The experience of trauma is unfortunately common. In a previous post, I discussed some ways we can incorporate the principles of trauma-informed care into the way we play games and relate to each other in gaming spaces. In this post I want to start a conversation for how these principles could look embedded into game design.
There will be some repetition in this post to catch up people who haven't read the earlier post about trauma informed care.
Why Should Game Designers Think About Trauma?
As revealed by the ACE study traumatic experiences are common: 66% of respondents experienced at least one adverse event in childhood and more than 20% reported three or more different kinds of adverse events. This study focused only on childhood in the U.S. Another study found that worldwide, 70% of respondents experienced a trauma in their life and 30.5% experienced four or more traumas.
Not everyone who experiences a trauma develops posttraumatic stress disorder. The absence of PTSD doesn't mean, however, that they are unaffected by it. There is a wide range of expected and normal reactions to severe stress.
There is also growing evidence that chronic stress causes changes to the mind and body's reactions in ways similar to PTSD. So even people who do not experience trauma as we might think of it can still experience PTSD-like changes from being in a fight-or-flight state on an ongoing basis.
The reality is, when we design and release games we are engaging with a group (humans on this planet) who likely have experienced trauma or chronic stress and will react differently as a result.
What is Trauma Informed Care?
Trauma informed care is a movement within the medical field to provide healthcare in a way that considers common trauma triggers and responses, and adapts its approach to be more safe and supportive with those reactions taken into account.
The core principles of trauma informed care can also provide useful guides for game designers.
The core principles of trauma-informed care are:
Applying the Principles to Game Design
Empowerment. At its core, empowerment is about insuring people have freedom of choice and action. Traumatic experiences often involve feeling powerless, which is why empowerment is so important. What does this look like in game design?
It begins with informed consent. Or in less medical terms: people should know what to expect if the engage in the game, and have a chance to agree to engage or not. To be clear, this is different from a "trigger warning", which focuses on letting people know of potential trauma triggers. This is more fundamentally about being honest about what is in the game and what to expect if you play.
This point often gets muddled by marketing. Marketing is about capturing interest, encouraging people to buy the game, and hopefully play it. Informed consent requires the space for "this game may not be for you, or not for you right now." People will often state that no game is for every person; as designers we need to embrace this idea and be upfront about what players can expect.
Some games intentionally explore power imbalances or loss of power. Just because the game mechanics can create a sense of powerlessness doesn't mean the game overall needs to. Designers can be upfront about the dynamics and provide tools to encourage communication so the players remain empowered throughout the experience. Resources like the TTRPG Safety Toolkit and Monte Cook's Consent in Gaming are a great starting place.
Choice. Choice means giving people different options so they can choose what they prefer. Choice can take many forms in game design.
It starts with players choosing to play our games. Not to belabor the point too much, but if people are surprised by a game's central premise because of poor communication around what a game is about, they didn't make the choice to play our game, they made the choice to play something else.
Choice can mean giving people options over the roles they take in a game. Clear descriptions of the different roles and what to expect is helpful. Having more role choices than minimum players needed means people have the freedom to discard certain content.
Choice can also mean being clear to players about what parts of the game can be cut out or changed. Fundamentally, any play group can decide to change or ignore a rule—and many do. But leaving that unspoken means we're putting the responsibility on every single game table to encourage choice in a healthy way. Why not, as designers, make it part of the rules that choice is an option? This can range from specific statements about "this rule is optional" all the way to general statements that "this game can be changed in any way that makes it fun for your group."
Collaboration. It may seem like collaboration is built into any TTRPG. And yet...so often the problems in playing games and questions people ask point to a break down in the collaboration process. Game designers cannot insure perfect communication at the table. But for a genre based on group-play, we can take some time to think through how our game contributes to the process.
Collaboration within trauma informed care is defined as "working with at least one other person towards a common goal or shared purpose." This dynamic is imporant because people with traumatic experiences may not be used to being considered in decision-making; they may not think to, or feel comfortable to, share their opinion. Collaboration is an active and overt process of 1) inviting people into the discussion and making space for everyone to participate; 2) identifying the most important needs of everyone; 3) defining the common goal; 4) pooling together everyone's expertise to reach the goal.
Okay, but what does this look like in game design? We aren't mediators and we aren't present as people collaborate, so how can we influence this?
First, collaboration is influenced most strongly by how people in the group view each other. If one person is viewed as more or less important (e.g. the GM always has the final say), that will undercut collaboration. Our games can make it clear either explicitly or implicitly that all players should have an equal voice.
Second, collaboration is based on sharing a goal. The game can provide guidance (or even define) the shared goal(s). This can take the form of defining GM/Player agendas. Or it can take the form of providing different advancement options/focuses in the game. Or it can be as simple as an introduction that says "this game is about [x]". Anything that helps the players discuss or identify a shared direction contributes to this dynamic.
Third, if the game involves significant decisions about gameplay, the rules can state that the group should discuss it. For example, when I designed Karma in the Dark, a game about exploring oppression in a cyberpunk future, the rules stated that every player had to be involved in the decision about the types of oppression that would be explored in gameplay. I explicitly did not want the GM deciding the oppressive themes without active player involvement and consent.
This could also take the form of providing questions or structure to the group's first session so they can establish parts of the shared game world together. This could take the form of a full session-0, or it could be embedded into character creation more generally. For example, Apolcalypse World provides specific guidance on session 1 and how to build the world through play. Good Society begins every new game with a process called "Collaboration" which explicitly guides the group through defining the content and tone-setting they want.
Finally, there are ways to embed collaboration in game mechanics. For example, in Blades in the Dark, if a player fails a roll and the GM describes consequences they don't like, the player can choose to resist the failure (i.e. "no, that doesn't happen"). The GM has a say about whether the consequences disappear completely or are reduced. It's an elegant, mechanical way of showing a balance between random dice outcomes, player preference, and a GM's narrative power.
For a more old-school style game example, in The Nightmares Underneath, the GM is encouraged to create new nightmare incursions (its form of dungeons) based on the nightmares of PCs who die. The GM is responsible for creating the nightmare, but is provided questions to ask the player so they can base it off the player's character.
Safety. Safety is about developing a setting that contributes to physical and emotional safety. I am not going to recreate the robust discussion around safety tools in TTRPGS in this post. Instead I want to focus on two points.
One, designers shouldn't push off all responsibility for safety onto individual game groups. Include safety tools in the game. For the Queen is one example: the "how to play" rules, which are read at the start of every game, include an explanation of the X-Card. There are many different safety tools, so we can pick the ones that fit our specific game or use them as inspiration to create our own.
Two, if the content deals with themes which may be triggering, deal with traumatic experiences, or want to empower players in response to a possible trauma, designers should seek out a mental health/trauma consultation. There is a growing awareness of the need to use consultants (or "sensitivity readers") for accessibility concerns, other cultures, and marginalized groups. We should also consider if the games we create need a mental health reader. An outside perspective, especially one trained in trauma care, can identify game elements which might create unsafe situations that aren't immediately obvious.
Trustworthiness. Within trauma informed care, trustworthiness is based on creating clear expectations. When working in the medical field, I often think about this as telegraphing what will happen and why.
In addition to being upfront about a game's content, it is important to consider how games are actually played. For example, there is a very good chance not all players in a group will read the entire rulebook. There is a very good chance some players won't read the rulebook at all. They will rely on the facilitator/GM/more rules minded players to bring the book's content into play.
How does this affect our design?
We should think about the experience of playing our game with no foreknowledge. Then decide if there are rules, expectations, or experiences that it is important for players to know. Then we need to think through the best way to communicate that to people who don't read the book.
This can take multiple forms. Perhaps the GM is given a short script to read to players at the first session about the game (e.g. a single paragraph or few sentences about the goal and content of the game). Perhaps the game includes one-page player handouts or one-page orientation sheets that summarize the key things players need to know. Or a rulebook could include a 1-3 page overview with instructions to make sure every player reads it before the game (as a few pages is more likely than a 100+ page rulebook).
The goal is to build up a sense of trust between the players and the game material, but it can also build up trust between the players at the table. If the GM is the one providing the orientation, for example, it is a brief step that begins to build up communication and expectations between the players and GM.
Depending on how the content is written, this can also provide a brief introduction to the game world for all players. It doesn't have to be a dry procedure; it can be the first step in pulling them into the game and engaging their interest.
This article is meant to start the conversation, not complete it. I provided a few details of how to think through designing around trauma-informed care principles. There are dozens of more ways to implement and consider them in our designs.
I often come back to something James Mendez Hoades wrote about writing games safely. The entire article is worth reading as he goes through designing safety at different levels, but I want to highlight this final goal: "no one can misinterpret your work, take it out of context, or repurpose it to support evil ends...they also won’t make things, inadvertently or otherwise, which hurt people." That goal is part of why we as designers should explicitly consider how our games will interact with the too-common experience of trauma.
I hope thinking through trauma-informed care can help all of us become more informed and thoughtful in our designs. I hope it can help us become more explicit in supporting safety in our games.
If you are a game designer who wants a mental health or trauma consultation, I offer those services when time allows. Feel free to contact me; if I can't assist with your project I will do my best to connect you with someone who can.
This blog is a mix of game design analysis, commentary on issues affecting indie dev spaces, and some personal reflections.