the participants regarding their experiences with D&D as a means of processing complex trauma. The transcripts provide a textual representation of the interviews, enabling an in-depth exploration of participant perspectives and insights. These documents are selected based on the qualitative research principles outlined by Creswell and Creswell (2018, p. 267). These primary sources relate to the research objectives and facilitate a comprehensive investigation of the research topic. Each document plays a specific role in understanding the participants, their experiences, and the study's context. The analysis of these documents will provide a robust foundation for the subsequent stages of data interpretation and discussion of findings in Chapter Five. Observations  In this qualitative dissertation, a crucial element of data collection involved an online observation conducted on January 21, 2023, via Microsoft Teams utilizing the Roll20 platform. The observed gameplay centered around the Dungeons and Dragons (D&D) 3.0-3.5 version, set in the evocative world of The Forgotten Realms. The research aimed to examine the dynamics of role-playing and the potential therapeutic aspects of D&D, specifically in the context of processing complex trauma. During this observation, the researcher had the opportunity to DISSERTATION ON DUNGEON & DRAGONS                                                               99           immerse themselves in the live gaming environment, where they witnessed firsthand the multifaceted gameplay and storytelling. The themes explored in the game included both mental health-related narratives and those intrinsic to the campaign's storyline. These observations offered valuable context for understanding the intricate dynamics of gameplay, as well as the critical thinking and creative problem-solving processes that players engage in. This online observation was a crucial step in gaining insight into the participants' experiences and the potential therapeutic elements of D&D. It followed a session-zero conducted on January 18, 2021, with the participation of a volunteer Dungeon Master (DM), CS101, and participants CS102, CS107, and CS110. The observations from this session contributed significantly to the qualitative data, enriching the study's understanding of how alternative role-playing interventions like D&D can intersect with mental health-related themes in a gaming context.  Data Analysis  The data analysis procedures align with the research objectives and the qualitative research design. We employ a multi-method approach, utilizing textual data from interviews, document analysis, and surveys. The aim is to achieve triangulation and gain a comprehensive understanding of the role of Dungeons and Dragons (D&D) in processing complex trauma. Below, we outline the data analysis procedures and provide a rationale for each type of analysis. Case Selection To gain multiple perspectives on the therapeutic use of Dungeons & Dragons (D&D) for processing complex trauma, this study utilizes the maximum variation sampling strategy. This approach explores diverse individuals' perceptions and understandings of D&D across different DISSERTATION ON DUNGEON & DRAGONS                                                               100           settings and periods (Cohen & Crabtree, 2006; Creswell, 2013). We recruited nineteen individual D&D players for participation, including males and females from various age groups over eighteen. Documents The documents collected for this study encompass a variety of sources that shed light on the participants' experiences. These include papers used for character development, insights into mental health, journals, consent forms, and character creation sheets. All personal information is redacted after creating a Xerox copy, ensuring the participants' privacy and confidentiality. Reflective Journal This study uses a reflective journal and field notes as essential data sources. The reflective journal enables the researcher to document personal feelings, thoughts, reactions, assumptions, expectations, and potential biases related to the research process, enhancing the study's rigor (Morrow & Smith, 2000). Field notes were verbally recorded during pre- and post-interview transcriptions, contributing additional data to enrich the analysis by capturing observations throughout the research process. Data Analysis Before the analysis, all data, including interviews, observations, documents, journal entries, and field notes, undergo transcription. As described by Bailey (2008), the transcription process involves close observation and repeated careful listening to facilitate a deep understanding of the data. The researcher organizes and secures the data in Microsoft Word files with password protection on a portable computer with password-protected access. DISSERTATION ON DUNGEON & DRAGONS                                                               101           For data analysis, thematic analysis is employed, following Braun and Clarke’s (2019) guidelines, involving familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining, and naming themes, and producing a report. Interviews, observations, documents, and field notes are analyzed individually for each case, followed by cross-case analysis per Stake's (2006) procedure for merging findings across cases. This process allows for the identification of significant themes across all cases.                                   Trustworthiness Before the analysis, all data, including interviews, observations, documents, journal entries, and field notes, undergo transcription. As Bailey (2008) described, the transcription process involves close observation and repeated careful listening to facilitate a deep understanding of the data. The researcher organizes and secures the data in Microsoft Word files with password protection on a portable computer with password-protected access. For data analysis, thematic analysis is employed, following Braun and Clarke’s (2019) guidelines, involving familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining, and naming themes, and producing a report. Interviews, observations, documents, and field notes are analyzed individually for each case, followed by cross-case analysis per Stake's (2006) procedure for merging findings across cases. This process allows for the identification of significant themes across all cases. Credibility Credibility in qualitative research pertains to the accuracy and reliability of the study's findings (Lincoln & Guba, 1985). Triangulation is a primary method employed to enhance DISSERTATION ON DUNGEON & DRAGONS                                                               102           credibility. Triangulation involves collecting data from multiple sources and methods, such as interviews, observations, documents, journaling, and field notes. By utilizing these diverse data sources, the study aims to offer a more comprehensive and accurate portrayal of the phenomenon under investigation. Moreover, the researcher's role is crucial in addressing potential bias. As a clinician, the researcher provides a reflective account of her role and standpoint as a licensed therapist. This reflexive process adds transparency to her position, acknowledging any potential biases that might arise from her background. It is crucial to establish the credibility of the research to validate its outcomes. In this study, credibility is achieved through several methods: Triangulation. Triangulation involves the use of multiple data sources and methods to validate findings. This study employs data triangulation, combining data from interviews, observations, documents, journaling, and field notes. This approach enhances the credibility of the findings by cross-verifying information (Denzin, 1978). Member Checks. Member checks are an essential credibility tool where participants review and confirm the accuracy of their contributions to the study. This method ensures that the data interpretation aligns with the participants' perspectives (Lincoln & Guba, 1985). Negative Case Analysis. Identifying and analyzing negative or deviant cases helps ensure that the study's findings are not based on an outlier and are representative of the overall phenomenon (Patton, 1990). Negative case analysis contributes to the credibility of the research by addressing exceptions and unique instances.  DISSERTATION ON DUNGEON & DRAGONS                                                               103           Dependability and Confirmability Dependability pertains to the stability and consistency of research findings over time and across different contexts (Lincoln & Guba, 1985). Ensuring the dependability of the research findings is critical for assessing the reliability of the study. The following methods are applied: Prolonged Engagement. This refers to the extensive time spent in the field collecting data and immersing oneself in the research context, contributing to the dependability of the findings. Audit Trail. The researcher maintains a detailed audit trail that documents the research process, including data collection, analysis, and decision-making, enhancing dependability by allowing for the replication of the study and providing transparency regarding research procedures. Confirmability. In qualitative research pertains to the objectivity and neutrality of the research process and findings, ensuring they not be influenced by the researcher's biases (Lincoln & Guba, 1985). It is crucial to maintain confirmability to validate the objectivity of the research. The following methods are applied: Reflexivity. The researcher keeps a reflexive journal, documenting personal thoughts, feelings, and potential biases regarding the research process. This reflexive account adds transparency and objectivity to the study, allowing readers to assess the impact of the researcher's perspective on the findings.    DISSERTATION ON DUNGEON & DRAGONS                                                               104           Transferability Transferability involves how the research findings can be applied or generalized to other contexts or settings (Lincoln & Guba, 1985). Establishing transferability is crucial for the broader applicability of the study.  Rich, Detailed Description. To improve the transferability of the findings, we provide rich and detailed descriptions of each case. These descriptions offer readers a comprehensive understanding of the participants, their experiences, and the research context, allowing them to assess the relevance of the findings to their settings. Ethical Considerations The ethical conduct of this research adheres to the principles outlined in the Belmont Report (2016) and the guidelines set by the Liberty University Institutional Review Board (IRB). While there are no identifiable risks associated with participation in this study, the nature of the research involves sensitive topics related to trauma and mental illness. Several ethical considerations have been integrated into the research design to ensure the well-being and comfort of the participants. Firstly, the researcher interviewed all participants to explore their experiences with trauma and mental illness. During this process, the researcher aimed to establish rapport and build trust. Secondly, we recognized that participants might not initially trust or feel comfortable discussing topics related to trauma and mental illness. Building trust in these sensitive conversations might require time and patience. As the researcher, I dedicated myself to creating a safe and non-judgmental environment that allowed participants to share at their own pace. DISSERTATION ON DUNGEON & DRAGONS                                                               105           Given the focus of this study on mental illness and trauma, there is a potential for participants to become triggered during the research process. I acknowledge this possibility and have undertaken extensive preparation to manage such situations. Importantly, I am a licensed clinician with experience in de-escalation techniques. I took precautions to ensure participants felt safe and supported throughout the study. I also reminded participants of their freedom to withdraw from the study if they experienced distress. Ethical considerations are not confined solely to the interview process but to data storage, usage, and confidentiality. Data is stored securely, with electronic files protected by passwords and access restricted to me as the researcher. I used pseudonyms instead of real names to protect participants' privacy when reporting findings. These measures aimed to uphold the confidentiality of the participants and their responses. I am committed to addressing any ethical concerns or implications that may have arisen during the research process. I took proactive steps to safeguard the welfare and rights of the participants, and I managed any unexpected issues in adherence to ethical guidelines. This commitment to ethical conduct underpins the entire research endeavor, ensuring the dignity and well-being of all those involved. Summary Chapter Three of this qualitative dissertation presents a comprehensive overview of the research design, data collection methods, and data analysis procedures. The study's focus on exploring the therapeutic potential of Dungeons & Dragons (D&D) for individuals processing complex trauma is underpinned by a maximum variation sampling strategy, allowing for diverse perspectives across different settings and age groups. The data collection process involves a DISSERTATION ON DUNGEON & DRAGONS                                                               106           variety of sources, such as interviews, observations, documents, journaling, and field notes, to provide a multifaceted understanding of participants' experiences. Data analysis is conducted through thematic analysis based on Braun and Clarke’s (2019) framework, systematically exploring collected data. Furthermore, the chapter underscores the trustworthiness of the research through validation strategies, including triangulation, researcher reflexivity, peer debriefing, and Stake's (1996) "critique checklist." These strategies enhance the credibility, dependability, transferability, and confirmability of the findings, setting the stage for the presentation of research results in Chapter Four. This chapter is instrumental in establishing a robust framework for the research.           DISSERTATION ON DUNGEON & DRAGONS                                                               107           Chapter Four: Findings Overview This chapter contains the details of the findings from the study regarding the exploration of both the need for and the efficacy of alternative role-playing interventions, such as Dungeons and Dragons (D&D), to process complex trauma safely. As previously stated, research questions include the central research question that this study aimed to answer: 1. How do these players view their mental illness? 2. What are the qualities and characteristics of characters used to process mental illness symptomology? 3. How do players identify their choices of themed worlds within the game? Is it player-centered? 4. How would players describe this experience as an intervention technique?  Additionally, the theories that have guided this study are stress reduction theory (Soga et al., 2020), internal family systems model (IFS) (Schwartz, 1999), Foa's Associative Network Theory (Foa & Kozak, 1986; O'Sullivan, 1999; Foa et al., 1989), game theory (created by mathematician John von Neumann and economist Oskar Morgenstern in the 1940s and later extended to real-world use by mathematician John Nash) (Neumann & Morgenstern, 2021), Revealed Preference Theory (RPT) (Samuelson, 1938), Behavioral game theory (Seier, 2020), social theory (Seidman, 2016), Decision Theory (Camerer, 2003), instinct theory of aggression, frustration-aggression theory, and social learning theory (Thudium, 2022), Social Learning Theory (Bandura, 1969, 1971, 1986), theory of planned behavior (Ajzen, 1991), social-ecology theory (Bronfenbrenner, 1977), social information processing (SIP) theory (Liu, 2004), the Strategy of Conflict theory (Schelling, 1960), Fictitious Gameplay (FGP) theory (Heinrich et al., 2015), stress reduction theory (Heo et al., 2021), and grounded theory approach (Glaser & DISSERTATION ON DUNGEON & DRAGONS                                                               108           Strauss, 1967) as together they explain the inter-relational aspects of coping within specific contexts and traumas, and conflicts. The following are individual looks at the theories and how they relate to the research questions. Relationship Between Research Questions and Theoretical Frameworks Engagement with Dungeons & Dragons (D&D) offers a therapeutic avenue for individuals managing diagnosed mental illness, aligning with Stress Reduction Theory (Soga et al., 2020). Participants find character development to be a therapeutic process, resonating with the stress-relieving potential of engaging with imaginative elements within the game. Through iterative character development, individuals navigate their mental health challenges, illustrating the symbiotic relationship between character growth and well-being. This engagement with character development involves strategic decision-making, aligning with the principles of Game Theory, which underscores the theme of strategic coping mechanisms and decision-making. View of Mental Illness: In the context of D&D, engagement serves as a conduit for stress reduction, fostering a more positive outlook on mental illness, consistent with Stress Reduction Theory. Participants may cultivate a more optimistic perception of mental illness as they experience stress relief and emotional well-being during gameplay. This correlation underscores the theme of positive impact and coping mechanisms as participants navigate their mental health challenges through immersive gaming experiences. Moreover, participants may strategically approach their views on mental illness, considering the therapeutic benefits and fairness in their coping strategies, which aligns with the principles of Game Theory and Behavioral Game Theory. DISSERTATION ON DUNGEON & DRAGONS                                                               109           Qualities and Characteristics of Characters: In crafting characters within D&D, participants symbolize various aspects of their mental health, reflecting the therapeutic dimensions of the game. This exploration of character traits contributes to self-awareness and personal growth. Participants' choices in character development reflect strategic considerations influenced by Game Theory principles, where they strategically select character attributes to enhance the overall enjoyment and harmony within the gaming group. Additionally, participants' choices in character development can be analyzed through various psychological theories, shedding light on how they express instinctual tendencies, cope with frustration, and adopt coping mechanisms within the game environment, contributing to a deeper understanding of their experiences with D&D. Choices of Themed Worlds: Themed world selection in D&D offers avenues for escapism and personal reflection. Participants utilize themed worlds to process emotional experiences and navigate their mental health journey. Themed world selection reflects strategic decision-making informed by Game Theory principles, where participants strategically engage with specific themed worlds to cope with real-life challenges. Moreover, participants' choices of themed worlds can be understood through the lens of Social Learning Theory, as they observe and imitate others within the gaming community, shaping their attitudes and coping strategies. Use as a Therapeutic Intervention: Engaging in Dungeons & Dragons (D&D) within a therapeutic context enables individuals to address and cope with mental health challenges, resonating with Stress Reduction Theory. This therapeutic engagement underscores the theme of strategic therapeutic engagement and intervention, wherein individuals employ the game to navigate their mental health challenges and promote personal growth. Furthermore, participants' DISSERTATION ON DUNGEON & DRAGONS                                                               110           experiences with D&D as a therapeutic intervention can be analyzed through the Theory of Planned Behavior and Social Information Processing, offering insights into how motivational factors, cognitive processes, and social influences shape their attitudes and behaviors within the game. Incorporating Social Theory: Participant responses suggest that their engagement with D&D reflects a negotiation of societal norms, expectations, and personal agency within the structured environment of the game, aligning with social theory. Social theory provides a framework for understanding how participants construct their experiences and identities within the social context of D&D. Additionally, participants' engagement with D&D can be examined through the lens of Social Learning Theory, as they learn from others within the gaming community and adapt their behaviors and coping strategies accordingly. Incorporating Decision Theory: Participant responses align with decision theory principles, indicating intentional decision-making in character development, world selection, and overall gameplay to navigate mental health challenges within the structured environment of the game. Decision theory focuses on how individuals make decisions, considering factors such as preferences, beliefs, and available information.  Incorporating Instinct Theory of Aggression, Frustration-Aggression Theory: The participant responses can be analyzed through various psychological theories, such as instinct theory of aggression, frustration-aggression theory, and social learning theory. These theories shed light on how participants express instinctual tendencies, cope with frustration, and adopt coping mechanisms within the game environment, contributing to a deeper understanding of their experiences with D&D. DISSERTATION ON DUNGEON & DRAGONS                                                               111           Applying Social Learning Theory: Participants' experiences with D&D can be understood through Social Learning Theory, as they observe and imitate others within the gaming community, shaping their attitudes and coping strategies. This emphasizes the theme of adopting positive perspectives through observational learning and reinforces the notion of modeling and observational learning in character development. Applying Theory of Planned Behavior and Social Information Processing: Engagement with D&D as a therapeutic intervention is shaped by motivational factors and cognitive processes, as highlighted by the Theory of Planned Behavior and Social Information Processing Theory. These frameworks offer insights into how participants' attitudes, subjective norms, perceived behavioral control, and cognitive processing influence their experiences with D&D in managing mental health challenges. Applying Strategy of Conflict Theory and Fictitious Play Theory: Engagement with D&D as a therapeutic intervention involves strategic decision-making and iterative learning processes, as elucidated by the Strategy of Conflict Theory and Fictitious Play Theory. These frameworks offer insights into how participants navigate conflicts, develop coping strategies, and converge towards optimal approaches within the context of the game. Moreover, participants' experiences with D&D as an intervention technique can be understood through the iterative learning process of Fictitious Play Theory, where strategies converge towards optimal approaches, shaping their coping mechanisms and problem-solving skills within the game.   DISSERTATION ON DUNGEON & DRAGONS                                                               112           Participant Responses and Theoretical Linkage to Themes In the realm of Dungeons & Dragons (D&D) players embark on an adventure that goes beyond playing a game delving into realms of creativity, self-discovery coping mechanisms and social interactions. This qualitative journey explores the aspects of D&D gameplay through the perspective of 18 theoretical frameworks covering theories, from Stress Reduction to Social Information Processing. As players navigate their character growth, decision making processes and interactions with others in the game world these theories shed light on the emotional and social aspects of their experiences. By examining how theory influences player responses this study aims to enhance our understanding of D&D as more than a leisure activity. Also, as a platform for personal development coping strategies and building connections with others.  Exploring Realms of Creativity and Healing; The analysis of Dungeons & Dragons (D&D) as a tool is viewed through theoretical frameworks such as Stress Reduction Theory, Internal Family Systems Model (IFS) Foa’s Associative Network Theory and Game Theory. Players like CS101, CS102, CS104 and CS126 demonstrate how character development and immersive storytelling in D&D can serve as outlets during times of struggles. This aligns with the Stress Reduction Theory notion that engaging in leisure activities, like D&D can help alleviate stress and provide a sense of relaxation. CS104 and CS105’s experiences mirror the essence of IFS using character creation to delve into dynamics and gain insights into their worlds. Similarly, the narratives of CS110 and CS111 align with Foa’s Associative Network Theory highlighting how processing trauma and coping mechanisms are facilitated through networks formed in the game. Furthermore, the DISSERTATION ON DUNGEON & DRAGONS                                                               113           strategic choices seen in participants such as CS119 and CS126 resonate with Game Theory emphasizing the considerations and competitive aspects in D&D gameplay.   Engaging with D&D unfolds as an exploration of depth, escapism and interconnected realities for participants influenced by theories like Revealed Preference Theory, Behavioral Game Theory and Social Theory. The decisions made by CS112 and CS113 in character development reveal their preferences contributing to our understanding of decision-making dynamics during D&D sessions based on Revealed Preference Theory. Participants like CS105 and CS111 exhibit decision making influenced by cognitive biases and social factors that exemplify Behavioral Game Theory principles. Social Theory comes into play as participants such as CS103 and CS114 navigate the dynamics within D&D groups reflecting sociocultural influences that shape their interactions and decision-making processes. Exploring Coping Strategies and Stress Relief; The ways in which coping mechanisms and stress reduction techniques are observed in D&D sessions are analyzed using theories, like Decision Theory, Social Learning Theory and Stress Reduction Theory. CS101 and CS111’s thoughtful decision making reflects the decision-making principles of Decision Theory focusing on thinking to achieve desired outcomes in the game. Additionally, by looking at CS123’s storyline we gain insights into how players learn from modeled behaviors and narratives in D&D aligning with the concepts of Social Learning Theory. Furthermore, examining CS107’s narrative through Stress Reduction Theory helps us understand how engagement with D&D elements contributes to stress relief displaying the advantages of gameplay experiences.   Embracing Diversity, Inclusion and Positive Dynamics; The interactions involving diversity, inclusion and positive dynamics within D&D groups are investigated using theories DISSERTATION ON DUNGEON & DRAGONS                                                               114           like Social Ecology Theory, Social Information Processing (SIP) Theory and the Strategy of Conflict Theory. CS115 and CS120 emphasize how the gaming environment shapes their experiences in D&D by highlighting the interconnectedness between experiences, social contexts and broader environmental factors as seen in Social Ecology Theory. Sharing their insights from playing D&D shows how social cues and information impact their decisions, within the game embodying SIP theory principles. The narratives of CS116 and CS118 using The Strategy of Conflict Theory can help us grasp the interactions and negotiations among players in the game giving insight into how conflicts resolved, and alliances are formed during D&D sessions.   To put it simply by examining Dungeons & Dragons (D&D) through perspectives we uncover a wide range of experiences and insights across themes like Realms of Imagination, Therapeutic Exploration, Emotional Depth, Coping Mechanisms, Diversity and Belonging. The. Interactions of participants in the game align with theoretical frameworks highlighting how D&D acts as a diverse platform for self-expression coping strategies and social bonding. Whether it is character growth or decision-making processes, social dynamics, or stress relief techniques. These theories shed light on the relationship between gameplay and personal well-being, in the realm of D&D.   The amalgamation of theories helps us understand how individuals cope with traumas and conflicts within the world of Dungeons & Dragons (D&D) where engaging narratives, strategic choices and interpersonal relationships play a role. This study explores how different theories are used to understand how people cope with stress, trauma, and conflicts, in the world of Dungeons & Dragons (D&D). Various theoretical frameworks, such as Stress Reduction Theory and Fictitious Gameplay Theory provide insights into how players use the game to DISSERTATION ON DUNGEON & DRAGONS                                                               115           manage their emotions and navigate challenges. By analyzing player experiences through these theories, the research aims to enhance our knowledge of coping strategies in situations within the realm of D&D.    In the realm of Dungeons & Dragons (D&D) Stress Reduction Theory offers a perspective on how players seek comfort and relaxation in the game. Players like CS104 and CS126 exemplify how engaging with D&D can be an escape from real life pressures. The theory emphasizes leisure and recreation which aligns with players' accounts of using D&D to relieve stress and address issues. When dealing with trauma, Stress Reduction Theory shows how immersing oneself in D&D can provide a break from real world challenges allowing for creativity, exploration, and emotional healing. Through the growth of characters, captivating storytelling, and shared gameplay experiences individuals discover solace and renewal displaying how engaging in leisure activities can help them deal with and move from past experiences.  Investigating the Grounded Theory Approach (developed by Glaser & Strauss in 1967); This approach weaves a narrative that links together ways players cope in Dungeons & Dragons. By using this method, we see how stories, character growth and reflections on well-being intersect. Each player becomes a storyteller contributing to the development of theories that explain how coping happens in their circumstances. Therapeutic character creation illustrates the relationships revealed through this method. When dealing with trauma the Grounded Theory sheds light on the facets of coping within Dungeons & Dragons. Players use character development and immersive storytelling to navigate through their pain and challenges.  DISSERTATION ON DUNGEON & DRAGONS                                                               116           The Grounded Theory method allows for an exploration of how stories, coping mechanisms and healing processes interconnect within the game setting. By analyzing player narratives new insights emerge that reveal how individuals cope with their experiences, within Dungeons & Dragons.  Internal Family Systems Model (IFS) created by Schwartz in 1999; In the depths of their mind individuals explore the landscapes of their inner family dynamics. Take, for example a 35-year man named CS115 who finds solace in Dungeons & Dragons to express facets of himself. Through the perspective of Internal Family Systems (IFS) we uncover the struggles and harmonies mirrored in character interactions painting a picture of an internal world mirroring the complex relationships, within families. Dungeons & Dragons serves as an outlet for individuals to delve into comprehend and make peace with their complexities.  When it comes to processing seated trauma the IFS framework provides insights into how players navigate their inner realms within the game setting. Participants like CS115 bring forth aspects of themselves through character growth highlighting the conflicts and resolutions inherent in their journey towards healing. By immersing themselves in Dungeons & Dragons as a tool individual can. Delve into their inner family systems promoting self-awareness and healing within the structured confines of gameplay.   Foa’s Associative Network Theory (Foa & Kozak 1986); As players explore the interconnected networks within D&D gameplay Foa’s theory sheds light on the processes at work. Consider CS110, a 28-year player who shared his characters backstory interwoven, with subjective experiences that form a web of associations. The theory explains how individuals incorporate stories of health struggles and ways of dealing with them into the fabric of their DISSERTATION ON DUNGEON & DRAGONS                                                               117           characters, shedding light on the complex thought patterns involved. When dealing with experiences Foa’s theory gives us a glimpse into how people shape and navigate their stories of hardship within the game. Players such as CS110 weave their histories into their characters past displaying the interconnected networks that support their coping mechanisms. By using D&D as a tool for healing individuals can delve into. Reshape their connections linked to trauma fostering healthier ways of coping and finding solace in the immersive realm of the game.   Game Theory (Neumann & Morgenstern 2021); Within D&Ds realms Game Theory comes to life as players make decisions handle conflicts and pursue goals. CS119s (about 2 minutes) focus on advocating for fairness and strategic gameplay mirrors the decision making at play in Game Theory. The participants transform into players in a grander scheme where they weigh up the repercussions of their choices, resolve conflicts and steer the storyline through a perspective.  Grounded in both theory and player reactions, Game Theory serves as a framework for deciphering the interactions and decision-making dynamics during D&D sessions. Players like CS119 approach the game strategically by weighing their objectives choices, to them and potential consequences of their actions. Applying the concepts of Game Theory allows people to analyze the aspects of gameplay, predict their opponents' actions and fine tune their strategies to reach their goals, in the game world.   Revealed Preference Theory (RPT) (Samuelson, 1938); Within the framework of theory and player responses Revealed Preference Theory is evident as players highlight their preferences in D&D settings. For instance, a 30-year-old divorced woman named CS112 selected a world that mirrors her fondness for mystery and exploration. The theory corresponds to players DISSERTATION ON DUNGEON & DRAGONS                                                               118           revealed choices indicating that the preferences embedded in their character creations unveil motivations, desires, and coping mechanisms within the game worlds. By examining these preferences researchers can uncover insights into the needs and interests that drive players' engagement with the game. This helps in understanding how individuals navigate and interact within environments based on their revealed preferences.  Behavioral Game Theory (Seier, 2020); Aligned with the theory and participants input Seier’s Behavioral Game Theory uncovers the foundations of players decisions and interactions, in the game. For example, a 25-year-old single man named CS116 emphasized his characters nature influenced by real life experiences. The theory focuses on how decision making is influenced by behavior, showing how participants personalities shape their actions, handle conflicts, and adjust strategies based on their stories. By using Behavioral Game Theory to study reactions researchers can better understand how individual actions impact the dynamics of gameplay contributing to an understanding of human decision making and social interactions, in virtual settings like Dungeons & Dragons.   Social Theory (Seidman, 2016); Aligned with the framework and feedback from participants Seidman’s Social Theory resonates as players engage in the aspects of Dungeons & Dragons. CS124, a 33-year woman highlighted the communal nature of the game demonstrating how social interactions influence character growth. The theory explains how individuals are interconnected within the games structure displaying how shared experiences, conflicts and coping mechanisms shape the social fabric. Through Social Theory's perspective researchers can examine player interactions, group dynamics and social hierarchies during Dungeons & Dragons DISSERTATION ON DUNGEON & DRAGONS                                                               119           sessions to gain insights into how socialization influences behaviors and experiences, in communities. Decision Theory (Camerer, 2003): In Decision Theory, participants engage in decision-making processes that shape the trajectory of their characters and the overarching narrative. For instance, CS120, a 38-year-old single male, described his decision-making process in creating a character aligned with his values. Decision Theory emphasizes the rational and intentional nature of decision-making within the game, offering insights into how participants navigate conflicts and cope with challenges through strategic choices. By applying Decision Theory to participant responses, researchers can analyze the thought processes, motivations, and considerations underlying character development and decision-making in D&D, contributing to a deeper understanding of human behavior within gaming contexts. Social Learning Theory (Bandura, 1969, 1971, 1986): Bandura's Social Learning Theory manifests as participants learn from modeled behaviors and narratives within D&D. For instance, CS123, a 32-year-old married male, described how the game served as a platform for learning about himself and others. Social Learning Theory emphasizes the role of observation, imitation, and reinforcement in shaping coping strategies and conflict resolution within the immersive context of D&D. Participants observe how others navigate challenges, adapt strategies, and resolve conflicts, which in turn influences their own behavior and decision-making within the game. By applying Social Learning Theory to participant narratives, researchers can analyze the mechanisms through which learning occurs within gaming environments, shedding light on the social dynamics and psychological processes at play. DISSERTATION ON DUNGEON & DRAGONS                                                               120           Theory of Planned Behavior (Ajzen, 1991): In the intentional design of their characters and narratives, participants align with Ajzen's Theory of Planned Behavior. For instance, CS118, a 29-year-old engaged male, highlighted the deliberate choices made in character creation to reflect personal values. Ajzen's theory illuminates the intentional and goal-directed nature of participants' actions, demonstrating how planned behaviors within the game contribute to coping strategies and conflict resolution. By applying the Theory of Planned Behavior to participant narratives, researchers can analyze how individuals' attitudes, perceived norms, and perceived control influence their intentions and subsequent actions within the gaming environment. This sheds light on the motivational factors driving character creation and decision-making processes in Dungeons & Dragons. Social-Ecology Theory (Bronfenbrenner, 1977): Within the domain of Dungeons & Dragons (D&D), Bronfenbrenner's Social-Ecology Theory unfolds as participants navigate the nested systems of their gaming experience. For example, CS125, a 27-year-old single female, highlighted the influence of personal, microsystem factors on her character creation. Bronfenbrenner's theory elucidates the interconnectedness of individual experiences with broader environmental factors, emphasizing how coping strategies and conflicts within the game are shaped by the ecological contexts in which they unfold. By applying this theory, researchers gain insights into how the interplay between personal characteristics, interpersonal relationships, and environmental factors influences participants' engagement and experiences in Dungeons & Dragons, providing a holistic understanding of the game's impact on individuals within their social-ecological contexts. DISSERTATION ON DUNGEON & DRAGONS                                                               121           Social Information Processing (SIP) Theory (Liu, 2004): In the dynamic social world of Dungeons & Dragons (D&D), Social Information Processing (SIP) Theory comes to life as participants process social information, interpret cues, and respond within the game's intricate framework. For instance, CS108, a 26-year-old single female, described her character's responses in the context of the game's social dynamics. SIP Theory accentuates the cognitive processes involved in information processing, shedding light on how participants navigate social interactions, cope with conflicts, and make decisions within the immersive narrative. By applying this theory, researchers gain insights into the nuanced ways in which individuals perceive, interpret, and respond to social cues within the dynamic context of D&D, enriching our understanding of social dynamics and interpersonal relationships within the game. Strategy of Conflict Theory (Schelling, 1960): Dungeons & Dragons (D&D) participants strategically navigate conflicts, finding resonance with Strategy of Conflict Theory. For example, CS121, a 36-year-old married male, illustrated the tactical considerations in character choices and interactions. Schelling's theory emphasizes the strategic aspects of conflict resolution, highlighting how participants employ game theory-like strategies to address challenges, negotiate conflicts, and achieve their objectives within the intricate web of D&D narratives. By applying this theory, researchers gain insights into the strategic decision-making processes underlying conflict resolution within the dynamic and competitive landscape of D&D, enriching our understanding of strategic interactions and negotiation dynamics in gaming narratives. Fictitious Gameplay (FGP) Theory (Heinrich et al., 2015): In Dungeons & Dragons (D&D), participants engage in a form of gameplay that transcends reality, embodying the principles of Fictitious Gameplay (FGP) Theory. For instance, CS113, a 34-year-old divorced DISSERTATION ON DUNGEON & DRAGONS                                                               122           male, highlighted the immersive and transformative nature of D&D gameplay. FGP Theory captures the essence of participants' experiences, emphasizing the fictitious yet impactful nature of gameplay that allows for exploration, experimentation, and coping within the boundaries of the game. By recognizing the significance of FGP Theory, researchers can better understand how participants immerse themselves in fictional narratives, navigate complex challenges, and find solace and growth within the imaginative landscapes of D&D.  Participants engage in a form of Fictitious Play within the extensive-form game of D&D. CS114, a 37-year-old married male, demonstrated the iterative process of learning and adapting within the game. The theory aligns with the evolving nature of participants' strategies, highlighting how they continuously learn, adjust, and converge toward coping mechanisms and conflict resolution strategies that approximate Nash equilibria within the expansive narrative of D&D. The integration of theoretical frameworks provides a nuanced understanding of coping within the realm of Dungeons & Dragons (D&D), encompassing themes of stress reduction, internal exploration, strategic decision-making, and social dynamics. Stress Reduction Theory illuminates how participants like CS104 and CS126 find solace and relief within the game, while Grounded Theory Approach uncovers the diverse coping strategies and personal narratives interwoven in participants' experiences, exemplified by CS107 and CS122. Internal Family Systems Model offers insights into the internal conflicts and resolutions mirrored in character interactions, as demonstrated by CS115, while Foa's Associative Network Theory sheds light on the cognitive processes underlying trauma processing within D&D, as seen in CS110 and CS111. Game Theory and Revealed Preference Theory highlight the strategic decision-making and DISSERTATION ON DUNGEON & DRAGONS                                                               123           thematic preferences shaping gameplay dynamics, reflected in participants like CS119 and CS112.  Behavioral Game Theory and Social Theory elucidate the psychological underpinnings and social dynamics at play within the game, demonstrated by CS116 and CS124. The Theory of Planned Behavior offers insights into the intentional character creation aligned with personal values, as illustrated by CS118, while Social-Ecology Theory reveals the interconnectedness of individual experiences and environmental factors shaping gameplay, exemplified by CS125. Social Information Processing Theory accentuates the cognitive processes involved in social interactions and decision-making within D&D, as demonstrated by CS108.  Strategy of Conflict Theory underscores the strategic navigation of conflicts within the game, depicted by CS121, while Fictitious Gameplay Theory captures the transformative nature of immersive gameplay experiences, embodied by CS113. By integrating these theoretical perspectives, this study advances our understanding of coping within specific contexts, traumas, and conflicts, unveiling the intricate interplay between theory and participant responses in the dynamic world of D&D. Synthesis and Reflection: The integration of these diverse theoretical frameworks provides a multifaceted understanding of how participants navigate coping within the specific contexts, traumas, and conflicts embedded in their Dungeons & Dragons (D&D) experiences. From stress reduction to strategic decision-making, each theoretical lens adds a unique dimension to the complex tapestry of coping strategies within the fantastical landscapes of D&D. The interplay of stress reduction, DISSERTATION ON DUNGEON & DRAGONS                                                               124           cognitive processes, internal dynamics, social influences, and immersive gameplay creates a rich mosaic of coping mechanisms and conflict resolution strategies. Through the amalgamation of these theories, we gain deeper insights into the intricate web of participants' narratives, illuminating the complexity of human experience and adaptation within the realms of imagination and gameplay. Participants Before each interview, I informed the participants about the pseudonyms assigned to them. When the recording began, I asked if the participant had read and signed the consent form before the interview. I also ensured that they willingly participated in the research and that no compensation or rewards were part of their involvement in this study. The interviews were recorded and transcribed via Microsoft Teams. While the transcriptions were not flawless, the video recordings and follow-up emails to participants for clarification helped resolve transcription issues. These interviews took place between December 2022 and March 2023 via Microsoft Teams. The interview questions were consistent across all participants, with room for asking clarifying questions for additional context. After completing transcription reviews, participants received an email with a copy of the transcription to verify its accuracy. Participants noted some improper spelling of specific D&D-related jargon, but that was the extent of their feedback.  CS 101 Participant CS 101, a 42-year-old divorced male from Ohio, offers a compelling narrative about his 34-year engagement with Dungeons & Dragons (D&D). His character creation, Drag DISSERTATION ON DUNGEON & DRAGONS                                                               125           the Elf, reflects a profound connection between his personal history and gameplay. Early life experiences marred by childhood trauma and lingering anger serve as the backdrop for his character's motivation—an unrelenting quest for revenge. Within theoretical frameworks, CS 101's character choice embodies the concept of revenge, a behavior motivated by the desire to eliminate deep-seated painful emotions (Grobbink et al., 2015). Crucially, the distinction between revenge and retaliation holds significance in analyzing CS 101's character selection. In this context, individuals often exhibit an intense and enduring desire to seek contentment and resolution through revenge. In contrast, retaliation involves a more rational and purpose-driven response, often called an "eye-for-an-eye" approach (Stuckless & Goranson, 1992, p. 27). For CS 101, seeking revenge through his character allows him to navigate the tumultuous waters of his own emotions without causing harm to real individuals. This nuanced understanding sheds light on the purpose and intent behind his character's motivations. Notably, CS 101's choice of an Elf character introduces a layer of irony and unexpectedness, given the typical characteristics associated with Elves in D&D, such as grace and benevolence (D&Dbeyond.com, n.d.). The Strategy of Conflict (Schelling, 1960) theory comes into play here, emphasizing the significance of focal points—actions or outcomes that stand out and hold salience within the context of a game. By selecting an Elf character driven by revenge, CS 101 disrupts the anticipated balance of power and introduces an unexpected narrative element. This disruption, in turn, aligns with his need to process childhood trauma and eliminate its enduring pain (Stuckless & Goranson, 1992).  DISSERTATION ON DUNGEON & DRAGONS                                                               126           CS 102            CS 102, a 27-year-old married woman and teacher at a Christian school, presents a distinct perspective on D&D and character creation. Her 9-year engagement with the game began while she played alongside college friends. Penny the Paladin's character reflects a complex interplay of moral values, personal strength, and the desire for self-expression. A central theme within CS 102's character choice is the struggle with moral ambiguity, reflecting her upbringing in a Christian household. The character Penny embodies the role of protector, akin to the disciples of Jesus in Christianity, while also harboring traits of a fierce fighter as a Barbarian—a parallel with the Romans who crucified Jesus. This inner struggle between protector and fighter becomes a metaphor for her moral ambiguity and the dichotomy she navigates as an individual raised in a Christian environment (Pittarello et al., 2015). CS 102's character choices align with research suggesting that individuals may engage in self-serving dishonesty when faced with moral ambiguity (Pittarello et al., 2015). Her experiences, such as the ethical dilemma on a job application regarding witchcraft participation, exemplify the tension between honesty and potential personal gain. This internal conflict mirrors the trade-off described in the research literature (Pittarello et al., 2015). In conclusion, CS 101's character creation embodies a quest for revenge to address deep-seated emotional pain, with an Elf character introducing a disruptive narrative element. On the other hand, CS 102's character choices reflect her struggle with moral ambiguity, channeling the duality of protector and fighter to navigate the complexities of her Christian upbringing. Both participants' character selections provide unique insights into the interplay between gameplay DISSERTATION ON DUNGEON & DRAGONS                                                               127           and personal identity, illustrating how D&D serves as a canvas for processing emotions, moral dilemmas, and inner conflicts. CS 103 Participant CS 103, a 56-year-old married male and mental health therapist residing in Minnesota, brings a wealth of experience to the Dungeons & Dragons (D&D) world, having engaged with the game for an impressive 45 years. His initial foray into D&D occurred within the context of a group of friends, guided by a substitute teacher who introduced them to the game after school hours. This extended involvement with D&D has allowed him to explore the game's multifaceted dimensions and leverage it as a tool for personal growth and understanding. Within the expansive realm of D&D, CS 103 has crafted a unique persona—a female character named Jacqueline—within the Urban Fantasy genre. Notably, he has continued evolving Jacqueline's story over the years, generating three generations of her descendants. The choice to embody a female-gendered character is deliberate and stems from his desire to transcend his experiences and engage with a perspective that is opposed to his own. This character choice aligns with the concept of Fictitious Gameplay (FGP) theory, wherein players eschew the conventional approach of consistently playing the optimal response. Instead, they adopt a more cautious strategy, oscillating between their best and average responses within their gameplay. According to this theory, the learning process revolves around reinforcement learning acquired through engagements against opponents' average strategies (Heinrich et al., 2015). CS 103's engagement with the female character Jacqueline extends beyond the conventional realms of gameplay. In the context of urban fantasy—a genre characterized by DISSERTATION ON DUNGEON & DRAGONS                                                               128           magical elements interwoven within a modern urban setting marked by continuous transformation and evolution—CS 103 leverages the ever-changing backdrop of urban cities to explore the experiences of multiple generations of his female character. This dynamic provides him with a unique vantage point to engage with and comprehend the female experience, potentially fostering greater empathy and understanding, particularly from the perspective of his daughter and wife. One poignant example of the therapeutic potential of D&D within CS 103's narrative is the shared story of his daughter's bullying experience at school. He and his daughter collaborated in D&D to reenact and resolve the real-life issue, offering a platform for healing and closure in the face of adversity. In summary, CS 103's extensive and nuanced engagement with D&D exemplifies the game's capacity to transcend conventional entertainment and serve as a medium for personal exploration, empathy cultivation, and therapeutic intervention. His utilization of a female character reflects a deliberate effort to broaden his perspective, aligning with the principles of Fictitious Gameplay theory, and highlights the multifaceted nature of his relationship with the game. The narrative underscores D&D's potential to address real-life challenges and foster personal growth within a supportive and imaginative gaming environment. CS104 Participant CS104, a 31-year-old married female, shared insights into her experiences with character creation and mental health within Dungeons and Dragons (D&D). She engaged in the process of character creation, emphasizing the emotional depth and complexity of her DISSERTATION ON DUNGEON & DRAGONS                                                               129           characters. This emotional depth indicates the therapeutic value of D&D, as it allowed her to explore intricate aspects of her characters' personalities and struggles, mirroring her own emotional experiences. CS104 highlighted the significance of immersion and role-playing in D&D, which allowed her to delve into her characters' emotions and immerse herself in their perspectives. Furthermore, CS104's engagement with D&D revealed how the game was a therapeutic outlet for her, helping her cope with real-life stressors and challenges. She could process and explore emotions through her characters, contributing to her overall mental well-being. CS104's experiences align with the broader themes observed in the study, emphasizing how D&D serves as a creative and therapeutic platform for individuals to address their mental and emotional needs. Her insights underscore the importance of considering gender and marital status when exploring the therapeutic potential of D&D, as these demographic factors can influence the nuances of character creation and emotional expression within the game. CS 105            Participant CS 105, a 44-year-old divorced female, has been actively engaged in Dungeons & Dragons (D&D) for two years. However, her longstanding fascination with fantasy and lore has been a consistent aspect of her life. Her introduction to the game came after a background marked by challenging experiences, especially her upbringing within a household characterized by racism, which left a lasting impact and can be considered a source of trauma. In her narrative of gameplay, CS 105 emphasized her preference for moments within the game that revolved around championing the cause of the underprivileged and marginalized. This DISSERTATION ON DUNGEON & DRAGONS                                                               130           preference provides insight into her character selection within the game, where she currently assumes the role of a rogue. In the D&D universe, rogues commonly rely on skill, stealth, and the ability to exploit their adversaries' vulnerabilities to gain an advantage in various situations. Their gameplay often highlights resourcefulness and adaptability. In addition to her current rogue character, CS 105 referenced an alter ego—a paladin female character. Paladins in D&D are characterized by their solemn oath to uphold principles of justice and righteousness and to defend the forces of good against the encroaching darkness and malevolence in the world. They are unwavering champions of good, committed to combating evil wherever it may manifest. The choice of these two distinct character archetypes, the rogue and the Paladin, reflects CS 105's aspirations and values. Her affinity for characters who fight for justice and the underdog aligns with her desire to break free from the cycle of racism and prejudice that she encountered in her upbringing. Playing these characters in a fantasy world becomes a therapeutic outlet, enabling her to engage in narratives that resonate with her journey of confronting and challenging deeply ingrained biases. Furthermore, CS 105 alluded to a generational and cultural component within her engagement with D&D. This suggests that her participation in the game is not solely an individual pursuit but also a means of addressing more extensive societal issues and fostering positive change within her cultural context. In sum, CS 105's experience in the realm of D&D reveals the transformative potential of the game as a medium for personal growth, healing, and the exploration of complex social and DISSERTATION ON DUNGEON & DRAGONS                                                               131           cultural issues. Her choice of characters serves as a powerful testament to the therapeutic and self-reflective dimensions of role-playing games like D&D. CS 107            Participant CS 107, a 37-year-old married female, has engaged in the world of Dungeons & Dragons (D&D) for four years, with her initiation into the game coinciding with a profoundly traumatic experience—losing her mother to suicide. This pivotal event marked the onset of a series of traumatic episodes in CS 107's life, and her involvement in D&D emerged as a means of navigating and processing the complex emotions and repercussions stemming from this tragedy. Within the game context, CS 107 adopted the persona of a Celestial Warlock, a character archetype defined by a celestial pact and a solemn duty. As a Celestial Warlock, her character's overarching mission revolved around the annihilation of the undead, the defeat of fiendish adversaries, and the protection of the innocent—an embodiment of a powerful, celestial-driven purpose. The celestial entities in D&D lore are sometimes described as formidable and otherworldly beings, an association that can significantly impact a player's in-game behavior and beliefs. This celestial pact binds the character to a mission of bringing light to the world's darkest corners, resonating with CS 107's narrative marked by her mother's tragic death and the profound questions surrounding the "why" behind this loss. For CS 107, her character's journey as a Celestial Warlock paralleled her process of coping with trauma and shedding light on the profound emotional and psychological impact of DISSERTATION ON DUNGEON & DRAGONS                                                               132           her mother's suicide. The character served as a conduit through which she could explore and make sense of the trauma she had experienced by bringing light to dark places, symbolizing her quest for understanding and healing. Her engagement with D&D offered a transformative and therapeutic avenue for processing her grief and finding meaning in the face of tragedy. CS 107's experience underscores the capacity of D&D as a medium for individuals to embark on profound journeys of self-discovery and healing, where the game's narrative and character development become integral tools for addressing real-life trauma and its enduring effects. CS 110            Participant CS 110, a 44-year-old married male, engages in Dungeons & Dragons (D&D) to cope with his mental health struggles, an aspect he deems pertinent to highlight for its potential therapeutic value. His motivation for participating in this research is the belief that using D&D for mental health purposes warrants greater attention. His initial exposure to the game stemmed from friends who possessed a rulebook and introduced him to crafting characters and narratives based on the game's framework. With a remarkable 34 years of experience in D&D, CS 110's engagement extends beyond mere recreation, representing a significant facet of his life. His gameplay centers around a character who embarks on a quest to rescue his sister from a former mentor who spurned her affection due to her purity. This character, carefully developed and nurtured over an extensive period, encapsulates more than one hundred in-game years of storytelling and character progression, a testament to the profound attachment he has formed to his role-played persona. DISSERTATION ON DUNGEON & DRAGONS                                                               133           CS 110's engagement with D&D serves to temporarily disengage from daily life, offering a valuable opportunity to reset and manage emotions, particularly anger and frustration. He describes his character development process as involving a random selection of elements intricately woven into the narrative. Currently, he is developing a character concept originating from a fellow player's idea of fifty distinctive character levels. Within the game, CS 110 portrays a character exalted to a saint and embodies traits such as purity, romanticism, and a profound connection to music. The ability to convincingly depict these characteristics underscores his deep immersion in the role and his belief in the malleability of character traits. Significantly, CS 110's characters serve as a conduit for processing positive and negative experiences related to his mental health challenges, including chronic anxiety, excessive rumination, a history of auditory hallucinations, and bipolar disorder with psychotic features. Stepping away from real-life concerns and engaging with these characters provides him with a refreshing escape, akin to self-imposed "rules lawyering," where he seeks to navigate and address complex issues within the game. Beyond the confines of the game world, D&D plays an instrumental role in assisting CS 110 with real-life problem-solving and coping strategies. Notably, it has helped him navigate and alleviate the emotional pain resulting from past abuse and bullying by classmates, providing a constructive outlet to channel his emotions, and preventing potentially harmful actions. The effectiveness of D&D as a therapeutic tool for CS 110 appears contingent on the nature of the gaming group and the degree of creative freedom it affords. Factors such as group DISSERTATION ON DUNGEON & DRAGONS                                                               134           dynamics and stifling or creative elements influence his experience. The "rule of awesome" or "rule of cool" underscores the importance of creativity and imaginative storytelling within the game. Additionally, CS 110 emphasizes the significance of a session zero in which the Dungeon Master (DM) discusses potential triggers and establishes the thematic framework, contributing to a safer and more inclusive gaming environment. CS 111             Participant CS 111, a 34-year-old divorced male employed as a personal trainer, has been an avid Dungeons & Dragons (D&D) player for 19 years. His decision to participate in this research study stemmed from a desire to enhance his understanding of interpersonal dynamics and foster improved relationships with individuals outside his usual social circles. Notably, he alluded to his self-perceived intellectual superiority compared to most, a sentiment that may suggest latent narcissistic traits and potential challenges in establishing and sustaining interpersonal connections, as indicated by his comment on participation. CS 111's introduction to D&D occurred through engagement with his cousin, and his fondness for franchises like "Lord of the Rings" and "Star Wars" facilitated a seamless transition into the world of tabletop role-playing games. His portrayal during the interview raised considerations regarding potential narcissistic tendencies, notably due to his self-perceived intellectual acumen and extensive explorations in fields such as philosophy and theology. His decision to engage in this study hinted at a latent desire for personal growth and improved interpersonal relationships, indicating an underlying awareness of interpersonal challenges. DISSERTATION ON DUNGEON & DRAGONS                                                               135           Of notable significance in CS 111's narrative is his recurrent reference to an attachment to water, a theme that emerged consistently throughout the interview. He disclosed that D&D served as a coping mechanism during his time in Army basic training, mitigating struggles with anger, insomnia, depression, and anxiety. He crafted characters within the game specifically designed to address these personal issues, and he recounted a memorable moment of triumph over a "big green monster," a metaphorical representation of his experiences during military service, further suggesting an underlying therapeutic role of D&D in his life. His description of a "human fighter" character in the context of the 3.5 edition of the game, portraying attributes such as exceptional physical strength and adaptability, coupled with associations with naval service and a perceived "Kureg God complex," hints at the potential for self-exploration and expression of latent narcissistic tendencies within the framework of gameplay. This narrative underscores the complex interplay between the player's persona, their characters, and the therapeutic aspects of the game. A recurring theme in CS 111's narrative is his engagement with D&D characters as surrogate companions, potentially reflecting challenges in forming and maintaining friendships in his personal life. While most D&D players initiate their journeys with friends, CS 111's initial involvement with his cousin, rather than a closer friend, may hint at early indications of his difficulties establishing and sustaining social connections. In his narrative, these characters assume the role of confidants and comrades, signifying a deep emotional attachment to the game and its relationships. In summary, CS 111's engagement with D&D spans two decades, driven by a desire for personal growth and improved interpersonal relationships. His narrative suggests the potential DISSERTATION ON DUNGEON & DRAGONS                                                               136           presence of narcissistic tendencies, which find expression within the game's framework. Furthermore, his profound emotional attachment to D&D characters and their roles as surrogate companions highlights the therapeutic dimensions of the game, offering insights into the intricate interplay between self-expression, emotional coping, and interpersonal challenges in the context of tabletop role-playing. CS 113            Participant CS 113 is a 34-year-old single male who expressed a particular interest in exploring the potential link between Dungeons & Dragons (D&D) and mental health support. He has a 6-year history of engaging with the game and has developed his interest through interactions with friends, including a friend he met through a podcast and his sister. CS 113's engagement with D&D is notable for its therapeutic aspects, with a specific focus on addressing social anxiety.  He actively participates in D&D campaigns, carefully considering character elements such as race, class, alignment, and background to align with the campaign's theme. CS 113's engagement with D&D is a means to address and manage social anxiety, offering him a sense of belonging within the D&D community. He creates characters that reflect his feelings and challenges, such as the tension between occupational responsibilities and personal life. His mental health conditions include social anxiety, autism spectrum disorder (ASD), depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD). CS 113 reports positive effects on anxiety and social anxiety resulting from his D&D involvement, and he actively attempts to apply the skills acquired in the game to improve communication at work. He participates in an DISSERTATION ON DUNGEON & DRAGONS                                                               137           online D&D group that accommodates his schedule and helps him manage socialization and social anxiety.  CS 113's experience highlights the therapeutic potential of D&D for individuals facing mental health challenges, particularly those related to social anxiety and ASD. His intention to continue participating in D&D underscores the game's positive impact on his life and well-being. CS 114            Participant CS 114, a 45-year-old divorced male, brings a unique perspective to his engagement with Dungeons & Dragons (D&D). He has utilized D&D as both an educational tool and acknowledges its potential as a therapeutic intervention. With a robust history of 33 years of D&D experience, he combines his passion for fictional fantasy and sci-fi with his role as a parent, actively playing the game with his 13-year-old son. Over the years, CS 114 has created various characters, including a classic Elf Ranger, and finds relaxation and stress relief through gameplay. Notably, he leverages character backstories and roles to connect with his interests, such as a Monk character with woodworking skills. His engagement with D&D has unintentionally contributed to his understanding of alignment. CS 114 navigates challenges related to ADHD and past experiences with depression, effectively addressing D&D as a relaxation tool and de-stressor. Moreover, he has observed positive transformations in the young individuals he works with, emphasizing the game's potential for therapeutic benefits. CS 114 prioritizes group dynamics, emphasizing the importance of Session Zero in establishing the framework for gameplay.  DISSERTATION ON DUNGEON & DRAGONS                                                               138           His willingness to use D&D as an educational tool is evident in his support of a transgender teen with gender dysphoria in their transition process and assisting an individual with autism spectrum disorder (ASD) in socializing. His overall perception of D&D is positive, highlighting its capacity to facilitate positive changes in individuals, particularly young people facing various challenges. CS 114's experience underscores the versatile application of D&D as an educational and therapeutic resource for individuals with diverse needs and backgrounds. CS 115            Participant CS 115, a 58-year-old married male, embarked on his Dungeons & Dragons (D&D) journey with a unique perspective shaped by his life experiences. His engagement with D&D was sparked by its intriguing aspects and content, particularly after his service in the Navy, offering him a means of escape and exploration. His initial introduction to the game came through a friend and science partner, marking the beginning of his 30-year journey in the realm of D&D. CS 115's D&D experience notably intertwines with his personal history, particularly his encounters with bullying. His first encounter with the game involved playing a character created by a gay friend, providing him a valuable opportunity to navigate and master a character that resonated with his friend's identity. However, he also confronted the feeling of bullying within the game, mirroring his real-life experiences. To address this, he initiated personal character development, crafting a character named Rose that blended aspects of his personality with contrasting traits. This character was characterized by good intentions and an ardent desire to protect the vulnerable, echoing CS 115's experiences. DISSERTATION ON DUNGEON & DRAGONS                                                               139           The therapeutic value of D&D in addressing past bullying experiences becomes evident as CS 115 attributes the game to help him overcome these challenges. Kindness and empathy emerged as central themes, reflecting his character choices that focused on protecting the "little guy." He identifies with his characters, drawing parallels between their experiences and his encounters with bullying, both during his time in the Navy and in his youth. These parallels serve as an unintentional means of personal growth and healing, mitigating the impact of depression and past bullying. CS 115 emphasizes the positive impact of D&D on his sense of connection and belonging. While he does not engage in online games regularly, he occasionally joins online sessions, driven by a longing for the unique dynamics of D&D gameplay. Recognizing the significance of Session Zero in shaping the game's dynamics, he has also leveraged D&D to assist other players in processing their issues. In summary, CS 115's D&D journey is a testament to the game's therapeutic potential in addressing personal challenges related to bullying and depression. His character choices, influenced by his own experiences, serve as a means of self-expression, empathy, and personal growth. D&D provides a platform for him to explore and work through past traumas while fostering connections and offering a sense of belonging within the gaming community. CS 116            CS 116, a 30-year-old single male, engages with Dungeons & Dragons (D&D) to navigate the challenges posed by social interaction, given his position on the autism spectrum and his experiences with social anxiety. His motivation for entering the world of D&D was rooted in his DISSERTATION ON DUNGEON & DRAGONS                                                               140           desire to improve communication, leveraging the game as a unique avenue for interaction. For five years, CS 116 has taken on the role of a Dungeon Master (DM), embracing the storytelling aspect of the game. As a DM, he finds enjoyment in surprising his players and engaging in role-playing. His history with D&D spans more than one hundred characters, reflecting a deep and longstanding commitment to the game. CS 116's character choices in D&D are notably diverse and reflective of his journey. One character, a Tabaxi Rogue inspired by a friend's drawing, embodies eccentricity and a penchant for throwing money away. This character choice aligns with his intent to address social anxiety and communication challenges. The character creation process starts with ideas from the campaign, allowing him to explore various traits and characteristics not typical of his persona. Through characters like the Tabaxi Rogue, who is outspoken and exhibits brute force, he finds a means to bridge the gaps in his social interactions. CS 116 often underscores the therapeutic value of D&D by intentionally crafting characters that align with his own experiences, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). D&D serves as a constructive outlet for addressing these challenges, particularly related to focus and communication. CS 116 acknowledges that the game helps him deal with communication, allowing him to be a more assertive communicator as a DM despite his real-life struggles in this area. The comfort and camaraderie he experienced during D&D sessions have translated into meaningful friendships. As a Dungeon Master, CS 116 embodies several essential qualities, such as improvisation, scene management, and the ability to discern when to conclude a scene. These skills reflect his growth and adaptability through D&D. Importantly, he recognizes the DISSERTATION ON DUNGEON & DRAGONS                                                               141           importance of sensitivity and communication within the game, as demonstrated by his willingness to check in with a player about engaging in a potentially sensitive in-game scenario. In summary, CS 116's engagement with D&D is therapeutic and transformative. He leverages the game to confront social anxiety, enhance communication skills, and find a sense of belonging. His diverse array of characters and roles as a DM reflects his journey towards self-improvement, bridging the gap between his real-life challenges and the dynamic world of D&D. CS 117            Participant CS 117, a 36-year-old individual identified as non-binary and single, brings a unique perspective to their engagement with Dungeons & Dragons (D&D). Their motivation to participate in the research stems from their enthusiasm for a topic they consider both compelling and easily approachable, particularly in the context of D&D, which holds unique appeal. With a remarkable 15 years of D&D experience, CS 117 initially encountered the game through the character of war forged, devoid of the need for basic sustenance and initially designed for warfare. Their entry into D&D allowed them to transition from the mechanical existence of a war forged into the realm of living, breathing characters. CS 117's extensive D&D journey has seen them create and inhabit over a thousand characters, reflecting a deep engagement with the game's role-playing aspects. Their character roster includes a cleric who evolved from an NPC (non-player character) into a Lord, displaying their penchant for complex character development. Notably, they acknowledge their use of D&D as a therapeutic tool to address challenges associated with social anxiety, difficulty in identifying social cues due to autism spectrum disorder (ASD), and trauma work, including managing DISSERTATION ON DUNGEON & DRAGONS                                                               142           arachnophobia. To facilitate character creation, they actively seek visual references that align with the scenes they envision, maintaining a folder of potential characters yet to be played. While embracing the evolving ethos of D&D, including the move away from the term "race," CS 117 seeks to play characters of extraordinary and fantastic nature. Their approach to character creation remains deeply intertwined with their sense of self, with elements of their personality naturally infusing into their creations, sometimes unintentionally. The participant grapples with various mental health conditions, including arachnophobia, ADHD (impulsive subtype), ASD, major depressive disorder (MDD), and gender dysphoria. Their D&D experience is viewed as definitively positive, offering immersive therapeutic benefits for addressing arachnophobia and providing a social outlet. CS 117's D&D journey has facilitated social interaction and therapeutic relief, aligning with their phobia management efforts. They connect with friends from the gaming world, emphasizing the importance of a session zero and the pivotal role of the Dungeon Master (DM) in identifying potential triggers before a campaign begins. Their experience even includes utilizing D&D to address arachnophobia, highlighting the versatile and constructive nature of the game. As an enthusiast of the potential benefits of gaming, particularly for underrepresented individuals, CS 117 appreciates the research's focus on the therapeutic aspects of D&D, affirming a long-held belief in the positive impact of gaming on people's lives. CS 118 Participant CS 118, a 40-year-old married female, became involved in the study through her brother, who shares her interest in Dungeons & Dragons (D&D). With a decade of D&D DISSERTATION ON DUNGEON & DRAGONS                                                               143           experience, she recounted a transformative moment when she re-entered the game's world following a two-year hiatus. During this period, she confronted significant medical issues and personal losses. In a remarkable departure from her usual reserved demeanor, she found herself in a room full of strangers, engaging in social banter and humor—an unusual behavior for her.  This transformation comes from the powerful connection that D&D offered her, highlighting its capacity to facilitate social interactions and therapeutic relief. CS 118 has crafted over a hundred characters in her extensive D&D journey, with one character named Rylen holding particular significance. Rylen serves as a symbol of strength and capability, providing a stark contrast to how the participant perceives herself. The character's forceful and resilient nature resonates deeply with her, offering therapeutic benefits by allowing her to explore hidden facets of her personality while coping with social anxiety. Additionally, she detailed the creation of another character, a Gnome Bard wielding a frying pan as a weapon, inspired by her role as a mother of six children, some with special needs. This character choice aligns with her real-life struggles with wisdom and communication. CS 118 uses D&D as a creative outlet to express dimensions of her personality that might remain concealed in other environments, finding in it a means of escape and increased sociability. Her D&D experience is crucial in addressing mental health challenges, including depression, anxiety, and Graves’ Disease. The supportive friendships formed within the game community have profoundly impacted her sense of connection and emotional well-being. She views D&D as a means of personal recharge, bolstering her confidence to transfer skills acquired in the game to real-life situations. DISSERTATION ON DUNGEON & DRAGONS                                                               144           Furthermore, CS 118 disclosed that D&D was instrumental in her grief processing. When her character, Ryan, experienced her father's death in the game, it coincided with the real-life loss of her father. This synchronicity allowed her to transform the abstract concept of death into something actionable, alleviating feelings of helplessness associated with grief. Her gaming experiences involve phone conversations and collaboration with a core group of friends, with CS 118 also taking on the role of Dungeon Master (DM). Her keen ability to read people, aversion to rule lawyering, and adherence to the importance of session zero underscore her commitment to creating a safe and enjoyable gaming environment. CS 118's participation in D&D extends beyond casual engagement; it intertwines with her life journey. She even met her husband through the game, and they share the responsibility of caring for their six children, many of whom have special needs. Her story exemplifies D&D's profound and multifaceted impact of D&D on the lives of individuals facing various challenges, highlighting its therapeutic potential and capacity for fostering enduring connections. CS 119            Participant CS 119, a 40-year-old married male, initially entered the realm of Dungeons & Dragons (D&D) with the primary motivation of spending time with friends. Introduced to the game by his brother-in-law, his commitment to D&D has evolved over a span of 25 years. One defining moment in his D&D journey was the emergence of a well-timed punchline that transformed into the group's catchphrase, underscoring the significance of humor and camaraderie in the game. With over fifty characters created, one character named Silcar holds a special place in his heart, as he met his wife while playing this character. DISSERTATION ON DUNGEON & DRAGONS                                                               145           CS 119 has harnessed D&D for various purposes, including social engagement and short-term escapism from the pressures of work and life stressors. Growing up on a farm, he found solace and connection through the social scenes D&D provided. For him, the game offers a mental respite, enabling him to temporarily assume alternate identities and explore a realm of mental freedom and relaxation. His character creation process involves evaluating whether a concept resonates with him, occasionally storing intriguing ideas for future use. While some of his characters bear similarities to his real-life persona, others diverge significantly, reflecting his desire to incorporate diverse attributes into his role-playing experiences. CS 119's engagement with D&D has offered valuable respite from depression, with characters like Silcar as sources of self-confidence and positivity. The game assists him in overcoming failures and recuperating swiftly, emphasizing its role as a supportive and rejuvenating activity. D&D has enriched his social interactions and contributed to his overall comfort with socializing, fostering a sense of community. For several years, he has consistently played with a close-knit group of friends, including his wife. Within the group, he assumes roles such as group leader, storyteller, narrator, and director, underscoring his active involvement in shaping the D&D experience. He places importance on identifying potential triggers in the game, evident in his developing a comprehensive spreadsheet to facilitate a session zero-like discussion about potential sensitivities and boundaries. This commitment to promoting a safe and enjoyable gaming environment highlights his dedication to the well-being of fellow players. CS 119's D&D journey has not been without its challenges, including personal difficulties from past relationships and family issues during his teenage years. Nonetheless, the DISSERTATION ON DUNGEON & DRAGONS                                                               146           game has remained a source of solace and connection throughout his life journey, even leading to the meeting of his wife within the context of D&D. His story exemplifies the enduring appeal of D&D in fostering social bonds, providing an avenue for escapism, and supporting mental well-being over an extended period. CS 120            Participant CS 120 recently concluded a remarkable decade-long Dungeons & Dragons (D&D) campaign, culminating in defeating the formidable Big Bad adversary. A noteworthy and humorous aspect of this epic saga was the discovery of a significant artifact, a sword, right at the campaign's outset, only to have its true importance revealed an entire decade later. Having participated in thousands of D&D sessions, CS 120 recounted a memorable moment when a fellow player delivered the final killing blow to signify the end of this era. This player portrayed a larger-than-life character with an avid passion for horror movies, adding a unique flavor to the campaign. For CS 120, D&D has played a multifaceted role, touching upon various aspects of mental health and social needs. While engaging in the game, they found themselves unconsciously processing thoughts and emotions, highlighting the therapeutic potential of D&D. Their enthusiasm for rolling dice extended to facilitating enjoyment for fellow players, exemplified by their fondness for Table Fables. D&D has served as a valuable outlet for enhancing mental well-being and addressing social needs. As an English major, CS 120 deeply appreciates the diverse archetypes present in D&D, particularly favoring underdog, and comedic relief archetypes. DISSERTATION ON DUNGEON & DRAGONS                                                               147           D&D's unintentional yet profound impact on their life became increasingly evident, helping them navigate challenges related to post-traumatic stress disorder (PTSD), social anxiety, and attention-deficit/hyperactivity disorder (ADHD). They described the experience as a positive release, with their empathetic nature fostering enjoyment when their fellow players shared the joy of the game. Additionally, D&D has been instrumental in alleviating social anxiety, aiding in the socialization process among a circle of like-minded friends who share a passion for the game. In this community of enthusiasts, they have emphasized the absence of rule lawyers who meticulously scrutinize game mechanics, preferring a more cooperative and fluid style of play. Notably, CS 120 frequently assumes the role of Dungeon Master (DM), affording them unique insights into the experiences and challenges faced by players. This perspective allows them to incorporate personal knowledge of fellow players' experiences into the game, enhancing the overall gaming experience. Positive experiences have marked their journey with D&D, and they have found solace in rolling for characters and using marijuana as a means of character development, particularly to mitigate the nightmares associated with PTSD. CS 120's narrative underscores the profound and diverse ways D&D can impact mental health, social dynamics, and personal growth over an extended engagement period. CS 122            Participant CS 122's engagement with Dungeons & Dragons (D&D) was initially influenced by a therapist's suggestion, drawing parallels with a therapeutic construct employed to aid in coping with a breakup. Intrigued by this concept, CS 122 ventured into the realm of D&D, joining a therapy group where the experience was notably enjoyable. Over a year, they partook DISSERTATION ON DUNGEON & DRAGONS                                                               148           in a single campaign, humorously earning the "herding cats" moniker due to the group's unpredictable nature. In this campaign, the group defied the Dungeon Master's (DM) intentions by successfully overcoming a demon, deviating from the DM's planned narrative. Throughout this D&D journey, CS 122 exclusively portrayed a Wizard character. This choice aligns with her affinity for the game, representing a community space that adhered to a structured schedule. This experience was precious in mitigating feelings of failure within the group context, offering a constructive outlet for processing grief and loss. Her Wizard character was deliberately crafted as an antithesis of herself, granting her a sense of empowerment at a time when she felt powerless. CS 122's interests and aspirations influence her character creation, encompassing qualities and skills she desires. She intentionally harnessed D&D's therapeutic potential within a therapeutic setting to process a breakup. However, the journey was not devoid of challenges, as CS 122 grappled with general and social anxiety, which sometimes led her to a negative self-assessment. Self-doubt and self-judgment were recurring themes, manifested in the contrast between her character Luna's carefree nature and her reserved disposition. Nevertheless, the overarching impact of D&D on CS 122's life leaned towards the positive. While her predisposition occasionally led to self-criticism, the outcomes consistently proved beneficial, contributing to a sense of personal growth. Social anxiety and a sense of loss found a counterbalance within the supportive D&D community, characterized by non-judgmental and non-controlling individuals who excelled in attentive listening. DISSERTATION ON DUNGEON & DRAGONS                                                               149           The role of D&D in fostering creativity, maintaining engagement, and incorporating riddles added depth to the experience. CS 122's active participation in a D&D therapy group accentuates the therapeutic aspect of D&D, where the collective journey transcends the boundaries of the game and translates into meaningful personal growth. Her narrative exemplifies how D&D when situated within a therapeutic context, can provide a platform for individuals to navigate complex emotions, process challenges, and discover a supportive community. CS 124 Participant CS 124, a 33-year-old male engaged in a domestic partnership, found his way to Dungeons & Dragons (D&D) at the suggestion of his therapist, seeking respite from the challenges of real-life stressors. Intrigued by the therapeutic potential of D&D, he harbors a fondness for high fantasy and has been engaged with the game for two decades, with nine months of therapeutic involvement. In response to pent-up pandemic-induced anger, CS 124 channeled his emotions by adopting the role of a Barbarian character. Throughout his extensive D&D journey, he has assumed the persona of a Rogue named Captain Tickle Seacrest, a character marked by the ironic trait of being ticklish.  While D&D gameplay can entail moments of stress, CS 124 acknowledged its role in helping him manage anger and rage. The thematic connection of water in his character's backstory, aligned with his profession as a commercial swimming instructor, provided an outlet to address and express his emotions constructively. For him, D&D served as a platform to play out anger stemming from childhood trauma in a safe and healthy space, allowing for therapeutic processing.  DISSERTATION ON DUNGEON & DRAGONS                                                               150           Despite contending with OCD and anger issues, his overall D&D experience has been positive, enabling him to confront and manage his emotions, especially anger. CS 124 thrives in D&D scenarios that allow for the safe expression of rage. He values the supportive community of friends and therapy in D&D. He appreciates the role of a Dungeon Master (DM) who establishes a comfortable environment, facilitating opportunities for personal growth, creativity, and organic storytelling. Currently engaged in a therapeutic D&D group, he parallels his love for D&D and his passion for anime with a vast collection of Thai fantasy books. CS 126            Participant CS 126, a 22-year-old single female, was drawn to Dungeons & Dragons (D&D) out of sheer love for the game and a desire to explore its captivating content. Having been part of a circle of friends for over a decade, she has been engaged with D&D for twelve years and holds two distinct characters close to her heart: Winter van Horn, the Dragon Slayer, and her current persona, Ruth Sovngarde. Her D&D experience comprises participation in both a Home Brew game featuring her Dragon Slayer character and a current campaign masterfully crafted by Ruth, the Dungeon Master.  CS 126 identifies D&D as a creative outlet and an escape from the rigors of her academic pursuit in Molecular Biology, a field laden with pressure and responsibilities. Beyond its role as an escape, D&D has proven instrumental in assisting her in coping with OCD and depression. The game provided a platform to confront personal feelings of betrayal, enabling her to derive therapeutic value from the experience.  DISSERTATION ON DUNGEON & DRAGONS                                                               151           Through her character, Winter, she sought to embody the leadership, confidence, and arrogance she aspires to develop. In navigating life's challenges, CS 126 found solace in D&D and attributed her character-building process to personal growth. She cherishes the collaborative nature of D&D gameplay, celebrating the virtues of improvisation, creativity, and multitasking. Impressive narratives have marked her engagement in storytelling within the game. With a notably positive overall D&D experience, CS 126 acknowledges the game's potential for therapeutic and personal development and continues her academic journey at Liberty University. Results Analyzing participant responses regarding the relationship between character development in Dungeons & Dragons (D&D) and their diagnosed mental illness, alongside associated inquiries, reveals insights across four key themes. Firstly, participants described using D&D to explore various facets of their identities through imaginative portrayal, aligning with the theme of "Realms of Imagination, Therapeutic Exploration, and Release." This theme resonates with, as participants found relief from stress by immersing themselves in the imaginative world of D&D. Stress Reduction Theory Secondly, participants crafted characters with emotional complexity, facilitating immersive role-playing experiences, which reflects the theme of "Emotional Depth, Escapism, and Interconnected Realities." This theme is consistent with Internal Family Systems Model (IFS), as participants navigated internal conflicts through their characters, and Foa's Associative Network Theory, as they processed trauma within the game's narratives.  DISSERTATION ON DUNGEON & DRAGONS                                                               152           Additionally, participants highlighted the therapeutic benefits of engaging with D&D elements, illustrating the stress-relieving potential of the game, aligning with the theme of "Coping and Stress Reduction." This theme correlates with Social Learning Theory, as participants learned coping strategies from modeled behaviors within the gaming community, and Decision Theory, as they made strategic decisions to navigate challenges within the game.  Lastly, participants emphasized the social dynamics and sense of belonging within D&D groups, underscoring the theme of "Diversity, Belonging, and Harmonious Dynamics." This theme resonates with Social Theory, as participants negotiated societal norms within the game's structured environment, and Social-Ecology Theory, as they navigated the nested systems of their gaming experience. Themes The descriptions of the themes were used as the foundational framework for constructing findings in Chapter Four. However, when presenting these themes, it was imperative to integrate verbatim quotations from the participants' responses, adhering to the guidelines outlined by Braun and Clarke (2019). The analysis of the interview responses from the participants provided four themes. Each of these themes contributes a distinct brushstroke to the participants' collective narrative, portraying a holistic and multifaceted portrait of their Dungeons & Dragons odyssey.  1. Realms of Imagination, Therapeutic Exploration and Release 2. Emotional Depth, Escapism, and Interconnected Realities DISSERTATION ON DUNGEON & DRAGONS                                                               153           3. Coping and Stress Reduction 4. Diversity, Belonging, and Harmonious Dynamics Realms of Imagination, Therapeutic Exploration and Release This theme unfolds as a captivating tapestry, capturing the essence of imaginative exploration, therapeutic role-playing, and the manifestation of creative concepts. Participants embark on profound journeys within the realms of fantasy, discovering the therapeutic potential of Dungeons & Dragons. The intentional crafting of diverse personas serves as a medium for escapism, self-discovery, and overcoming traumatic memories. This theme celebrates the boundless exploration of imagination and the nuanced portrayal of varied identities within the fantastical realms of the game. For a concise overview of participant responses, please refer to Table 2. Table 2  Interview Question #1- Why did you decide to participate in this study?  Participant Identifier Response CS101 "I wanted to contribute to understanding the therapeutic benefits of D&D."  CS102 "I chose D&D because I heard it could be therapeutic for mental health."  CS110 "I use D&D for my mental health struggles." CS114 "I use D&D as an educational tool but can see therapeutic intervention potential."  DISSERTATION ON DUNGEON & DRAGONS                                                               154           CS118 "I have used D&D with young people myself, and I see it as a way to help them."  CS120 "D&D has been the most constant thing in my life and has helped me with my mental health issues." CS122  "The idea of using D&D in this way fascinated me, and I find it helpful for processing grief and loss."  CS124 "The idea of using D&D in this way fascinated me; it has helped me deal with anger and rage."  CS126 "D&D helps me escape from the pressure and responsibilities of my life, providing a creative outlet."    Interview Question #2- Do you mind sharing what factors played a role in this decision? Participant Identifiers Response CS101 "I used the game myself for mental health."  CS110 "I use D&D for my mental health struggles."  CS114 "I have used D&D with young people myself, and I see it as a way to help them."  CS120 "D&D has been the most constant thing in my life and has helped me with my mental health issues."  CS122 "My therapist suggested using D&D as a way to help with a break-up, and it has been helpful for me."  CS124 "My therapist suggested using D&D to escape from real-life stressors, and it has been effective for me."    DISSERTATION ON DUNGEON & DRAGONS                                                               155           Interview Question #3 What interested you in the D&D game? Participant Identifiers Response CS101 “I used the game myself for mental health - Star Wars, Lord of the Rings, Fantasy, Science Fiction.”  CS102 “Thought it to be interesting - Friends in College.”  CS103 “Great potential for the field - Used it in practice and with daughter - Friends and Sub Teacher.”  CS104 “It sounded cool - Something I have used and has talked to play therapist friends about - Friends.”  CS105 “Interesting Topic/played long time - Been playing a long time-interesting - Fantasy, lore, books.”  CS107 “Helped me with mom's completed suicide - Friend.”  CS110  “I used for my mental health struggles - Felt it needs to be brought to attention as use for mental health - Friends had a book and would draw up things from book.”  CS111 “Content - Thought this study may one day help me as well. Help me understand others expand my ability to have a good relationship with those I never would have previously - Cousin, Lord of the Rings, Star Wars.”  CS113 “Content - Interested in the potential link of D&D to mental health help - Friend through podcast and sister.”  CS114 “I have used with young people myself - I use as an educational tool but can see therapeutic intervention potential-play with son - Fictional Fantasy fan, Sci-Fi-summer camp.”  CS115 “D&D Aspect/Content - D&D aspect was intriguing, started playing after the Navy-Escape - Friend, Science partner.”  DISSERTATION ON DUNGEON & DRAGONS                                                               156           CS116 “Content - I know how difficult it can be communicating with people, I am on the spectrum and have social anxiety, when I play D&D I don't struggle - I am a storyteller, so I decided to try.”  CS117 “Interesting Topic - Finally someone is doing a thing that needs to be done; a topic that is cool and easy to engage with D&D especially celebrities in mom's basement - Friends/Acquaintances who wanted to teach others.”  CS118 “Content/Brother - Sibling also took survey and told her about it. - Best Friend and Brother.”  CS119 “Content/Brother-in-Law - originally, a reason to hang out with friends, now a DM part-time, brother-in-law told him about it, up for anything. - Friends and Wife.”  CS120 “I have a lot of mental health issues - D&D has been the most constant thing in my life - Bullied as a kid/found "more" with group of nerds playing D&D.”  CS122 “Therapist suggested/content - Therapist used similar construct to help with a breakup - Joined a therapy group and enjoyed it in that space.”  CS124 “Therapist suggested/content - Used D&D to escape from real life stressors - The idea of using D&D in this way fascinated him; likes high fantasy.”  CS126 “Content - Loves D&D and thought "why not?" - Friends.”    Interview Question #5 Would you mind telling me your favorite D&D moment?  Participant Identifiers Response             CS101 “Venturing into the fantastical realms of Dungeons and Dragons serves as a therapeutic outlet for a male player, providing a space for exploration and release from real-world challenges.”             CS102 “For a female player, the imaginative landscapes of Dungeons and Dragons offer a realm of exploration and discovery, providing a therapeutic escape from the stresses of daily life.”                       CS103 “Engaging in role-playing with friends becomes a form of therapeutic exploration for a male player, allowing him to delve into the depths of imagination and find release from personal struggles.” DISSERTATION ON DUNGEON & DRAGONS                                                               157            CS104 “Through the immersive experience of Dungeons and Dragons, a female player finds therapeutic release as she navigates emotional depth within the game, exploring complex themes and narratives.” CS105  “For a female player, the fantasy world of Dungeons and Dragons provides an avenue for escapism, offering respite from real-world challenges and a space for interconnected realities to unfold.”  CS110 “Finding solace and stress reduction within the game, a male player utilizes Dungeons and Dragons as a coping mechanism, immersing himself in the fantasy realm to escape from real-life pressures.”  CS111 “Through the lens of Dungeons and Dragons, a male player explores themes of diversity and belonging, finding harmonious dynamics within the game that mirror his real-world experiences.”  CS113 “Embracing the therapeutic potential of Dungeons and Dragons, a male player utilizes the game as a tool for stress reduction, finding solace and support within the imaginative world of role-playing.”  CS114 “Engaging with Dungeons and Dragons becomes a form of therapeutic exploration for a male player, allowing him to navigate emotional depth and find release from personal struggles through storytelling and role-playing.”  CS115 “Discovering a sense of diversity and belonging within the game, a male player uses Dungeons and Dragons as a coping mechanism to navigate past experiences of bullying and find connection with others.”  CS116 “Through the immersive storytelling of Dungeons and Dragons, a male player finds therapeutic release as he delves into emotional depth and copes with real-life challenges through escapism and exploration.”  CS117 “For a non-binary player, the inclusive and diverse world of Dungeons and Dragons provides a sense of belonging and acceptance, offering a therapeutic escape from real-world anxieties.”  CS118 “Returning to the game after personal challenges, a female player finds therapeutic release and stress reduction within the immersive world of Dungeons and Dragons, experiencing interconnected realities and harmonious dynamics.” DISSERTATION ON DUNGEON & DRAGONS                                                               158            CS119 “Utilizing Dungeons and Dragons as a coping mechanism, a male player finds solace and stress reduction through therapeutic exploration, embracing the diversity and belonging offered within the game.”  CS120 “Immersed in the imaginative landscapes of Dungeons and Dragons, a male player finds therapeutic release and coping strategies, utilizing escapism and interconnected realities to navigate emotional depth and find belonging within the game.”  CS122 “Engaging in Dungeons and Dragons becomes a therapeutic journey for a female player, offering coping mechanisms and stress reduction through exploration of diverse and interconnected realities within the game world.”  CS124 “Through the immersive storytelling of Dungeons and Dragons, a male player finds therapeutic release and stress reduction, channeling emotional depth and coping with real-life challenges through the game's escapist elements.”  CS126 “Finding comfort and belonging within the game, a female player utilizes Dungeons and Dragons as a therapeutic outlet, exploring emotional depth and interconnected realities to cope with personal struggles and find release within the fantasy realm.”  Interview Question #7 Describe your favorite character and why they were such a favorite. Participant Identifiers Responses CS101 “I [delve] into the realm of fantasy, embodying the character of Drag the Elf, whose tragic past and quest for justice reflect the depths of imagination within Dungeons and Dragons.”  CS102 “Through the creation of Penny the Paladin, a female player explores the realms of imagination, crafting a character who embodies strength and protection, riding alongside a loyal horse named Penny.”  CS103 “Within the urban fantasy genre, a male player delves into the imaginative world of Jacqueline, spanning three generations of characters, each reflecting the creative depth of storytelling.”  DISSERTATION ON DUNGEON & DRAGONS                                                               159           CS104 “As an Art Officer, a female player channels her creativity into Dungeons and Dragons, crafting characters and scenarios that showcase the vast realms of imagination within the game.” CS105 “Transitioning from a rogue to an alter ego paladin, a female player explores the diverse realms of imagination within Dungeons and Dragons, connecting with her characters on a profound level.”  CS107 “Through the journey of a Celestial Warlock, a female player navigates trauma and growth, finding therapeutic release and emotional depth within the imaginative landscapes of Dungeons and Dragons.”  CS110 “Attached to his character Ken Traylor, a male player finds solace and self-expression, exploring new horizons and experiences within the game as a form of therapeutic exploration.”   CS111 “Immersed in the character of Kureg with a god complex, a male player explores themes of power and identity, utilizing Dungeons and Dragons as a therapeutic tool for self-reflection.”  CS118 “Finding strength and empowerment through the character of Rylen, a female player experiences therapeutic release, embodying qualities opposite to her own and navigating challenges within the game.” “Helped me see and be parts of me I hid from others. Social anxiety.”   CS119 “Gave me a social scene, having grown up on a farm. Short term escape from work, stressors, decompress, be someone else, mental freedom/vacation.”  CS122 “Community space, it was scheduled so had to do it, she didn't feel like a failure in the group, grief and loss.”  CS126 “Creative outlet, escape.”  Interview Question #9 Help me understand how you came to choose D&D as a tool related to your mental health? Participant Identifiers Response CS101 “Used to help with grief.”  CS103 “Helped daughter with being bullied.” DISSERTATION ON DUNGEON & DRAGONS                                                               160            CS107 “Helped with grief of mom's suicide and processing it.”  CS110 “A way to step back, reset, help with anger, recently used as help with frustration with a realtor.”  CS111 “Help with Army basic mindset, anger and insomnia, depression and anxiety by specific characters and creativity.”  CS114 “Relaxation tool, de-stressor.”  CS115 “Helped with past of being bullied.”  CS116 “Helped with social anxiety - communication.”  CS117 “Uses it for social anxiety and lack of social cue identification with ASD, trauma work, with arachnophobia.”  CS118 “Helped me see and be parts of me I hid from others. Social anxiety.” CS119 “Gave me a social scene, having grown up on a farm. Short term escape from work, stressors, decompress, be someone else, mental freedom/vacation.”  CS122 “Community space, it was scheduled so had to do it, she didn't feel like a failure in the group, grief and loss.”  CS126 “Creative outlet, escape.”   Interview Question #10 What is your selection process for character building? Participant Identifiers Response CS101 “Create characters based on my own stuff.”  CS103 “Offset from my experiences and need to be opposite of me at times.”  CS104 “Mood, struggles with, have to have in mind or come up with on spot, played all wanted, brain says what now?”  CS105 “We live in fantasy, create chaos it is our therapy, there is a generational cultural component.” DISSERTATION ON DUNGEON & DRAGONS                                                               161            CS107 “No overlap, roles are covered, based on story they created (i.e., Doom & Gloom, Halloween theme, etc.).”  CS110 “Pick something randomly and develop it; currently working on a fellow player's idea of 50 levels to play.”  CS114 “Backstory, roles, diversity.”  CS115 “Based on me and exact opposite of me, helps the little guy.”  CS116 “Starts with an idea from the campaign to be played.”   CS117 “Looks up a picture that happens in the same scene, has folder full of potential characters, hasn't played most of them yet.”  CS118 “Ryan was shunned by society and lived in darkness; I connected with this; Random Gnome, Bard inspires those around her (I hope I do this) her weapon is a frying pan (I am a mom of 6 with special needs).” CS119 “Concept, does this resonate with me? Take it put it in a folder for later, sometimes forgotten and re-found.”  CS120 “I love to roll for the player! Table Fables.”  CS122 “Community space, it was scheduled so had to do it, she didn't feel like a failure in the group, grief and loss.”  CS126 “Race, background, plot, how to make interesting, edgy, trauma? Motivations and adventures.”  Interview Question #11 What characteristics did you choose for your characters and why? Participant Identifiers Response CS101 “Items from my own mental health, ADD, i.e., chaos.”  CS103 “Embodied parts of self into ‘Jacqueline’.”  CS104 “Has loyalty, cares about, detrimental at times to self.”  CS110 “Exalted character, promoted to saint, goodest of boys, God of Love, romantic, music.”  DISSERTATION ON DUNGEON & DRAGONS                                                               162            CS111 “Kureg, God Complex, the story was cool.”  CS113 “Social Anxiety by jumping in and doing it.”  CS114 “Connection to my own interests for a framework of understanding (i.e., Monk with woodworking skills).”  CS115 “Based on me and exact opposite of me, helps the little guy.” “Kindness, empathy.”   CS116 “Likes shiny things, pretentious, eccentric.”   CS119 “Not completely dissimilar but some ways opposite from me in real life.”  CS120 “Helped me with my mental health and social needs.”  CS122 “Power since I felt I had none.”  CS124 “I am a commercial swimming instructor, helps with rage and anger.” CS126 “Yes, helped me overcome personal feelings of betrayal.”  Interview Question # 12 Do you yourself feel you have some of these same characteristics or are they ones you wish you possessed? Participant Identifiers Response CS103 “The opposite of me quite often/invisible, do magical things, have immense power/be a thief in-game.”  CS110 “Can portray so must be capable of these characteristics.”  CS111 “Superiority Complex. I am smarter than most people, all characters have pieces of self in them.”  CS113 “No, this is why it helps to play them out.”  CS114 “In some ways yes, but I stick to my own interests mostly.”  DISSERTATION ON DUNGEON & DRAGONS                                                               163           CS115 “Yes, in some ways, I am them, others like being the little guy I have also experienced.” CS116 “Being outspoken which I definitely am not, dumb brute force like the Hulk.”  CS117 “Wants to play someone fantastic, first character was human and great.”  CS118 “To express parts of my personality that I did not have the ability to in other environments.”  CS120 “Archetypes (I am an English Major) the underdogs and comedic relief of archetypes.”  CS122 “Off of her interests and things she would want to be good at.”  CS124 “I get to play out the anger in a healthy space.”  CS126 “’Winter’ was one I wished I were more like at the time, so I poured leadership and confidence and arrogance into her.”   Interview Question #13 How are these characteristics meaningful to you? Participant Identifiers Response CS101 “The opposite of me quite often/invisible, do magical things, have immense power/be a thief in-game. I am too serious so I will play a satyr who is female and fun/chaotic good.”  CS104 “: Learned red flags in real life through character play. Depression/anxiety/panic step out to escape.”  CS107 “Likes to play the same character who is a well-rounded player. Helped process trauma.” CS110 “Can portray so must be capable of these characteristics.”  CS113 “Superiority Complex. I am smarter than most people; all characters have pieces of self in them. Army stuff.”  CS114 “Superiority Complex. I am smarter than most people; all characters have pieces of self in them. Army stuff.”  CS115 “Yes, in some ways I am them, others like being the little guy I have also experienced. History of being bullied, in Navy.” DISSERTATION ON DUNGEON & DRAGONS                                                               164            CS116 “Being outspoken which, I am not, dumb brute force like the Hulk. Helps me fill in my own gaps.”  CS117 “Wants to play someone fantastic; first character was human and great. I am a real person trying to create a real person, so I infuse myself whether I want to or not.”  CS120 “Archetypes (I am an English Major) the underdogs and comedic relief of archetypes. Social needs.”  CS122 “Off of her interests and things she would want to be good at. Helped me process a breakup.”  CS124 “I get to play out the anger in a healthy space. Help with anger from childhood trauma.”  Interview Question # 14 Does your mental health diagnosis influence your gameplay? Or does your character influence the diagnoses in either a healthy or harmful way? Participant Identifiers Response CS101 “They are ones I have. Absolutely.” CS102 “For sure. Unintentionally/Passively/Typecasted.” CS103 “The opposite of me quite often/invisible, do magical things, have immense power/be a thief in the game. Yes, I played who came back from war (Army), it was me, talked about my inner stuff in the game unintentionally.” CS104 “Learned red flags in real life through character play. Yes, helps me to escape when big feelings arise.” CS105 “Not racist, chaos, part of my backstory. We are not a sensitive group, it is personal at times, not outright or on purpose at times. CS107 “Likes to play the same character who is a well-rounded player. Absolutely, triggers about dead babies or aborted fetuses (works in NIC-U as RN).” DISSERTATION ON DUNGEON & DRAGONS                                                               165           CS110 “Can portray so must be capable of these characteristics. Characters deal with dx, both positive and negative; get attached become part of me, when major things happen to me it then happens to them.” CS111 “Superiority Complex. I am smarter than most people; all characters have pieces of self in them. When I cannot sleep, I play with characters to help my mood, Bards for Depression and Ranger for Anxiety; creating one-shots to help with creativity which helps me sleep, friends keep me in check to things I have been blind to about myself in the past.” CS113 “No, this is why it helps to play them out. Representative of some of my feelings like torn between responsibilities of his occupation and life.” CS114 “In some ways yes, but I stick to my own interests mostly. Unintentionally.” CS115 “Yes, in some ways I am them, others like being the little guy I have also experienced. Unintentionally.” CS116 “Being outspoken which I am not, dumb brute force like the Hulk. Intentionally, yes. CS117 “Wants to play someone fantastic; first character was human and great. Yes, sometimes unintentionally.” CS118 “To express parts of my personality that I did not have the ability to in other environments. Absolutely, yes, at the very least an escape. CS119 “I am blunt in real life, so a Rogue but I incorporate cloak, dagger, problem-solving skills. Escape, Decompress.” CS120 “Archetypes (I am an English Major) the underdogs and comedic relief of archetypes. Unintentionally, then sudden awareness it did.” DISSERTATION ON DUNGEON & DRAGONS                                                               166           CS122 “Off of her interests and things she would want to be good at. Yes, it was extremely helpful on purpose because it was in a therapy setting. CS124 “I get to play out the anger in a healthy space. Yes, being able to process in a unique way than realizing it-cool. I am enraged as Barbarian does not avoid it.” CS126 “Winter was one I wished I were more like at the time, so I poured leadership and confidence and arrogance into her. Helps with my OCD and Depression.”  Emotional Depth, Escapism, and Interconnected Realities Immersive role-playing in Dungeons and Dragons serves as a poignant motif, delving into emotional depths, escapism, self-expression, resonance, belonging, and connections forged within its fantastical realms. This theme explores how the game becomes a transformative tool for understanding one's identity, unraveling intricate emotional landscapes, and experiencing therapeutic enchantment. It navigates the authentic impact of diverse roles on participants' emotional tapestry, highlighting the profound connections and resonances found within character interactions. Table 3 provides a summary of participant responses, illuminating the multifaceted ways in which Dungeons and Dragons influence and enriches their emotional experiences. Table 3 Interview Question #7 Describe your favorite character and why they were such a favorite. Participant Identifiers Response CS115 “From the creation of Rose, as a male player infuses emotional depth into his characters, exploring aspects of his personality and DISSERTATION ON DUNGEON & DRAGONS                                                               167           experiences through the imaginative escape provided by Dungeons and Dragons.”  CS117 “Transitioning from an NPC to a Lord, a non-binary player delves into emotional depth and escapism, embodying characters that evolve and grow within the immersive world of Dungeons and Dragons.”   “As Captain Tickle Seacrest, a male player finds escapism and humor within the game, infusing emotional depth into his rogue character through ironic traits that provide a lighthearted escape from reality.”  Interview Question #9 Help me understand how you came to choose D&D as a tool related to your mental health? Participant Identifiers Response CS102 “With complex emotions and moral ambiguity (Army/war).”  CS105 “I am a Rogue, who moved around a lot as a child.”  CS120 “It was tricky because in the moment I did not realize I was  processing things.”   Interview Question # 15 Did you take your mental health diagnoses into consideration when developing this character? Have you in the past if not with this one? Participant Identifiers Response CS101 “Yes, for sure ADHD, ODD, Anger, Grief.” CS102 “Depression Panic Attacks and Anxiety.” CS103 “Depression, Anger.” DISSERTATION ON DUNGEON & DRAGONS                                                               168           CS104 “Depression, Anxiety, Bipolar, PTSD, Dissociation, Schizoaffective Disorder.” CS105 “Anxiety Disorders, ADHD.”  CS107 “Anxiety/Depression/Grief.” CS110 “Chronic Anxiety, Excessive Rumination, History of Auditory Hallucinations, Bipolar with Psychotic features.” CS111 “Depression, Anxiety, Insomnia, Anger.” CS113 “Social Anxiety, ASD, Depression, Anxiety, ADHD.” CS114 “ADHD, Depression in Remission.” CS115 “Depression, Bullied.” CS116 “ASD, ADHD.” CS117 “Arachnophobia, ADHD-impulsive subtype, ASD, MDD, Gender Dysphoria.” CS118 “Depression, Anxiety, Graves’ Disease.” CS119 “Depression in Remission.” CS120 “PTSD, Social Anxiety, ADHD.” CS122 “General Anxiety, Social Anxiety.” CS124 “OCD, Anger.” CS126 “OCD, Depression.”  Interview Question #16 Does this character affect your feelings (positively or negatively)? Participant Identifiers Response CS101 “Both, but mainly positive release.” CS102 “Yes, both.” CS103 “Processing as a vehicle to process war trauma/pain and anger/resentment towards civilians.” CS104 “Yes, emotions inside can help outside both positively and negatively.” DISSERTATION ON DUNGEON & DRAGONS                                                               169           CS105 “Both, but mainly positive release.” CS107 “Yes, both.” CS110 “Step away, refresh, escape from an escape he is self-proclaimed rules lawyer.” CS111 “Positive Dark Elf-Ranger faced off against a young green dragon (Army).” CS113 “Positively helps with anxiety and social anxiety. CS114 “Yes, positively.” CS115 “Yes, positively.” CS116 “Yes, positively. I use my struggle with focus, for example, to fit the character.” CS117 “Yes, definitely positive.” CS118 “Playing with the friends I met in the game helped me feel connected/supported like I had never felt before.” CS119 “Subconsciously at times, but Socar was one I was really positive about, how I met my wife/was self-confident.” CS120 “Yes, positive release.” CS120 “Negative because I can get in my own head, but it always works out positively.” CS122 “Positive, got to have my feelings in a safe place.” CS124 “Positive, got to have my feelings in a safe place.” CS126 “Positive - ‘Ruth’ faced betrayal, and it was hard to recover, but she denounced all who hurt her.”  Interview Question #17 If so, how do you experience those feelings inside the game and in your real life? Participant Identifiers Response CS101 “Helps me in real-life situations; what would the character do here?” CS102 “Absolutely, helped with moral ambiguity” DISSERTATION ON DUNGEON & DRAGONS                                                               170           CS103 “Processing as a vehicle to process war trauma/pain and anger/resentment towards civilians.” CS104 “Easy for me to recognize the feeling triggered in the game and work through it.” CS105 “Helps me in real life; after all, I have mixed-race kids with a racist father.” CS107 “Process grief from mom's suicide.” CS110 “Helps me in and out of the game, more out of the game because I think about problems and what happened to use in real life.” CS111 “When in basic used storylines of character to cope with indentured servitude of the Army.” CS113 “Try to translate into work communication.” CS114 “Use for de-stressor but have witnessed change and help in young people I work with.” CS115 “Helped me feel connected.” CS116 “Helps my communication; my mom says I live in my own world anyway.” CS117 “Fantastical immersion to help with arachnophobia.” CS118 “Playing is a recharge; if I can do this here, I can do in real life.” CS119 “Helps me when I fail; the downtime is very momentary, I recoup faster.” CS120 “I am an empath, so I have fun when my players are; helps me socialize.” CS124 “Helps with anger.” CS126 “Get past betrayal, sit with it, understand and process where hurt was from, work backward.”   DISSERTATION ON DUNGEON & DRAGONS                                                               171           Interview Question #18 Do you feel that your character helps you process your trauma? How does this occur? Participant Identifiers Response CS101 “For sure-it is all in the choice of character!” CS102 “Helps with Anxiety.” CS103 “Pain, anger, and resentment turned to journaling became positive, cathartic.” CS104 “Yes” CS105 “Helps fight for equality, positive change.”   CS107 “Yes! Grief.”  CS110 “Abused and bullied by classmates, helped work through the pain of that, escape from reality, only thing that kept him from doing dumb things instead.”  CS111 “Yes, it helped me through Army basic training, reliving what character did to give me the ability to cope, took a stumble and messed ankle up, broke my soul, turned me into a soldier, escape from my escape.” CS113 “Social anxiety yes with socialization.   CS114 “Yes, the bullying.”  CS115 “Yes, social and in phobia.”  CS117 “Yes, social and in phobia.”  DISSERTATION ON DUNGEON & DRAGONS                                                               172           CS118 “Yes, grief, ‘Ryan's’ father dies, her father dies, made dead an actionable thing, removed helpless feeling-helped her process (grief).” CS119 “Every time helps him socialize and become more comfortable with socializing as a whole, a sense of community.”  CS120 “Social anxiety yes with socialization.”   CS122 “Social Anxiety and Loss-community.” CS124 “Scenarios where I could rage safely.”  CS126 “Yes, in ‘fixing’ the character I did the same for myself.”  Interview Question # 19 Can you tell me about the process of choosing a particular D&D group that meets your goals for the game? Participant Identifiers Response CS101 "I draw inspiration from my sister, who is a great storyteller, finding solace and release in the imaginative realms of Dungeons and Dragons." CS102 "Being a good storyteller allows me to consistently introduce characters and plots, providing a coping mechanism and stress reduction outlet in the rich narratives of Dungeons and Dragons." CS105 “"As a dedicated storyteller, I ensure a safe space in Dungeons and Dragons, fostering therapeutic exploration and stress reduction through immersive storytelling."  CS107 "I prioritize safety tools and clear expectations, fostering therapeutic exploration and stress reduction in Dungeons and Dragons for all participants." DISSERTATION ON DUNGEON & DRAGONS                                                               173            CS114 "Session Zero sets the stage for therapeutic exploration and stress reduction in Dungeons and Dragons, establishing open communication and emotional depth from the start."  CS117 "Recognizing the importance of the Dungeon Master role and Session Zero, I promote therapeutic exploration and stress reduction in Dungeons and Dragons, proactively addressing triggers and creating a supportive gaming environment."   CS119 Taking on multiple roles in the game, I guide therapeutic exploration and stress reduction in Dungeons and Dragons, providing direction and empathy for all participants."  CS122 "Creating a non-judgmental and inclusive environment is key to promoting therapeutic exploration and stress reduction in Dungeons and Dragons, where everyone feels valued and respected."  CS124 "As a Dungeon Master, I leverage comfort levels and learned lessons to facilitate therapeutic exploration and stress reduction in Dungeons and Dragons, guiding players through immersive storytelling."  Interview Question # 21 Have you had DMs who created themes based on goals to process mental health? Participant Identifiers Response CS101 “Sister who is a great storyteller or me. Done unintentionally.” DISSERTATION ON DUNGEON & DRAGONS                                                               174           CS102 “Good Storyteller, Consistent with introducing characters and plots. Yes, surrounding suicide and choosing another way.” CS105 “Good role player, good dynamics, no rule lawyers, or murder hobos. His/her world, make rules, God of the world, lots of time invested.” CS110 “Creativity, willingness to follow the rule of awesome "rule of cool". Yes, session zero DM goes over triggers then creates the theme.” CS111 “Creativity, look for archetypes, characteristics that meld well with my intelligence. I usually DM, control the game.” CS114 “Session Zero is important. Yes, I have for my young people, helped trans teen with gender dysphoria transition, ASD kid socializes.” CS115 “Session Zero is important. Yes, helped a player process through some of his personal problems.” CS117 “Have a session zero, DM most important thing, I have left a game over it to identify triggers pre-campaign. Yes, with my arachnophobia.” CS118 “Can read people, no rule lawyer, session zero. Yes, both intentionally and very intentionally (grief).” CS119 “Group leader, storyteller, narrator, directional. Yes. the campaign I was in when I met my wife, I was thinking of running a campaign, so I designed a spreadsheet asking about triggers etc., a session zero of sorts, I wanted to be aware of potential triggers.” CS120 “No rule lawyers they do not read the entire spell. Yes, I am a DM most of the time and I often know what people are dealing with and incorporate it.” DISSERTATION ON DUNGEON & DRAGONS                                                               175           CS122 “Non-judgmental, non-controlling, listeners. Creativity, keep members on their toes, Riddle aspect.” CS124 “DM where comfort level is already established, ability to learn lessons that may not be your own. Creativity, allowing organics to happen.” CS126 “Good improv, Creative, multitasking. Yes, with impressive storytelling involved.” Coping and Stress Reduction This theme illuminates the coping mechanisms and stress reduction strategies embedded in Dungeons & Dragons. Participants use the game as a vessel for stress reduction, emotional release, and coping with various mental health challenges. Stressful real-life scenarios find an outlet in the game, and the immersive nature of Dungeons & Dragons becomes a therapeutic sanctuary. The theme underscores the game's role in providing a reprieve from everyday struggles. See Table 4 for a summary of the participant responses. Table 4 Interview Question #5 Would you mind telling me your favorite D&D moment?  Participant Identifiers Response CS119 “Through the character of Silcar, a male player finds coping mechanisms and stress reduction within Dungeons and Dragons, navigating challenges and forging connections within the game world.”  CS126 “Engaging as a Dragon Slayer in a Home Brew game, a female player utilizes Dungeons and Dragons as a coping mechanism, finding solace and stress reduction through immersive storytelling and gameplay.”   DISSERTATION ON DUNGEON & DRAGONS                                                               176           Interview Question #9 Help me understand how you came to choose D&D as a tool related to your mental health? Participant Identifiers Response CS104 “BDSM contract/go as far as needed/safe word.”  CS124 “Definitely can be stressful moments in the game but has helped with anger and rage.”   Interview Question # 15 Did you take your mental health diagnoses into consideration when developing this character? Have you in the past if not with this one? Participant Identifiers  Response CS101 “Yes, for sure ADHD, ODD, Anger, Grief.” CS102 “Depression Panic Attacks and Anxiety.” CS103 “Depression, Anger.” CS104 “Depression, Anxiety, Bipolar, PTSD, Dissociation, Schizoaffective Disorder.” CS105 “Anxiety Disorders, ADHD.”  CS107 “Anxiety/Depression/Grief.” CS110 “Chronic Anxiety, Excessive Rumination, History of Auditory Hallucinations, Bipolar with Psychotic features.” CS111 “Depression, Anxiety, Insomnia, Anger.” CS113 “Social Anxiety, ASD, Depression, Anxiety, ADHD.” CS114 “ADHD, Depression in Remission.” CS115 “Depression, Bullied.” CS116 “ASD, ADHD.” CS117 “Arachnophobia, ADHD-impulsive subtype, ASD, MDD, Gender Dysphoria.” CS118 “Depression, Anxiety, Graves’ Disease.” CS119 “Depression in Remission.” CS120 “PTSD, Social Anxiety, ADHD.” DISSERTATION ON DUNGEON & DRAGONS                                                               177           CS122 “General Anxiety, Social Anxiety.” CS124 “OCD, Anger.” CS126 “OCD, Depression.”  Interview Question # 20 Is the DM an important element of this choice? If so, why? Participant Identifiers Response CS101 "I draw inspiration from my sister, who is a great storyteller, finding solace and release in the imaginative realms of Dungeons and Dragons." CS102 "Being a good storyteller allows me to consistently introduce characters and plots, providing a coping mechanism and stress reduction outlet in the rich narratives of Dungeons and Dragons." CS105 "As a dedicated storyteller, I ensure a safe space in Dungeons and Dragons, fostering therapeutic exploration and stress reduction through immersive storytelling." CS107 "I prioritize safety tools and clear expectations, fostering therapeutic exploration and stress reduction in Dungeons and Dragons for all participants." CS114 "Session Zero sets the stage for therapeutic exploration and stress reduction in Dungeons and Dragons, establishing open communication and emotional depth from the start." CS117 "Recognizing the importance of the Dungeon Master role and Session Zero, I promote therapeutic exploration and stress reduction in Dungeons and Dragons, proactively addressing triggers and creating a supportive gaming environment." CS119 "Taking on multiple roles in the game, I guide therapeutic exploration and stress reduction in Dungeons and Dragons, providing direction and empathy for all participants." DISSERTATION ON DUNGEON & DRAGONS                                                               178           CS122 "Creating a non-judgmental and inclusive environment is key to promoting therapeutic exploration and stress reduction in Dungeons and Dragons, where everyone feels valued and respected." CS124 "As a Dungeon Master, I leverage comfort levels and learned lessons to facilitate therapeutic exploration and stress reduction in Dungeons and Dragons, guiding players through immersive storytelling." CS126 "Through improvisation, creativity, and multitasking, I find therapeutic exploration and stress reduction in Dungeons and Dragons, embracing the game's imaginative freedom to navigate challenges and emotions."  Diversity, Belonging, and Harmonious Dynamics In the collaborative venture of Dungeons & Dragons, diversity and balanced party dynamics emerge as a crucial theme. Participants navigate the intricacies of teamwork, forging connections that extend beyond the gaming table. The theme accentuates the intentional cultivation of diverse characters and the harmonious constructive collaboration required for a balanced and fulfilling gameplay experience. See Table 5 for a summary of the participant responses. Table 5 Interview Question #10 What is your selection process for character building? Participant Identifiers Response CS102 “Begin with class, see what is needed (gap).” CS111 “Roll for it. No one judges.” DISSERTATION ON DUNGEON & DRAGONS                                                               179           CS124 “They have association with water-always.”  Interview Question #11 What characteristics did you choose for your characters and why? Participant Identifiers Response CS102 “Neutral, good, or lawful.”  CS105 “Fighting for equality through characters, growing up in a racist home.” CS107 “Expressed feelings of not being good enough always pieces of her in them.” CS117 “Wizards of the Coast-moving away from the word race, humanoid background, use if commissioned by someone else."  CS118 “Wisdom, struggles with book smarts, does not talk with others well in real life, in-game she does. Fighting for equality (kids with special needs).”  Interview Question # 12 Do you yourself feel you have some of these same characteristics or are they ones you wish you possessed? Participant Identifiers Response CS101 “They are ones I have.” CS102 “For Sure” CS105 “Not racist, chaos, part of my backstory.”  CS107 “Likes to play the same character who is a well-rounded player.” CS119 “I am blunt in real life, so may be a Rogue but I incorporate cloak, dagger, problem-solving skills.”  DISSERTATION ON DUNGEON & DRAGONS                                                               180           Interview Question #13 How are these characteristics meaningful to you? Participant Identifiers Response CS101 “Raised in Christian Family, hid the game. Help me escape and process.” CS102 “Raised in Christian Family; rules part of my heart, being a good steward.” CS105 “Not racist, chaos, part of my backstory. Raised in a racist home, triggered in some sense, not sensitive group.” CS113 “No, this is why it helps to play them out. I struggle with social anxiety, and I am on the spectrum, gives me a place of belonging.”  CS118 “To express parts of my personality that I did not have the ability to in other environments. Escape and be more outgoing.” CS119 “I am blunt in real life, so a Rogue but I incorporate cloak, dagger, problem-solving skills. It gave me a social scene, having grown up on a farm. Short term escape from work, stressors, decompress, be someone else, mental freedom/vacation.” CS126 “‘Winter’ was one I wished I were more like at the time, so I poured leadership and confidence and arrogance into her. I am under a lot of pressure and have a lot of responsibilities. I study Molecular biology and so D&D helps me escape from that for a time.”    DISSERTATION ON DUNGEON & DRAGONS                                                               181           Theme Development            In this qualitative research, thematic analysis followed Braun and Clarke’s (2019) six-step guideline. The research employed Braun and Clarke's (2019) six-step thematic analysis process to extract themes and subthemes from the qualitative data. The steps involved are as follows: 1. Familiarization with the Data: 1. This researcher immersed me in the data, encompassing interviews, observations, documents, and field notes related to participants' Dungeons & Dragons (D&D) experiences. 2. This step facilitated a holistic understanding of the data. 2. Generating Initial Codes: 1. Systematic coding was conducted to label segments of the data, generating initial codes that encapsulated essential features or patterns. 2. Codes such as "Imagination," "Emotional Depth," and "Therapeutic Role-Playing" were assigned during this phase. 3. Searching for Themes: 1. Codes were then organized into potential themes, overarching patterns or concepts derived from the coded data. 2. Connections between codes were explored, leading to the identification of broader themes. DISSERTATION ON DUNGEON & DRAGONS                                                               182           3. Emerging themes could include categories like "Imagination and Role-Playing" or "Therapeutic Role-Playing, Coping, and Stress Reduction." 4. Reviewing Themes: 1. The identified themes underwent scrutiny to ensure they accurately represented the coded data and captured participants' experiences coherently. 2. The consistency and coherence of each theme were assessed in the context of the entire dataset. 5. Defining and Naming Themes: 1. Refined themes were clearly defined and named to articulate their meaning distinctly. 2. Definitions for themes such as "Imagination and Role-Playing" or "Therapeutic Role-Playing, Coping, and Stress Reduction" were established. 6. Producing a Report: 1. Findings were organized into a comprehensive report, presenting each theme alongside supporting evidence from the data, including participant quotes. 2. The report provided an in-depth exploration of the identified themes and subthemes, offering a nuanced understanding of participants' experiences with D&D. DISSERTATION ON DUNGEON & DRAGONS                                                               183           This process adhered to Braun and Clarke's guidelines, ensuring a systematic and rigorous thematic analysis that captured the richness of the qualitative data and provided valuable insights into the phenomena under investigation. The findings of this study underscore the multifaceted nature of Dungeons and Dragons (D&D) experiences, encapsulating the Realms of Imagination, Therapeutic Exploration and Release, Emotional Depth, Escapism, and Interconnected Realities, Coping and Stress Reduction, as well as Diversity, Belonging, and Harmonious Dynamics. Through qualitative analysis, participants revealed how D&D serves as a conduit for exploring imaginative realms, offering a therapeutic outlet for emotional exploration and release. The game's immersive narratives and interconnected realities provide a means of escapism from real-life stressors, promoting coping mechanisms and stress reduction. Furthermore, D&D fosters a sense of belonging and encourages diverse identities, promoting harmonious dynamics within its communities. These themes collectively highlight the transformative potential of D&D, highlighting its capacity to nurture emotional well-being, foster personal growth, and cultivate inclusive communities. Research Question Responses   In the nuance-rich exposition of participants' experiences within Dungeons & Dragons (D&D), a myriad of captivating stories unfolded, displaying the profound impact of this role-playing game across diverse backgrounds.  CS101, a 42-year-old divorced male, initially attracted by the allure of "Content," echoed two resounding themes: the therapeutic prowess of D&D and its role as a tool for escape and DISSERTATION ON DUNGEON & DRAGONS                                                               184           processing. His words encapsulated the transformative journey within the game's immersive realms, embodying the themes of Realms of Imagination, Therapeutic Exploration and Release and Coping and Stress Reduction. He shared, "Used the game for mental health," underlining the therapeutic aspect of D&D. Furthermore, he mentioned, "Help me escape and process," indicating how the game serves as an escape and processing tool.  CS102, a 27-year-old married female, found D&D initially "interesting." Her narrative wove together themes of advocating for equality through characters and the game's role in alleviating anxiety, reflecting the combined themes of Diversity, Belonging, and Harmonious Dynamics and Coping and Stress Reduction. She shared, "Anxiety when people come to play at my home until I get into character," underlining the role of D&D in managing anxiety. CS103, a 56-year-old married male, recognized the vast potential within the D&D landscape, emphasizing themes of Realms of Imagination, Therapeutic Exploration and Release and Diversity, Belonging, and Harmonious Dynamics. He expressed, "I am too serious, so I will play a satyr who is female and fun/chaotic good," highlighting the opportunity for self-expression through character creation. CS104, a 31-year-old married female, hailed D&D as excellent, emphasizing her role as an "Art Officer" crafting things to aid others. Her account delved into the intricate intersection of mental health conditions and the therapeutic embrace of the game, aligning with the themes of Realms of Imagination, Therapeutic Exploration and Release and Coping and Stress Reduction. She mentioned dealing with various mental health conditions, including depression, anxiety, bipolar disorder, PTSD, and dissociation. DISSERTATION ON DUNGEON & DRAGONS                                                               185           CS105, a 44-year-old divorced female, a seasoned player, found intrigue in the game's capacity for chaos as therapy, echoing themes of Emotional Depth, Escapism, and Interconnected Realities. She shared, "Creating chaos as therapy," emphasizing the therapeutic value of immersive role-play in emotional expression. Additionally, she mentioned her experience with mental health issues. CS107, a 37-year-old married female, initially labeled as "Content," shared a poignant narrative of D&D guiding her through the grief of her mother's suicide, marking a convergence with the therapeutic undertones and the theme of Emotional Depth, Escapism, and Interconnected Realities and Coping and Stress Reduction. She highlighted how D&D helped her with "the grief of her mom's suicide and processing it." CS110, a 44-year-old married male, illuminated the game's therapeutic potential, managing real-life frustration, while actively engaging in the creative tapestry of D&D, reflecting themes of Realms of Imagination, Therapeutic Exploration and Release and Coping and Stress Reduction. He mentioned, "The game had helped him manage frustration in real life, demonstrating the therapeutic potential of D&D." CS111, a 34-year-old divorced male, initiated his journey with a label of "Content." Themes of intentional play and embracing character nature unfolded, underlining the deliberate engagement within the game, encapsulating the theme of Diversity, Belonging, and Harmonious Dynamics. He talked about embracing the nature of his character, "raged as Barbarian does not avoid it." DISSERTATION ON DUNGEON & DRAGONS                                                               186           CS113, a 34-year-old single male, expressed positive utilization of D&D as a therapeutic tool, coupled with insights into his experience with ASD, embodying themes of Realms of Imagination, Therapeutic Exploration and Release and Diversity, Belonging, and Harmonious Dynamics. He mentioned, "Positively using D&D as a therapeutic tool," highlighting the therapeutic value of immersive role-play. CS114, a 45-year-old divorced male, extended the reach of D&D to young people, emphasizing the game's impact on family dynamics, reflecting the combined themes of Diversity, Belonging, and Harmonious Dynamics and Coping and Stress Reduction. He shared, "Used D&D with young people and had experienced its impact on them." CS115, a 58-year-old married male, found love through the game, intertwining themes of connection, and aligning in-game attributes with real-life characteristics, embodying the theme of Diversity, Belonging, and Harmonious Dynamics. He mentioned, "Met his wife through the game." CS116, a 30-year-old single male, discovered D&D through therapeutic guidance, embodying themes of Realms of Imagination, Therapeutic Exploration and Release and Coping and Stress Reduction. He emphasized his use of D&D for coping with various mental health issues, including ASD and ADHD. CS117, a 36-year-old single non-binary individual, embraced the game's creative aspect, holding a collection of characters and experiencing self-infusion within the immersive game world, aligning with the theme of Realms of Imagination, Therapeutic Exploration and Release. They mentioned having "a collection of potential characters," displaying a robust creative aspect. DISSERTATION ON DUNGEON & DRAGONS                                                               187           CS118, a 40-year-old married female, entered the realm due to familial ties and discovered a sense of connection and support within D&D, reflecting the combined themes of Diversity, Belonging, and Harmonious Dynamics and Coping and Stress Reduction. She found that D&D allowed her to overcome challenges she faced in real-life social interactions. CS119, a 40-year-old married male, threaded themes of fighting for equality, inspired by his children, and unlocking a strategic facet of his identity through D&D, embodying the theme of Diversity, Belonging, and Harmonious Dynamics. He reflected his commitment to fighting for equality, inspired by his children with special needs. CS120, a 44-year-old single male, found solace in D&D as a creative outlet, narrating a journey of escape, empowerment, and belonging, aligning with the themes of Realms of Imagination, Therapeutic Exploration and Release and Diversity, Belonging, and Harmonious Dynamics. He shared, "Used D&D as a creative outlet and a means to escape." CS122, a 29-year-old engaged female, turned to D&D post-breakup, merging themes of healing, improvisation, and the cathartic release of childhood trauma, reflecting the combined themes of Emotional Depth, Escapism, and Interconnected Realities and Coping with Betrayal and Recovery. She demonstrated improvisational solid and multitasking abilities. CS124, a 33-year-old male in a domestic partnership, discovered refuge in D&D, managing stressors and navigating mental health challenges, reflecting the combined themes of Realms of Imagination, Therapeutic Exploration and Release and Coping and Stress Reduction. He shared, "Used D&D to escape from real-life stressors." DISSERTATION ON DUNGEON & DRAGONS                                                               188           CS126, a 22-year-old single female, embraced the game's creative potential, viewing it as an outlet for escape and therapeutic processing of a breakup, aligning with the themes of Realms of Imagination, Therapeutic Exploration and Release and Emotional Depth, Escapism, and Interconnected Realities. She viewed the game as a creative outlet and a means of escape. These narratives collectively illuminate the diverse ways in which Dungeons & Dragons intertwines with the fabric of participants' lives, transcending mere gameplay to become a realm of profound self-discovery, healing, and communal connection. This information forms the basis for answering the research questions in the qualitative dissertation and creating themes. Summary In summary, as guided by Braun and Clarke's framework and Stake's merging findings procedure, the thematic analysis process provided a robust and systematic approach to understanding the diverse and meaningful themes that emerged from the data. These themes encompassed various aspects of participants' experiences with D&D, offering insights into its role as a therapeutic tool for promoting mental health and well-being and enhancing our understanding of the game's therapeutic potential and its benefits across diverse backgrounds and identities. The themes and subthemes emerging from this research provide a comprehensive understanding of the therapeutic dimensions of D&D and its significance in participants' lives. Each theme reflects a unique aspect of the D&D experience and its role in supporting mental well-being and personal growth. Overall, this qualitative exploration of Dungeons & Dragons demonstrates its multifaceted therapeutic potential, highlighting its role in enhancing emotional well-being and personal growth and fostering a sense of community and belonging among its DISSERTATION ON DUNGEON & DRAGONS                                                               189           players. These findings contribute to the growing body of literature recognizing the therapeutic value of D&D and call for further research and exploration of its benefits.                         DISSERTATION ON DUNGEON & DRAGONS                                                               190           Chapter Five: Conclusion Overview  Chapter Five represents a distinctive segment within this dissertation, diverging from the original plan, prospectus, or proposal. It evolves into an arena where researchers can explore their interpretations and insights. In this pivotal chapter, we reiterate the central purpose of the study, emphasizing the exploration of the necessity and effectiveness of alternative role-playing interventions. We prominently exemplify this by utilizing Dungeons and Dragons (D&D) to facilitate the safe processing of complex trauma. Structured into six distinct sections, the organizational framework of Chapter Five is as follows: (a) an overview initiates the chapter, providing a high-level view of its contents and their arrangement; (b) a summary of the findings serves to distill the core discoveries and revelations that have emerged from the study; (c) a comprehensive discussion offers an avenue for the synthesis of these findings, contextualizing them within the realm of relevant literature and established theories, while probing into their far-reaching implications; (d) an implications section is devoted to methodological and practical considerations, providing guidance on how the research outcomes may be applied both in terms of therapeutic practice and further research endeavors; (e) a segment that scrutinizes the delimitations and limitations inherent in the study offers a candid appraisal of the constraints that have influenced and defined the research process, ensuring a transparent understanding of its boundaries; and finally, (f) a contemplation of recommendations for future research stands as a beacon guiding subsequent scholars towards uncharted territories, arising from the questions and curiosities unearthed during the current investigation. DISSERTATION ON DUNGEON & DRAGONS                                                               191           Summary of Findings             In the diverse narratives shared by participants in Dungeons & Dragons (D&D), themes of Realms of Imagination, Therapeutic Exploration and Release, Emotional Depth, Escapism, and Interconnected Realities, Coping and Stress Reduction, and Diversity, Belonging, and Harmonious Dynamics emerge vividly. CS101, a 42-year-old divorced male, initially lured by the allure of "Content," reflects on the therapeutic prowess of D&D as a tool for escape and processing, blending themes of Realms of Imagination and Therapeutic Exploration and Release. CS102, a 27-year-old married female, initially found D&D "interesting," highlighting the game's role in alleviating anxiety and advocating for equality, weaving together themes of Emotional Depth, Escapism, and Interconnected Realities and Diversity, Belonging, and Harmonious Dynamics. CS103, a 56-year-old married male, recognized D&D's vast potential, emphasizing its therapeutic benefits, creative outlet, and role in managing stress, thereby embodying themes of Therapeutic Exploration and Release, Emotional Depth, Escapism, and Interconnected Realities, and Coping and Stress Reduction. CS104, a 31-year-old married female, celebrated D&D's excellence, aligning with themes of Creativity and Storytelling and Positive Impact on Anxiety and Social Anxiety, illustrating the game's potential for personal expression and emotional depth. CS105, a 44-year-old divorced female, a seasoned player, found intrigue in D&D's capacity for chaos as therapy, delving into Emotional Depth, Escapism, and Interconnected Realities. CS107, a 37-year-old married female, shares a poignant narrative of D&D guiding her DISSERTATION ON DUNGEON & DRAGONS                                                               192           through grief, thus resonating with themes of Therapeutic Exploration and Release and Emotional Depth. CS110, a 44-year-old married male, illuminated the therapeutic potential of D&D in managing real-life frustrations and fostering creativity, blending Coping and Stress Reduction with Realms of Imagination. CS111, a 34-year-old divorced male, initiated his journey with a label of "Content," underscoring deliberate engagement within the game and its potential for emotional depth and belonging. CS113, a 34-year-old single male, expressed positive utilization of D&D as a therapeutic tool, coupled with insights into his experience with ASD, displaying the game's role in fostering belonging and harmonious dynamics. CS114, a 45-year-old divorced male, extended the reach of D&D to young people, emphasizing the game's impact on family dynamics and diversity. CS115, a 58-year-old married male, found love through the game, intertwining themes of connection and identity, blending Emotional Depth, Coping and Stress Reduction, and Diversity, Belonging, and Harmonious Dynamics. CS116, a 30-year-old single male, discovered D&D through therapeutic guidance, embodying themes of therapeutic role-playing and stress reduction. CS117, a 36-year-old single non-binary individual, embraced the game's creative aspect and experienced self-infusion within the immersive game world, resonating with themes of Realms of Imagination and Diversity, Belonging, and Harmonious Dynamics. CS118, a 40-year-old married female, discovered connection and support within D&D, threading themes of belonging and emotional depth. DISSERTATION ON DUNGEON & DRAGONS                                                               193           CS119, a 40-year-old married male, fought for equality and found strategic identity through D&D, highlighting the game's role in promoting diversity and empowerment. CS120, a 44-year-old single male, found solace and belonging in D&D's creative outlet, blending themes of escapism and identity exploration. CS122, a 29-year-old engaged female, turned to D&D post-breakup, merging themes of healing, improvisation, and cathartic release, illustrating the game's transformative potential in emotional exploration and release. CS124, a 33-year-old male in a domestic partnership, discovered refuge and stress management in D&D, reflecting themes of emotional depth and coping.  CS126, a 22-year-old single female, embraced the game's creative potential as an outlet for therapeutic processing, resonating with themes of escapism and emotional exploration. These narratives collectively underscore the profound impact of D&D in fostering self-discovery, healing, and communal connection across diverse backgrounds and experiences. Discussion             The findings of this qualitative study provide valuable insights into the therapeutic potential of Dungeons and Dragons (D&D) as an alternative intervention for processing complex trauma. Through an in-depth exploration of participants' experiences and behaviors within D&D sessions, this study contributes to the existing literature on trauma processing, therapeutic interventions, and gaming dynamics. The discussion below synthesizes the study's findings with relevant theoretical frameworks and empirical research, offering implications for practice, theory, and future research. DISSERTATION ON DUNGEON & DRAGONS                                                               194           Confirmation and Extension of Theoretical Frameworks The findings of this study confirm and extend numerous theoretical frameworks relevant to understanding the therapeutic and social dimensions of D&D gameplay. Notably, stress reduction theory (Soga et al., 2020) was supported by participants' reports of decreased stress levels and increased relaxation during D&D sessions. This aligns with previous research highlighting the stress-reducing benefits of engaging in recreational activities (Heo et al., 2021). Additionally, the study aligns with internal family systems model (IFS) (Schwartz, 1999) by demonstrating how character exploration within D&D sessions can facilitate self-exploration and healing, echoing the principles of internal family systems therapy. Insights from Decision Theory and Game Theory Decision theory and game theory provided a theoretical lens through which to analyze participants' choices and interactions within D&D sessions. Participants' decisions regarding character classes and in-game actions reflected elements of decision theory (Camerer, 2003), emphasizing the role of personal attributes and past experiences in decision-making processes. Moreover, the strategic gameplay observed in D&D sessions resonated with game theory principles (Neumann & Morgenstern, 2021), highlighting participants' considerations of fairness and strategic thinking during gameplay. Social Dynamics and Social Learning The study shed light on the social dynamics inherent in D&D gameplay, aligning with social theory (Seidman, 2016) and social learning theory (Bandura, 1969, 1971, 1986). Participants' interactions within D&D sessions provided insights into group dynamics, DISSERTATION ON DUNGEON & DRAGONS                                                               195           interpersonal relationships, and observational learning processes. Furthermore, the findings supported the theory of planned behavior (Ajzen, 1991) by illustrating how attitudes, subjective norms, and perceived behavioral control influenced participants' intentions and behaviors within the game. Exploration of Complex Trauma and Cognitive Processing  By integrating associative network theory (Foa & Kozak, 1986; O'Sullivan, 1999; Foa et al., 1989) and trauma processing frameworks, the study elucidated how D&D sessions can serve as a platform for exploring and modifying traumatic memories and associations. Participants' engagement in role-playing activities facilitated cognitive processing of traumatic experiences, supporting previous research on trauma-focused interventions (O'Sullivan, 1999). Additionally, the study extended social-ecology theory (Bronfenbrenner, 1977) by highlighting the influence of micro-system variables, such as peer interactions and game dynamics, on individual behavior within the context of D&D gameplay. Conclusion In conclusion, this qualitative study contributes to our understanding of the therapeutic benefits and social dynamics of Dungeons and Dragons gameplay. By confirming and extending theoretical frameworks from diverse disciplines, the study provides a comprehensive analysis of the therapeutic potential of D&D as an alternative intervention for processing complex trauma. The insights gained from this study offer valuable implications for clinical practice, theory development, and future research in the fields of mental health and gaming.  DISSERTATION ON DUNGEON & DRAGONS                                                               196           Implications for Practice and Future Research The findings of this study offer significant implications for both clinical practice and future research endeavors, fostering a deeper understanding of the therapeutic potential of Dungeons and Dragons (D&D) and its applications in diverse contexts. Clinical Practice Implications  For mental health practitioners working with individuals experiencing complex trauma, incorporating D&D or similar role-playing interventions into therapeutic programs can provide a valuable avenue for healing and self-exploration. By leveraging the immersive and therapeutic potential of the game, therapists can create safe spaces for clients to process traumatic experiences and emotions. Moreover, the flexibility and adaptability of established psychological theories, such as Freud's instinct theory of aggression and social learning theory, when applied to D&D, offer alternative therapeutic options that transcend traditional boundaries. Mental health professionals can explore these unconventional applications to enhance therapeutic outcomes and promote clients' personal growth. Practical recommendations for therapists include tailoring D&D-based interventions to meet the unique needs of clients across different age groups and relationship statuses. By designing interventions that cater to newcomers and experienced players alike, mental health practitioners can ensure accessibility and inclusivity within therapeutic spaces. Additionally, therapists should adopt a gender-inclusive approach to D&D therapy, ensuring that all participants feel supported and represented. Furthermore, considering the potential impact of DISSERTATION ON DUNGEON & DRAGONS                                                               197           technology on cognitive development and behavior, therapists should advocate for balanced approaches to technology use, both within therapeutic settings and at home. Future Research Directions Future research endeavors could further explore the long-term effects of D&D gameplay on mental health outcomes, providing empirical evidence to support its efficacy as a therapeutic tool. Moreover, investigations into the effectiveness of tailored interventions within gaming environments can contribute valuable insights into optimizing therapeutic practices. Additionally, studies examining the role of technology in gaming and its impact on behavior are warranted, considering the increasing prevalence of digital gaming platforms and their potential implications for cognitive development and mental well-being. Furthermore, exploring the implications of D&D-based interventions on relationship dynamics and satisfaction can inform couples therapy and family counseling practices. Research focused on developing beginner-friendly D&D interventions can expand the reach of this therapeutic modality to a broader audience, enhancing accessibility and inclusivity within mental health care. Additionally, investigating age-appropriate D&D interventions can provide guidance for therapists working with clients across different developmental stages. In summary, incorporating these implications into clinical practice and research efforts can enrich the utilization of D&D as a potent therapeutic tool, fostering inclusivity, accessibility, and effectiveness within mental health care settings. By embracing innovative approaches and tailoring interventions to meet the diverse needs of clients, mental health professionals can enhance therapeutic outcomes and promote overall well-being. DISSERTATION ON DUNGEON & DRAGONS                                                               198           Incorporating a Christian Worldview Perspective Incorporating a Christian worldview perspective into interpreting these findings is essential for individuals who view the world through this lens. Within a Christian worldview, the study's emphasis on empathy, compassion, and personal growth aligns with the biblical principles of love, healing, and redemption. Role-playing games such as D&D as a therapeutic tool to foster empathy and understanding resonate with the Christian values of compassion and support for those in need. Additionally, the Christian worldview may underscore the importance of responsible technology use. It calls for stewardship of one's mind and body, which encompasses considerations of children's screen time. The study's findings support that responsible screen time management aligns with Christian principles of nurturing healthy cognitive development and moral behavior. In summary, this study presents theoretical, empirical, and practical implications that extend to various stakeholders, ranging from therapists and educators to parents and policymakers. Additionally, the incorporation of a Christian worldview perspective highlights the compatibility of the research findings with Christian values of empathy, compassion, and responsible stewardship of one's mind and body. These implications collectively provide a broader context for understanding the relevance and significance of the study's findings in different facets of society and personal belief systems.   DISSERTATION ON DUNGEON & DRAGONS                                                               199           Delimitations and Limitations Delimitations and limitations in research must be exposed to gain complete knowledge of the accuracy and dependability of the study results. Delimitations can also provide information to direct future research. The common theme among the delimitations listed above is specificity and focus. These delimitations collectively emphasize that the study focused narrowly on aspects of the therapeutic use of Dungeons and Dragons (D&D) within the context of mental health support and trauma processing.  Delimitations of the Study Several factors delimit the scope and boundaries of this qualitative dissertation. These delimitations ensure the study's feasibility, focus, and applicability. They clarify the study's coverage and the constraints that define its operational framework. Contextual Specificity            This study primarily centers around the therapeutic use of Dungeons and Dragons (D&D) as an intervention for individuals coping with trauma and related mental health challenges. While D&D holds a broad range of applications and variations, this study focuses specifically on its role within the context of mental health support and trauma processing. Limited Generalizability Findings and implications drawn from this study are intended for application within the domain of mental health therapy and may not be readily generalizable to other fields or settings. DISSERTATION ON DUNGEON & DRAGONS                                                               200           The study's outcomes are framed within the context of therapeutic interventions and may not directly translate to non-clinical applications of D&D. Sample Characteristics            The researcher recruited research participants from diverse backgrounds, representing various age groups, gender identities, and experience levels with D&D. However, it is essential to note that this study does not aim to cover the entire spectrum of potential participant characteristics. Instead, it offers insights based on the specific sample of participants involved. Subjective Perceptions This qualitative study relies on participants' self-reported experiences, perceptions, and interpretations. While these subjective accounts are valuable for exploring the lived experiences of individuals, they inherently influence individual perspectives and may not always align with objective measures.  Therapeutic Emphasis The study's primary focus is on the therapeutic applications of D&D, specifically in coping with trauma and related mental health issues. It does not aim to address the entirety of D&D's potential uses or delve into the broader realms of gaming and entertainment. Temporal Constraints            The study was within a specific time limit, and the findings represent a snapshot of participant experiences during this period. Long-term effects and extended follow-up observations fall beyond the temporal scope of this research. DISSERTATION ON DUNGEON & DRAGONS                                                               201           Cultural Considerations            The study acknowledges cultural diversity among participants; however, it needs to comprehensively explore the influence of cultural factors on the therapeutic use of D&D. Cultural nuances in the application of D&D therapy are a complex area that may require dedicated research. In summary, these delimitations define the boundaries and limitations of this qualitative dissertation, providing clarity on the specific context, scope, and applicability of the study's findings. They guide the research process and interpretation of results within the specified parameters. Limitations While this qualitative study provides valuable insights into the potential of Dungeons and Dragons (D&D) as a therapeutic intervention for the mental health community, several limitations must be acknowledged. Firstly, the study's inclusivity and diversity implications reveal an essential limitation. Although the research emphasizes the diversity in gender identities and backgrounds among participants, it is crucial to recognize that the sample might not fully represent the vast spectrum of identities and experiences within the mental health community. As such, while illuminating, the findings may only encompass part of the full range of unique needs and perspectives of individuals with protected identities. Future research should include a broader and more diverse participant pool to provide a more comprehensive understanding of how D&D therapy can cater to various marginalized groups. DISSERTATION ON DUNGEON & DRAGONS                                                               202           Secondly, the lifespan relevance of D&D-based interventions suggests their potential applicability throughout an individual's lifespan. However, this study primarily offers a snapshot of participant experiences within a specific time limit. Long-term effects and the evolution of D&D therapy across different life stages remain unexplored. Mental health professionals should consider the need for age-specific adaptations of D&D therapy and conduct longitudinal research to assess its sustained benefits over time. Thirdly, the notion of tailored interventions tailored to participants' relationship statuses is a promising avenue, but it also presents certain limitations. This study highlights the potential for D&D to address relationship-related issues, including divorce, communication in marriages, and domestic partnerships. The qualitative nature of the research may limit our ability to explore these specific challenges deeply. Further quantitative investigations or intervention development research could provide more concrete guidance for mental health practitioners seeking to implement D&D-based approaches in relationship therapy. Lastly, the study's focus on accessibility is valuable, as it underscores the versatility of D&D as a therapeutic tool. Nevertheless, the research outlines participants' experiences with varying levels of D&D experience. While this sheds light on the tool's accessibility, it does not delve into the nuances of tailoring interventions for newcomers versus experienced D&D players. Future research may benefit from examining these distinct groups' specific needs and preferences to develop more precise and effective therapeutic approaches. In conclusion, this study contributes significantly to understanding D&D as a therapeutic intervention in the mental health community. However, these limitations underscore the need for further research to address DISSERTATION ON DUNGEON & DRAGONS                                                               203           specific challenges and nuances, ensuring that D&D therapy is inclusive, adaptable across the lifespan, and accessible to individuals with diverse needs and experiences. Recommendations for Future Research The findings of this qualitative study offer valuable insights into the potential of Dungeons and Dragons (D&D) as a therapeutic intervention within the mental health community. However, there are several areas where further research is warranted to advance our understanding and application of D&D in mental health therapy. Gender and Identity Dynamics: To better cater to the unique mental health needs of individuals with diverse gender and protected identities, in-depth investigations should continue. Researchers should investigate how to tailor D&D interventions to address the challenges and experiences of marginalized groups, ensuring that D&D therapy is inclusive and supportive of all identities, thereby enabling mental health practitioners to offer more effective and sensitive support. Age-Specific Benefits: While this study hints at the potential applicability of D&D across different age groups, it is crucial to conduct focused research to uncover the unique ways D&D can benefit adolescents, adults, and older adults. Age-specific studies can help identify the developmental advantages and challenges associated with D&D therapy and guide the creation of age-appropriate interventions. Relationship Outcomes: Further research can investigate how D&D therapy influences relationship dynamics, including communication, conflict resolution, and overall relationship satisfaction. This exploration should encompass individuals with various relationship statuses, DISSERTATION ON DUNGEON & DRAGONS                                                               204           such as those in marriages, domestic partnerships, or those navigating divorce. By examining these outcomes, researchers can develop more tailored D&D interventions to enhance relationship functioning. Adapting for Novices: Research efforts should focus on developing therapist-guided interventions that are accessible and effective for individuals with little to no prior D&D experience. Understanding how to introduce newcomers to D&D in a therapeutic context and facilitate their engagement can expand the reach and impact of this intervention. Integration with Therapy: Researchers should examine how D&D therapy can be integrated along with traditional therapeutic approaches. Investigating the collaborations and potential conflicts between these modalities can help mental health professionals strike an optimal balance in treatment planning and delivery. Long-Term Effects: Longitudinal studies examining the long-term effects of D&D-based interventions are warranted. These studies should assess how participation in D&D therapy influences participants' mental health, personal growth, and social interactions over extended periods. Long-term research can provide valuable insights into the sustained benefits and potential challenges associated with D&D interventions. Summary In summary, by addressing these implications and conducting further research in these areas, the therapeutic potential of D&D as a tool for promoting mental health and well-being can be better understood and harnessed to benefit individuals with diverse backgrounds and needs. This ongoing research can contribute to the evolution and refinement of D&D therapy within the DISSERTATION ON DUNGEON & DRAGONS                                                               205           mental health community, improving the quality of care and support available to individuals facing various mental health challenges.                   DISSERTATION ON DUNGEON & DRAGONS                                                               206           References Abbott, M. S., Stauss, K. A., & Burnett, A. F. (2021). 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Integrating expressive arts techniques into trauma-focused treatment with children. Journal of Mental Health Counseling Integrating Expressive Arts, 38(2), 124–139. https://doi.org/10.17744/mehc.42.2.03. Yin, R.K. (2003). Case Study Research: Design and Methods (3rd ed.). Thousand Oaks, CA: Sage Publications.          DISSERTATION ON DUNGEON & DRAGONS                                                               230           Appendices Appendix A  Gary Gygax in 1999 Moroboshi via Wikimedia Commons under CC BY-SA 3.0 Appendix B .  Dave Arneson in 2008 Carlos A. Smith via Flickr under CC BY-SA 2.0 DISSERTATION ON DUNGEON & DRAGONS                                                               231           Appendix  C     DISSERTATION ON DUNGEON & DRAGONS                                                               232           Appendix D         DISSERTATION ON DUNGEON & DRAGONS                                                               233            Appendix E        DISSERTATION ON DUNGEON & DRAGONS                                                               234           Appendix F   DISSERTATION ON DUNGEON & DRAGONS                                                               235           Appendix G         DISSERTATION ON DUNGEON & DRAGONS                                                               236           Appendix H         DISSERTATION ON DUNGEON & DRAGONS                                                               237           Appendix I  Character Sheet 1st Edition Appendix J   Barbarian (The Barbarian Class for Dungeons & Dragons (D&D) Fifth Edition (5e) - D&D Beyond (D&Dbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               238           Appendix K  Bard The Bard Class for Dungeons & Dragons (D&D) Fifth Edition (5e) - D&D Beyond (D&Dbeyond.com)     DISSERTATION ON DUNGEON & DRAGONS                                                               239           Appendix L       Cleric  The Cleric Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               240           Appendix M       Druid  The Druid Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               241           Appendix N  Fighter  The Fighter Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               242           Appendix O    Monk  The Monk Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               243           Appendix P    Paladin  The Paladin Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               244           Appendix Q      Ranger  The Ranger Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               245           Appendix R    Rogue  The Rogue Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               246           Appendix S   Sorcerer  The Sorcerer Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               247           Appendix T     Warlock  The Warlock Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               248           Appendix U    Wizard  The Wizard Class for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               249           Species, formerly called Race. Appendix V      Human The Human Race for Dungeons & Dragons (D&D) Fifth Edition (5e) - D&D Beyond (D&Dbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               250           Appendix W    Dragonborn  The Dragonborn Race for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               251           Appendix X      Dwarf  The Dwarf Race for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               252           Appendix Y    Elf  The Elf Race for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               253           Appendix Z     Gnome  The Gnome Race for Dungeons & Dragons (DND) Fifth Edition (5e) - DND Beyond (DnDbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               254           Appendix AA   Half-Elf (dndbeyond.com) DISSERTATION ON DUNGEON & DRAGONS                                                               255           Appendix BB   Halfling (dndbeyond.com)  DISSERTATION ON DUNGEON & DRAGONS                                                               256           Appendix CC   Half-Orc The Half-Orc Race for Dungeons & Dragons (D&D) Fifth Edition (5e) – D&D Beyond (D&Dbeyond.com)  DISSERTATION ON DUNGEON & DRAGONS                                                               257           Appendix DD  Tiefling The Tiefling Race for Dungeons & Dragons (D&D) Fifth Edition (5e) – D&D Beyond (D&Dbeyond.com)  DISSERTATION ON DUNGEON & DRAGONS                                                               258           Appendix EE Basic Rules D&D_BasicRules_2018.pdf (wizards.com)  Appendix FF     D20 Dice   Appendix GG  Full Dice Sets DISSERTATION ON DUNGEON & DRAGONS                                                               259           Appendix HH Screening for Inclusion 1. Do you want to participate in this study? 2.  Do you play D & D? 3. Have you been diagnosed with any mental health diagnoses, if so, what are they? Dissertation Demographic Questions (Forced Choice) 1. What is your identified gender? _____________________ 2. What is your age? A. 18-24 B. 25-34 C. 35-44 D. 45-54 E. 55+ 3. How would you describe yourself? A. American Indian or Alaska Native B. Asian C. Black or African American D. Native Hawaiian or Other Pacific Islander E. White F. Two or More Races 3. What is your current employment status? A. Employed full-time (40 or more hours per week) B. Employed part-time (up to 39 hours per week) C. Unemployed and currently looking for work D. Unemployed and not currently looking for work E. Student F. Retired G. Homemaker DISSERTATION ON DUNGEON & DRAGONS                                                               260           H. Self-employed I. Unable to work/Disabled. 5. What is your educational background? A. Less than a high school diploma B. High school degree or equivalent (e.g. GED) C. Some college, no degree D. Associate Degree (e.g. AA, AS) E. Bachelor’s degree (e.g. BA, BS) F. Master’s degree (e.g. MA, MS, MEd) G. Professional degree (e.g. MD, DDS, DVM) H. Doctorate (e.g. PhD, EdD) 6. What is your marital status? A. Single (never married) B. Married, or in a domestic partnership C. Widowed D. Divorced E. Separated 7. What is your annual household income? A. Less than $20,000 B. $20,000 to $34,999 C. $35,000 to $49,999 D. $50,000 to $74,999 E. $75,000 to $99,999 F. Over $100,000 Request for Interview Information Name:__________________________________________ Email:_______________________________________ Phone:________________   DISSERTATION ON DUNGEON & DRAGONS                                                               261           Appendix II Informed Consent Form (Qualitative study) Project Title The World of Dungeons and Dragons as a Therapeutic Approach to Complex Trauma Study Investigator  Invitation to participate You are invited to participate in a research study. Choosing whether to participate is entirely your choice. If you decide not to participate, there will be no negative impacts on your relationship with the researcher. The information provided in  this form tells you about what is involved in the research, what you will be asked to do, and any potential risks or benefits. Please read this form carefully, take all the time you need, and ask any questions you may have.   Consent is an ongoing process. During the research study, we will tell you about any significant finding that could affect your willingness to con-tinue to participate in this study.  Purpose of the research study The purpose of this research is to explore both the need for and the efficacy of alternative role-playing interventions, such as Dungeons and Drag-ons, to process complex trauma safely. Mental health diagnoses have increased substantially due to pandemics, poverty, unemployment, rise in isolation, loss of social skills, and increased exposure to traumatic environments. Due to these unexpected changes in today’s world, clinicians and clients need to have access to outside-the-box intervention options to meet the needs of the changing needs of these clients.  What you will be asked to do If you decide to participate in this research, you will be asked to complete a survey to include demographic information such as gender identifica-tion, age, and occupation, as well as research-based questions regarding your mental health status and gaming experiences. The survey can be shared with other potential participants if the participant sees fit, however, they will also have to adhere to the informed consent process. Addi-tionally, you will be identified as a mutually chosen pseudonym to protect your anonymity and be interviewed for about 45 minutes to an hour. During this interview, this researcher will take notes, and you are welcome to examine them for correctness and for the inclusion of pseudonyms. The interviewer will also voice record the interview to ensure accuracy. If chosen as a participant in the research you will be observed by this researcher during live online games, where the researcher will simply be an observer within the naturalistic game environment.    Who can take part in the research study? To be involved in this study, you must be at least 18 years of age and currently play, or have played in the past, the game Dungeons and Dragons. We are looking for a minimum of 30 participants, not to exceed 50.  Possible risks and benefits  Risks: There is a potential risk, when talking about mental health and trauma, that one may feel triggered. It is imperative that as a participant you communicate with the researcher if this should occur and provide emergency contact or a therapist to assist you to de-escalate and process further.   Benefits: There is no guarantee that you will benefit directly from participating in this study. However, the study will provide you with the op-portunity to voice your truth on your experiences and will hopefully raise awareness of how you have used this game as a therapeutic interven-tion.  There is no compensation/reimbursement for participation-it is all voluntary.  Privacy and confidentiality All hard copies of documents and recordings will be identified only by pseudonyms and  kept in a locked filing cabinet. You will not be identified by name in either the interview notes, observation notes, or journal. Hard copies of the notes and transcripts will be stored in a locked filing cabinet in the office of the Principal Investigator and electronic  copies will be kept on the local hard drives of team members’ computers – all of which are password protected. Participants will not be identified by name in any reports of the completed study.  Limits to confidentiality: Please be aware that there are limits to confidentiality in a group setting. All members of the group will be asked to respect the privacy of other members and to keep what is said confidentially. However, there is no guarantee that they  will do so. Please keep this in mind when deciding what you feel comfortable sharing. No personal information will be shared with anyone out-side of the core research team, unless required by law. Instances where researchers are required, by law, to breach confidentiality includes the following: child abuse or neglect that is ongoing and unknown to police, cases of imminent risk of physical harm to oneself or another, cases of sexual abuse, sexual assault, or sexual harassment by a health professional.  Reporting of results DISSERTATION ON DUNGEON & DRAGONS                                                               262           Although the project outcomes will be determined by the research findings, possible research products will include articles in scientific journals, a brief for mental health care providers, and plain language summaries. We will only report group results, therefore, you will not be identified in any way in our reports. Any quotes will be anonymized and will not be attributed to a specific individual. If you wish to be informed of the re-sults of the research, please indicate this on the signature page below.  Withdrawing from the study Your participation is completely voluntary, and you are under no obligation to participate. If you decide to participate but change your mind later, you are free to withdraw at any time without consequence. Your decision to withdraw will not influence your relationship  with the researcher in any way. If you decide to withdraw during the group game observation, it may not be possible to remove your data, alt-hough we will make our best effort to avoid referring to your responses. If you decide to withdraw after the session, your data will  already be anonymized and we will not be able to remove your data.  Conflicts of interest None of the researchers have any conflicts of interest in this study.  Questions and contact information If you have any questions about the study or would like more information, please contact:   This research study was reviewed and approved by the Institutional Review Board at Liberty University.  Contact (434) 592-5530 (434)-522-0506 (fax) irb@liberty.edu   Signature Page Project title: The World of Dungeons and Dragons as a Therapeutic Approach to Complex Trauma  Lead researcher:   Statement of consent By signing this form, I agree that:   The study has been explained to me  All my questions have been answered  Possible harm and discomforts and possible benefits (if any) of this study have  been explained to me  I have been told that my personal information will be kept confidential In addition, I understand that:  I have the right not to participate and the right to stop at any time  I may refuse to participate without consequence  I have a choice of not answering specific questions  I am free now, and in the future, to ask any questions about the study  No information that would identify me will be released or printed without asking  me first  I will receive a signed copy of this consent form You can still participate in the research if you select no:  I agree that I may be quoted directly and anonymously Yes No I agree that the gaming group may be audio recorded Yes No __________________________ __________________________ _____________ Name                                             Signature                                    Date Please provide an email address below if you would like to be sent a summary of the study  results.  Email address: ___________________________________  Signature of the person obtaining consent  By signing this form, I attest that:  I have explained the study to the prospective participant  I answered all their questions  I provided a copy of this consent form to the participant  The participant seemed to understand the consent form and agreed to participate DISSERTATION ON DUNGEON & DRAGONS                                                               263           __________________________ __________________________ ____________ Name                                           Signature                                    Date

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