Dungeons and Dragons – Maybe you grew up playing it. Maybe you think it’s impossible. Perhaps your original encounter with it was on the hit show Stranger Things. Or maybe you’re actively involved in a Dungeons and Dragons (D&D) campaign right now. In Public Affairs Today, the Louisville-based mental health clinic OCD and Anxiety Colorado uses D&D to help children and youth with anxiety, ADHD, obsessive compulsive disorder (OCD), and other mental health diagnoses.
D&D was invented in the 1970s. This is a fantasy tabletop role-playing game. This is facilitated by a Dungeon Master, or Game Master. He is the one who tells the story, helps create all the details of the fantasy world, and directs the action. Basically, it’s a group 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 character, come up with their own backstory, and make decisions throughout the story as that character.
Clinician Peg Wyman is a Licensed Social Worker (LSW) and Board Certified Behavior Analyst Assistant (BCaBA). He is certified as a “Therapeutic Play Master” through the Play Development Method.
“The idea is that you want to tell a fun story with friends in which good things happen,” Wyman said. “And sometimes that involves taking on the role of another.” This role can be a higher version of yourself, or a completely different version of yourself.
“The idea is that you play games and explore these things that you can’t explore as much in real life, and then you get together with a group to tell a story together, collaboratively,” she explained.
What their approach entails is something called Exposure and Response Prevention therapy (ERP). Which the International Foundation for OCD defines as the practice of coping with thoughts, images, objects, and situations that worry you and trigger obsessions.
In Anxie-D&D, Wyman uses the players’ “content”—the things every child tries to work on in therapy—and incorporates it into the game so they can face it in a safe environment.
“We had someone who was afraid of bugs, and so I made the suptender (we didn’t do bartenders, ‘suptender’ to make it age-friendly) a giant cockroach man. And they had to talk to the giant cockroach man to get to the story and get the information they needed.”
It was tough for the players at first, Wiman said, but they were able to do it. And in the end, “they were like, ‘Yeah, he’s right, I guess.’
Or maybe a child has a problem 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 power (say, a high Wisdom score) to solve the puzzle and advance the story.
The play development method Payge uses was co-developed by an occupational therapist named Virginia Spellman, who is based in Sentinel, CO. Her organization, the STAR Institute for Sensory Processing, also runs campaigns promoting D&D for children in person and online. She said they have trained thousands of facilitators in this method, and they estimate that 1,000 certified play masters are now actively running these programs—with children’s groups in therapeutic settings, in community settings such as libraries, and with groups of adults, including groups of veterans. The group is spread across the United States, Canada, Hong Kong, Australia and the United Kingdom.
D&D has probably always helped nerdy kids for as long as it has existed. Spellman told me that she found her way to this work when she realized that her nine-year-old son was struggling with anxiety at school, but completely opened up while playing Dungeons and Dragons. She noticed that his D&D character dealt with obstacles really well, and celebrated his successes with confidence. And that formalizing something like this would be a great way for older kids who struggle to get permission to “show off.”
OCD and Anxiety Colorado was recently established about a year ago. Eli Garza, LCSW, its founder and senior clinician, grew up in Superior. She created the clinic to meet the needs of children who grew up like her.
“I was misdiagnosed and undertreated for OCD throughout my youth. It really wasn’t until I was 25 and a doctor myself that I discovered I had OCD and what evidence-based treatment was,” Garza said. “At the time, I had gone through years and years of treatment in Boulder County, and felt like whatever I did, I was really screwed up, and thought there must be something wrong with me or that I wasn’t trying hard enough.”
Garza says this is a common experience for children and young adults with OCD. At age 25, she says she was bedridden, unable to eat, and afraid to drink water. She didn’t leave her home, but received residential OCD treatment, which she says saved her life.
After that, she spent years working in various high-end OCD care programs across the country. When she moved back to Colorado, she worked at CU Anschutz’s OCD clinic, where she says the program repeatedly failed to get children the high-level OCD care they needed, especially children on Medicaid.
“I found that as far as the treatment programs, the pediatric OCD treatment options that I left, nothing changed,” Garza said. That’s why she founded OCD and Anxiety Colorado.
Still, children who need a higher level of care must be referred to specialists, sometimes in other states. And Garza has hit Medicaid roads that prevent it.
The International OCD Foundation recently released its report on OCD care in the United States, which states that between 81% and 98% of OCD patients do not receive effective, evidence-based treatment, and only 2% of OCD patients receive 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 access evidence-based treatment.
Earlier this year, Garza wrote a letter to Colorado lawmakers asking them to address roadblocks that he says prevent children with OCD on Medicaid from getting the treatment they need. In her letter, she explained how “clinicians are routinely forced to provide inpatient care for children who cannot eat, sleep, and leave their homes because there is no high level of evidence-based OCD care in Colorado Medicaid. These cases are not rare. They are normal.”
This story appeared in Public Affairs, KGNU’s weekday morning show that features in-depth discussions of local news issues. Click here to listen to other episodes of Public Opinion.
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