The Bodhana Group: How Gaming Eases Mental Health

Tabletop gaming is a great hobby. It leads to a lot of fun with the right people, but there's been a non-profit organization that sees this hobby as a means for mental healing. They are The Bodhana Group, and they have been training therapists and mental-health experts to use board games and tabletop RPGs to assist those living with everything from autism to depression to social anxiety. They strive to find and develop new and innovative systems and approaches to mental health care and awareness, all based on the belief that certain patients are not properly served by more traditional mental-health systems.

TechRaptor has partnered with Safe in Our World, a charity focused on mental health awareness in gaming. We joined their LevelUp program in order to offer more resources and support to all of our team members. Visit our blog to learn more or to donate for Mental Health Awareness Month.

I managed to sit down with The Bodhana Group's founder, Jack Berkenstock Jr., and talk with him about his group along with the unique challenges of cutting through the stigmas of mental health and the gatekeeping elements of gaming, and doing so in the shadow of recent events.

Autism and Organic Therapy

Even through the format of a Zoom call, I was more than happy to see Berkenstock's energy and passion shine through, and I was glad to see a year of isolation hasn't dimmed his infectious joy. It was an almost instant reminder of the fact that I didn't see him at all in 2020. But once we started talking, it was as if it was just yesterday. As our conversation began we talked briefly about those who Berkenstock felt would be best served by his group's services.

“What you run into is there are a lot of folks who don't grok to what's out there because it doesn't speak to who they are as a client. It doesn't speak to who they are as a person. And the Gamer Identity, whether you are an online gamer or whether you are a console gamer, or whether you are a board gamer or tabletop RPG, all of those fixtures are a part of a person's core identity. Our vision statement is we advocate for and utilize tabletop gaming for education, skill building, and therapy.”

Berkenstock continued talking about its effectiveness with those on the autism spectrum. “Instead of doing the typical group where they do, 'OK Johnny, we are going to practice our Reciprocal Eye Communication' or 'practice our statements to other people,' we ask can we build skill-building and development into the very fabric of gaming itself?'”

It was enlightening since I was diagnosed with autism at a young age. The simple acts of body language, reading a room, and even just socializing with other people was a daunting task during my childhood. Berkenstock tuned into that stress perfectly, how just going to a gaming group is a gauntlet of small but daunting challenges.

“Just going with a person you don't know to pick out a game from the available library in a game store, or sitting down to play a new game, something you're not inherently familiar with, you're taking chances," he said. "But on the other hand, that person is now developing skills in a way that doesn't feel antiseptic.”

Gaming is inherently interactive, and board gaming is inherently communal. With that in mind, with the right group, structure, and reinforcement, it can feel more organic than a more clinical Social Engagement Group exercise.

Berkenstock is also aware of how things like this can potentially backfire. He talks to me about an instance where there is a gaming group of 20–25 people, all dealing with some form of social anxiety hanging out and having fun... but none of them branch out. It can lead to situations where universalization of these crucial skills do not happen outside of these very circumstances, referring to it like getting a car but never taking it on the highway.

But those that take that leap suddenly have a much stronger social circle than they had before. Going out to a local game shop means they are interacting in the general public, interacting with patrons and players. But above all, by their gaming groups, they have an understanding of gaming shorthand.

As difficult as it is for those not on the spectrum to understand, expressing yourself and not being laughed at for how you do it can be a massive cause for anxiety. Looking into gaming, there is an entire lexicon of shorthand and inside terms that express so much to those in the know. How many times have you recognized phrases like “quick-time event,” “dedicated face,” or even something as innocuous as "hit points," "stealth sections," "dialogue options," "branching paths," or "boss fights?" Go even further and there is an entire identification system for many situations, character traits, and even expected roles people play in groups. This is a vital and precious communication system that helps cut down on so many communication woes.

“For some folks, just getting out of the house to the store is a phenomenal undertaking," Berkenstock said. "If gaming is a comfort zone that that person knows, we utilize that. We often say that gaming is not the destination; gaming is the vehicle."

Safety Tools, Session Zero, and Gatekeeping

Despite strides being made in various fields, there is still a lot of negative stigma around mental health and a lot of barriers to entry when it comes to gaming as a whole. Sadly, it is a question that doesn't have an easy answer. Mental health can be affected by so many different things throughout one's life experiences. For example, anxiety can lead to feeling overwhelmed by something complex or unfamiliar elements—something that definitely applies to tabletop gaming. Even when it comes to Dungeons and Dragons, which tries to keep its system as accessible as possible, there is a learning curve to tabletop RPGs.

Berkenstock mentions the all-too-real phenomenon of Imposter Syndrome. It is that lingering idea in the back of your head that you do not belong where you are, that one little slip up will get you caught. That pops up a lot with people with these disorders. Framed another way, the person is not worried about whatever it is they are diagnosed with, but that because of it, a misunderstanding will happen and they will be barred from the group.

From autism to depression to anxiety, the idea of swift judgment because you couldn't control it is a shared fear. What doesn't help these fears is the prevailing mainstream idea that mental health is all about willpower and just thinking happy thoughts; trust me, it doesn't work.

And my interviewee agreed. Berkenstock confessed as someone diagnosed with severe ADHD and Bipolar Mood Disorder, there are days where despite all of the good that he has done as a mental-health worker and therapist, he has bouts of anxiety. Even those who dedicate their lives to helping people with these very disorders learn to cope like everyone else.

So what exactly can gaming groups large and small do to help these potential new players feel welcome? Two words: Safety and consent. Tabletop veterans might be familiar with the idea of “session zero,” where players make their characters and discuss with the Game Master what they want from the adventure going forward. This is not just a great way to set expectations and boundaries for the adventure, it is a great opportunity for the GM to express content warnings for potentially triggering subject matter, especially if it's a system meant for older players.

This extends to board games as well. A simple beer-and-pretzels experience like Pavlov's Dogs can be a nightmare for those with performance anxiety. On the other extreme, the high-intensity choices that come from survival board games like Dead of Winter can be devastating for players with a history of trauma or high anxiety.

This is not censorship; it is Trauma Informed Care. Much like how universal precautions are taken when it comes to hazardous materials or bloodborne pathogens, Trauma Informed Care errs on the side of caution when it comes to potential triggers. It is better to have it and not need it. Five or 10 minutes taken aside for this can make a world of difference.

In fact, there's a very good chance someone in your gaming group copes with one of these things mentioned above. According to the CDC, one in seven children have experience some form of abuse or neglect, which can lead to long-term mental health issues. More importantly, this means there's a very high chance given the average number of players of a tabletop game is about six, it is likely that someone at that table has dealt with something serious or may even know someone who is experiencing something serious. If no session zero is had, if none of this responsibility is taken, it can lead to some unintentional damage. This doesn't mean everyone has to air their dirty laundry in a public forum; it's more that it is better to assume there's something than to assume there is not.

Berkenstock compounds on this practice. He says that it's also good to get into the habit of doing another session zero every time a new player enters the group or a major event happens in the story, just so the players have time to discuss and decompress the situation.

But by all means, use Safety Tools. There are plenty of these tools available for groups of all stripes. There is the use of the X Card, the concept of Lines and Veils, there's even an extremely useful app on itch.io called Script Change. There are even small bits of reading to help as well. In addition to Berkenstock's very own Wizards, Warriors, and Wellness, which is available in PDF format on DrivethruRPG.com, there is also Consent in Gaming available for free at Monte Cook Game's website. These are vital tools whether or not you are starting out as a GM, or wish to run therapeutic experiences of your own.

But the biggest surprise is that not only can these tools help give voices to people, they can help start different kinds of personal growth. Berkenstock spoke personally about a game session he ran as part of a COVID Relief Group, running an RPG for university students. A player ended up objecting to how the group was demonizing dragons in this fantasy world. In short, the players were taking credit for slaying a dragon (which they didn't) and looting its hoard, which led to this agreed shorthand that all dragons were bad and taking their stuff was a good thing. The player stated that it was analogous to racial tension and asked if the group could step away from painting with a broad brush.

To paraphrase the student, “I deal with stuff like that every single day in real life, I don't need it in my game. I've washed the N-word off my car. I have been beaten within an inch of my life just because I'm Black.” What followed was a quiet moment of understanding followed by a transformative moment of understanding and an apology.

Post-Pandemic Anxieties and Valid Play

Berkenstock had a probing question when it came to our community post-COVID: What is our transition plan? How do people pivot from a year and change of Zoom calls and working from home to going out and being part of the world again?

“I gave my first out-of-my-social-circle hug today, and it was WEIRD!” Berkenstock exclaimed as I laughed. But that laugh quickly soured because I knew what he meant: Getting back to normal wasn't going to be easy or quick.

“I've been away for so long, and there's a part of me that finds a certain level of comfort in not having to go out. Not having to interact to a degree," he said. "Let's look at folks with anxiety or depression. People with social skills challenges. I think part of the struggle might be getting people back out who are used to staying in.”

Just to sell this shift even more, Jack mentioned when The Bodhana Group was working with the Harrisburg University of Science and Technology on a case study about gaming and anxiety. Because of Covid, the study had to be done through Zoom, and an overwhelming majority of those participating in the study said they would have dreaded doing it in a room with strangers. It is no longer just people with a history of anxiety, but regular people who have normalized this lockdown lifestyle. It is far too early to see how this post-Covid anxiety will affect us, but addressing it as something all too real is a start.

Despite the untold amounts of stress it has wrought however, Berkenstock remained optimistic. He hoped that people don't just snap back to things being normal again and a bit more empathy and care comes from this—more hugs, more concerns, and a more strengthened community. In a few small ways, that is happening. He mentioned that his real life meet-ups now have at least half an hour where everyone just catches up. Even my own personal online RPG groups have had nights where the GM just asks if we can just sit and talk. There are even sessions where it was more about characters hanging out at taverns or fancy dinner parties than about fighting monsters and getting treasure.

“We talk about it a lot in The Bodhana Model about how one of the reasons that role-playing as therapeutic intervention works so well is that people will inject into the narrative what they feel that they need. We have found this time and time again," Berkenstock said. "If I wanna work on daddy issues, I am going to inject a strong male presence into that session. If I want to be more relaxed, I'll add more humor potentially into that session. We find that a lot of these situations happen. You don't get something in your real life, your fantasy world is going to attempt to bring what you feel you need.”

And at the risk of preaching to the choir, that awareness and empathy lies at the heart of what makes gaming as a whole such a powerful and beautiful experience. From the outside, it looks like impenetrable numbers and dice and people sitting around a table talking about weird ideas. But when everything goes right, you will have stories that will live on in your memory forever and make some of the most steadfast friends you will ever find.

And to those who are still afraid of taking those crucial steps, of being terrified of reaching out, Berkenstock has this to say:

“There is a game out there for everyone. Using gaming as a way to introduce yourself to other people is much easier than more intense awkward social situations for most. Most of the pressure is on the game. But find people that are accepting and not judgmental to share in this hobby. This comes from me speaking as both a mental-health expert and a Buddhist: You have everything that you need to be happy. There is nothing you need to make you happy. We decide, even in pockets of misery, in pockets of difficult struggle, we still decide inherently to be happy at some level. Part of that is acceptance. Part of that is knowing there will be days where you can't handle your anxieties.

That is OK. That is OK that there are moments where it is stronger than you. But that does not mean it will always be stronger than you. And part of that is just knowing that there will be highs and lows, finding groups and hobbies so we can share these moments. That is where we get the full benefit of social systems.

When we game together, we create memories. As we create these memories we make these bonds with people. You are creating stories, you are creating these indelible moments that you don't have with anyone else who is not there. You are creating closeness. Those stories are no less visceral than people telling you about the day their child was born or the day they met their husband or wife. These are moments that are locked in time. Moments we tap into when we feel less than strong.

We define ourselves through stories, and the stories we create around the table are no less important than the ones in real life.”

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If you or someone you know believe that this form of therapy may be beneficial, you can participate in a webinar, attend their online convention Save Against Fear, or even schedule training for gaming therapy application by reaching The Bodhana Group here.

Happy National Health Month everyone. You are seen, you are loved, and there is always a place at the gaming table for you.