Dungeons and Dragons. Maybe you grew up playing it. Maybe you think it’s uncool. Maybe your main encounter with it has been on the hit show Stranger Things. Or maybe you’re actively part of a Dungeons and Dragons (D&D) campaign right now. On today’s A Public Affair, the Louisville-based mental health clinic OCD & Anxiety Colorado is using D&D to help children and young adults with anxiety, ADHD, Obsessive Compulsive Disorder (OCD), and other mental health diagnoses.
D&D was invented in the 1970s. It’s a fantasy tabletop role-playing game. It’s facilitated by a Dungeon Master, or Game Master. That’s the person who sort of narrates the story, helps create all the details of the fantasy world, and guides the action. Basically, it’s a bunch of people, sitting around a table, playing different roles and imagining a story together. It uses a set of parameters about what characters can do and how. But it’s the players who invent their own character, come up with their backstory, and make decisions throughout the story as that character.
Clinician Payge Wyman is a Licensed Social Worker (LSW) and Board Certified Assistant Behavior Analysts (BCaBA). She’s getting certified as a “therapeutic game master” through the Game to Grow approach.
“The idea is you wanna tell a fun story with friends that has cool things happening in it,” said Wyman. “And sometimes that’s gonna involve taking on a different role.” That role could be a heightened version of yourself, or a completely different version of yourself.
“The idea is that you get to play and explore these things that you can’t explore as much in real life, and then you come together with a group to collaboratively, cooperatively tell the story,” she explained.
What underlies their approach is something called Exposure and Response Prevention therapy (ERP). Which the International OCD Foundation defines as practicing confronting the thoughts, images, objects, and situations that make you anxious and provoke obsessions.
In Anxie-D&D, Wyman uses the players’ “content” — the things each kid is trying to work on in therapy — and incorporates that into the game so they can confront it in a safe environment.
“We had someone who had a fear of bugs, and so I made the souptender (we didn’t do bartenders, ‘souptender’ so that it can be all ages friendly) a giant cockroach man. And they had to talk with the giant cockroach man to move through the story and get the information that they needed.”
That was hard for the player at first, said Wyman, but they were able to do it. And by the end, “they were like, ‘yeah, he’s all right, I guess.’”
Or maybe a kid has trouble with self-confidence. Wyman will put their character in a situation where they have to solve a puzzle on behalf of the group, and their character is the only one in the group with the right strengths (say, a high wisdom score) to solve that puzzle and advance the story.
The Game to Grow method Payge is using was co-developed by an Occupational Therapist named Virginia Spielmann, who is based in Centennial, CO. Her organization, STAR Institute for Sensory Processing, also runs Game to Grow D&D campaigns for kids in person and online. She said they have trained thousands of facilitators in the method, and they estimate that around 1,000 certified game masters are actively running these programs now — with groups of kids in therapeutic settings, in community settings like libraries, and with groups of adults, including a veterans group. The groups span the US, Canada, Hong Kong, Australia, and the UK.
D&D has probably always helped neurodivergent kids as long as it’s existed. Spielmann told me that she found her way to this work when she realized her nine-year-old son was struggling with anxiety at school, but totally opened up while playing Dungeons and Dragons. She noticed his D&D character was dealing with setbacks really well, and celebrating his successes confidently. And that formalizing something like this would be a good way for older kids who are struggling to have permission to “play pretend.”
OCD & Anxiety Colorado was founded fairly recently, about a year ago. Alie Garza, LCSW, its founder and senior clinician, grew up in Superior. She created the clinic to address the needs of kids who grew up like she did.
“I went through my whole adolescence having misdiagnosed, untreated OCD. It actually wasn’t until I was 25 and a clinician myself that I discovered that I had OCD and what the evidence-based treatment was,” said Garza. “At that point, I had gone through years and years of treatment in Boulder County, and felt like no matter what I did, I was actually getting worse, and figured that it must have been something wrong with me or that I wasn’t trying hard enough.”
Garza says this is a common experience for kids and young adults with OCD. By the age of 25, she says she was bedbound, unable to eat, and scared to drink water. She wasn’t leaving her home, but did residential OCD treatment, which she says saved her life.
After that, she spent years working in different higher level OCD care programs throughout the country. When she moved back to Colorado, she worked at the OCD Clinic at CU Anschutz, where she says she witnessed the program repeatedly fail to get kids the higher level OCD care they needed, especially kids on Medicaid.
“I discovered that nothing had changed since I had left, as far as treatment programs, treatment options for pediatric OCD,” said Garza. That’s why she founded OCD & Anxiety Colorado.
Still, kids who need higher levels of care need to be referred to specialists, sometimes in other states. And Garza has run into Medicaid roadblocks preventing that.
The International OCD Foundation recently published their report on OCD care in the US, which says between 81% and 98% of OCD patients aren’t receiving effective, evidence-based treatment, and only 2% of OCD patients are receiving that Exposure and Response Prevention therapy, which they call the gold standard of OCD treatment. It also says that on average, it takes patients seven years to gain access to evidence-based treatment.
Earlier this year, Garza wrote a letter to Colorado lawmakers asking them address the roadblocks that she says are preventing kids with OCD on Medicaid from getting the treatment they need. In her letter, she described how “clinicians are routinely forced to piece together outpatient-level care for children who could not eat, could not sleep, and could not leave their homes, because no higher levels of evidence-based OCD care were available within Colorado Medicaid. These cases are not rare. They are the norm.”
This story aired on A Public Affair, KGNU’s weekday morning show featuring in-depth discussions on local news issues. Click here to listen to other episodes of A Public Affair.