Role-Playing Games and Well-Being

: Do role-playing games (RPGs) affect the player’s well-being? Several studies suggest that they might have an impact, but the topic of RPGs and well-being is usually only mentioned as a side note or curiosity. A clear, coherent picture on the topic of RPGs and well-being is missing. This review article aims to provide that picture by compiling the already ex - isting knowledge in one place. I ask the questions: What can we learn from the already existing research? How should RPGs and well-being be studied? What questions need resolving? What can be gained from studying RPGs and well-being? RPG studies is a young academic interdisciplinary field of research, as is also the research of arts and well-being. They both are heterogeneous and related to a variety of academic traditions. They both are also dispersed, pragmatic, and until recently, scattered and lacking cohesive traditions or methodologies. Many basic ontological questions remain unsolved and the definitions of key concepts vary. They overlap in several discourses, such as the ones about (1) practices of sociodrama and replication therapy; (2) social, cultural, and digital capital; (3) leisure time research; (4) performance studies; (5) the topic of erotic role-play; (6) problematic vs. therapeutic gaming; and (7) health education. Previous research and practices focus mainly on live action role play (larp) and well-being, suggesting a positive impact. Online RPGs share their own traditions, but studies on tabletop RPGs and well-being are difficult to find. The studies are often case-studies or examine abstract topics such as human experiences. In these studies, it becomes evident that RPGs do indeed impact well-being. However, questions such as how, why, and what features in RPGs affect well-being remain unanswered. In addition, the research has mainly been executed from the perspec - tive of either RPGs or arts and well-being. Interdisciplinary cooperation is the key to successfully diving into the world of RPGs and well-being. Doing so would offer both fields useful practices, interesting perspectives, new opportunities for pub - lication and academic discussion. It would not only add knowledge about RPGs and well-being but offer perspective to the unresolved ontological questions of each field. Eventually, further study on RPGs and well-being could transfer into the usage of RPGs in the fields of well-being, health, and therapy in a similar manner that arts are currently being used.


INTRODUCTION
During the recent decade, role-playing games (RPGs) have been studied as a significant part of western culture, (MacCallum-Stewart et al. 2018), performance (Hoover et al. 2018) participatory art (Cox 2018;Pettersson 2005;, pervasive games (Montola 2012a), an educational method (Hammer et al. 2018), and a form of political expression (Kangas, et al. 2016). Some studies also approach the topic of RPGs and well-being. (See e.g. : Taylor 2018;Stenros and Bowman 2018;Brown and Stenros 2018;Bowman and Schrier 2018, 399-400;Bowman 2010, 127-154;Trammell 2018;Pettersson 2010, 168-173;Meriläinen 2012.) With this review I provide an overview on the research of RPGs and well-being, and the possibilities the topic holds in the future. I begin by presenting the traditions and methodologies of roleplaying game studies and the study of arts and well-being. Next, I pinpoint previous research that has somehow addressed the topic of RPGs and well-being in six sections: (1) practices of sociodrama and replication therapy; (2) social, cultural, and digital capital; (3) leisure time research; (4) performance studies; (5) the topic of erotic role-play; (6) problematic vs. therapeutic gaming; and (7) health education. I discuss what we can learn from already existing research on the topic and examine the best ways to study RPGs and well-being. Finally, I discuss the possibilities arising from combining RPG research and the study of arts and well-being. The emphasis of this text is on Nordic and North American research.
The purpose of this review is to better define the framework of RPGs and well-being, enabling new spaces and interdisciplinary opportunities for both fields, and by doing so, encouraging new studies about the topic. Eventually, this could enable approaching RPGs in a similar way that arts are currently around the world. For example, a Nordic larp focused upon deep immersion into a socially realistic setting dealing with the refugee crisis is quite different than a traditional American fantasy boffer larp focused upon heroic displays of battle prowess, but both traditions are called larp. Other analog games related to RPGs (board games, card games, miniature games) or other phenomena related to these (fan culture, etc.) are also often addressed in RPG studies. However, research of online RPGs has traditions of its own (Stenros and Harviainen 2018, 115). In some studies, online RPGs are included and observed as one branch of RPGs (see Zagal and Deterding 2018a;Bowman 2010;Simkins 2015), but in others, online RPGs are excluded (see Stenros and Harviainen 2018, 115;Leppälahti 2009;Pettersson 2005, 10;Meriläinen 2012). Furthermore, RPGs are occasionally referred to as "non-digital" or analog games, which excludes online RPGs (see Montola 2012, 102).
In RPG studies, the ontological and epistemological questions twirl around the need to understand the topic of the study, RPGs, better. The essence of character versus self has been theorized on several occasions (Sihvonen 1997;Bowman and Schrier 2018;Brown and Stenros 2018, 432-434;Pettersson 2018, 87-96;Järvelä 2019). The ontological questions about playing/being in a character and immersion --such as what is self, what is character, and where is the line between the two --and the epistemological issues rising when measuring human experiences --for instance, the biasness and subjectivity of experiences; the loss of knowledge of oneself in a character --are at the core of RPGs, and therefore RPG studies (see Zagal and Deterding 2018b).
Academic RPG studies are strongly influenced by RPG communities. Conference books from RPG events such as Knutepunkt or Wyrd Con are commonly used as references in academic research (see Montola 2011, 102;Harviainen 2016;Long 2016). The Nordic tradition of RPG studies especially has been developed by active, academic individuals from the role-playing community with the support of the group (Stenros and Harviainen 2018, 114-119).

THE TRADITION AND METHODOLOGY OF ART AND WELL-BEING RESEARCH
Well-being is a phenomenon that correlates with the surrounding culture and society, and is influenced by various individual, social, cultural, economic, material, and political variables (see WHO 2015 andSaari 2011a, 10). Well-being has been said to consist of individuals' needs and their fulfilment, and of opportunities to participate and act in their environment. Experiencing well-being means that people have a possibility to live in such a way that their lives become meaningful to themselves (Lehikoinen and Vanhanen 2017, 15). In the Well-Being Assessment, the term is defined as "a condition in which all members of society are able to determine and meet their needs and have a large range of choices to meet their potential" (Ketovuori 2011, 107). Sociologist Erik Allardt (1976) defines well-being by fulfilment of three components: having, loving, and being (basic needs, social connections, and self-expression) (p. 17-21). The context of arts and well-being emphasize the importance of human agency to one's well-being: participation, doing something meaningful, and functioning as a part of something bigger (Pirnes and Tiihonen 2010, 207;Virjonen and Rouhelo 2018, 9-1). In addition, they tend to focus on a person's own estimation of their well-being (Nenonen et.al. 2014, 236;Lilja-Viherlampi and Rosenlöf 2019).
The word culture stands for the behaviours, artefacts, and beliefs that define social identity (Riqueime and Rosas 2009, 352). Art in all its forms is an essential part of culture. The Merriam-Webster English dictionary defines art as something that is created with imagination and skill, that is beautiful, or that expresses important ideas or feelings. According to Ketovuori (2011, 107), art as a concept is too broad to grasp because, on an individual level, it always means something slightly different. This is because we all live in our own cultural bubble and define art from our perspective. In the context of arts and well-being, the element of cultural agency is essential and even more important than the actual artistic or esthetic outcome. Therefore, I also approach art as a piece of work or act that reflects the artist's own culture, that is created with imagination, and that expresses important ideas or feelings.
The research of art and well-being in its current form originated in the early '70s from the field of sociology, although the idea of culture having a direct role in healing illnesses and in promoting recovery and well-being appears in several cultures throughout the history (Lehtonen 2005, 3-4;Clift and Camic 2016b;Bourdieu 1974). During the last 60 years, the idea of using arts and culture in a broader context of well-being of communities and individuals has been gaining ground (Clift and Camic 2016b, 3). For instance, in 1974, Pierre Bourdieu wrote about the importance of cultural capital (knowledge, skills, intellect, experiences, relationships) to social capital (social networks, ability to function socially, participation, sense of belonging) in his article Cultural Reproduction and Social Reproduction. He does not use the words "health" or "well-being," but the idea of the causality between art and well-being is presented (Bourdieu 1974). His work and ideas about causality are considered as an opening for a certain way of thinking, which enabled pilot projects in the 1980s that deployed the arts for community health development (Belfiore 2016;White 2009).
Today, culture --a broader concept that includes art --is seen as a part of humanity and thus, as a part of an individual's well-being (Lehtonen 2005, 4; see: WHO 2015; Fancourt and Finn 2019). It has become an essential part of the indicators used to measure the well-being of nations, such as the Human Well-Being Index (Prescot-Allen 2001, 13; Ketovuori 2011, 107). The number of publications about arts and well-being is increasing and so is the number of the regional and national Arts for Health organisations around the globe (Clift and Camic, 2016b, 3-4). Most of this research either supports the hypothesis that art impacts well-being or examines the reasons behind such impacts. The common consensus is that participating in cultural activities is associated with a better life and well-being (see Gladstone-Barrett and Hunter 2016;Vella-Burrows 2016;Robertson 2016;Cuypers et al. 2012;Johansson et al. 2001;Kim and Kim 2009;Nenonen et al. 2014, 235;Laitinen 2017;White and Hillary 2009;Clift and Camic 2016a;Fancourt and Finn 2019).
Sociology and psychology are common approaches to the research of arts and well-being, as are also the health sciences, the research of art and culture, social and culture politics, economics, and anthropology (Laitinen 2017, 16;Saari 2011b, 33;Clift and Camic 2016b). The sociological approach is strongly impacted by Bourdieu's (1974), and Putnam's (1993, 177) work and theories about social capital in relation to cultural capital. Sociologist research on art and well-being is often very pragmatic, tied to a specific social phenomenon (such as youth), and case studies and constructive approaches are common (see Koivisto et al. 2010). Then again, the physical or psychological effects of art in individuals are examined in medical sciences and the focus of the research is on an individual rather than a society or community (see Trzaskowski et al. 2014;Bittman et al. 2013). In psychology, the research covers ontological issues such as the essence of well-being or happiness, whereas in economics, well-being is researched in the context of money and resources in a relativistic manner (Saari 2011b, 33) With all these perspectives, the field is dispersed.
The philosophical and methodological approaches of arts and well-being also vary widely. Pragmatism is common, but so are relativism and even critical realism. It is easy to find qualitative and quantitative research, and case studies are especially popular (Clift and Camic 2016a and 2016b; Lilja-Viherlampi and Rosenlöf 2019). In quantitative research, respondents' well-being is usually measured by comparing indexes, such as Quality of Life (QOL) and Self-Rated Health (SRH) (Saari 2011a, 21;Hoffrén and Rättö 2011, 219;Nenonen et al. 2014). QOL is measured by asking the respondents how they feel about their life in terms of psychological and physical factors, purpose in life, sense of belonging, and environmental resources, whereas SRH has been used to examine the effects of cultural participation (Nenonen et al. 2014, 236). Noticeably, even in quantitative research, attempts have been made to understand the experience of an individual when participating in culture or arts (See: Nenonen et al. 2014, 236;Cuypers et al. 2012;Johansson et al. 2001;Michalos 2005;Michalos andKahlke 2008 andNummela et al. 2008 and2009). Qualitative research and case studies tend to verbalize these experiences and understand the impact that culture has on one's health on a deeper level. The case studies are often focused on traditional forms of art and culture, such as theatre, dance, painting/ drawing, sculpture, and music Camic 2016a and2016b;Lilja-Viherlampi and Rosenlöf 2019). What connects all this research is that it is holistic and gives value to human experience.

RPGS, ART, AND WELL-BEING
The disciplines of RPGs and art and well-being have many similarities and overlap in several places. Well-being is such a wide concept that most of the studies about the player's relationship with the role, immersion, transgression, sexuality, discrimination, physical aspects of RPG, self-expression, identity, emotions, power, and control can be interpreted as studies about RPGs and well-being. In addition, RPGs can be approached from various points of observation, which means that majority of the research about arts and well-being is also somehow related to RPGs. In this chapter, I present research that addresses some aspects of RPGs and well-being: the most evident overlaps.

Practices of sociodrama and replication therapy
The most evident overlap is found in their histories, specifically in sociodrama and replication therapy. As a matter of fact, the concept of pretending to be someone else to better understand them or oneself, or otherwise gaining profit is something very natural and found in religious and shamanic traditions, and even in animal behavior (see Belfiore 2016, 13-14;Huizinga 1938;Stenros 2015;Montola 2012). According to Marvin Carlson (2004, 75) this is because playing a role or pretending not only meets reality in an essential manner, but allows us to find, test, and develop materials for responsible behaviour in the real world.
In the 1920's, Jacob Levy Moreno started to explore roles as a social structure and, eventually, in therapeutic processes. In 1946, he presented the idea that role-play or being in a character can be therapeutic in group settings and called this process sociodrama (see Moreno 1946;Carlson 2004;Stenros 2015;Montola 2012, 102;Huizinga 1939;Bowman 2010, 12-13). Theodore Serbin and Vernon L. Allen (1968) approached the possibilities of role-play or drama in therapy from a different angle. They thought that the therapeutic part of drama happens outside of character: the director or therapist gives the actor feedback and thus helps them to develop. In their opinion, the aim is to learn social and psychological skills in a similar manner that an actor learns from a director. Their approach to using role-play or drama as therapy is called replication therapy (Serbin and Allen 1968;Carlson 2004).
Viola Spolin developed several drama games that are used globally for pedagogical and artistic purposes, but also in therapy (Spolin Games Online 2018). However, it is important to notice that "roleplay" is a different thing than role-playing games. In the context of Moreno (1946), Serbin and Allen (1968), or even Spolin (Spolin Games Online 2018) role-play simply means playing to be someone else for a while and is similar to improvisational theatre. Studying role-play is not necessarily RPG research (Stenros 2015, 11 and2018, 11;Blatner 2007;Montola 2012, 105-106. See also Yardley-Matwiejczuk 1997;Crookall et al. 1987).

Social, cultural, and digital capital
A second obvious overlap between RPGs, arts, and well-being studies can be found from sociology and in the research of social and cultural capital. Social capital refers to an individual's set of social skills and abilities (e.g. social networks, ability to function socially, participation and sense of belonging), cultural capital refers to the cultural abilities that increase social status or cultural competence (e.g. knowledge, skills, intellect, experiences and relationships), whereas digital capital refers to the set of digital skills (e.g. content-creation, intelligence, problem-solving, and communication). Sociologist Pierre Bourdieu's texts about the importance of cultural capital to social capital resonates with Fine's early work about RPGs as a social phenomenon and microcultural system (Bourdieu 1974;Fine 1983;Williams et al. 2018). For example, Fine suggests that RPGs act as an arena for young people to practice their social skills, form social connections and thus improve their social capital (Fine 1983, 59-62). This has been further researched by game educator Mikko Meriläinen (2012). Then again, observed in the light of Putnam's research, social capital is built on events of co-operation, trust, and civic activity, and is strongly linked to collective well-being that appears also on individual level (Putnam 1993, 177). Davis and Boellstroff (2016) and Kuppers (2007) offer an interesting crossing point with disability, cultural capital, and particular vulnerabilities their target groups face. Kuppers is a disability activist, and accessibility is strongly present in her work about community practices. Her work is directly adaptable in certain kinds of RPG events, such as larps or conventions, thus bringing accessibility and well-being to the RPG scene, but it also has a message of possibility of social empowerment via cultural and social capital. Then again, Davis and Boellstroff (2016) have studied disability in online RPG environments. They examined how playing in the virtual world Second Life impacted people with Parkinson's disease's (digital) social capital and well-being. They discovered that the players gained not only access to social networks, but forms of embodied engagement, object creation, and life satisfaction previously lost because of their illness. Not only did they gain digital social capital, but also digital cultural capital. (Davis andBoellstroff 2016, 2112.) Nardi (2010) also approaches the themes of social and cultural capital. Her ethnography paints a realistic picture of the online RPG World of Warcraft. She states that the act of gaming in a guild provides a possibility to meet new people from different social classes with diverse interests from all over the world, while also being fun and eye-opening (Nardi 2010, p.23-24). Her notions are an example of the increased digital cultural capital researched by Davies and Boellstroff (2016).
Bourdieu and Putnam are also present in discussion about RPGs and race. Dietrich (2013) writes about the portrayal of avatars, the character representations that a player can choose from when playing an online RPG. According to him, in most electronic RPGs, there are no non-white avatars available. The opportunity to play with an avatar that visually resembles the player is reserved for the players of Caucasian heritage. According to him, this enhances the normative Whiteness. Loponen (2019) also talks about the problematic representation of racialized races in fantasy worlds, as well as in RPGs. He states that fantasy books and RPGs are representations of our time and that we repeat harmful, racial stereotypes in RPG worlds. He also points out the problems in the general moral structure of RPGs, where killing orcs or robbing random villagers is rewarded without question. Fein (2015 and has also studied the transformativity of role-playing (especially larp) amongst people with autism. Fein does not mention social or cultural capital in her ethnography, but she describes the larp (camp) where she conducted her research as a catalyst for an increase of social and cultural capital: I argue that the camp engaged participants by being congruent with their needs on three levels: in the structure of its practices, the narratives that comprised its mythology, and the nature of its community. The structured social practices of role-playing, from the character design sheets to the genre-specific formality of interactions, constituted a sociocultural ecology whose affordances provided the support and organization participants needed for successful social coordination. (Fein 2015) Similarly, Cross and Atherton (2016, 13) confirm that gameplay may serve as an essential tool for increasing social capital for people with autism.

Leisure time research
The concepts of cultural capital, social capital, and self-expression are also in close relation with concepts of leisure time and free time. This is also the approach that is usually applied to RPGs (e.g. : Fine 1983;Meriläinen 2012;Stenros 2018). The take is similar in arts and well-being: the respondents' assumed position to art or culture is hobby or leisure time activity instead of profession (e.g.: Gladstone-Barrett and Hunter 2016; Vella-Burrows 2016; Robertson 2016; Virjonen and Rouhelo 2018, 9-10;Tomka 2013;Pirnes and Tiihonen, 2010;Clift et al. 2016).
According to the principles of cultural agency, the positive impact an individual gains from culture or arts varies according to the level of the individual's own activity and their level of involvement. People are divided into experiencers, partakers, and actors according to the level of their engagement (Tomka 2013, 261;Virjonen and Rouhelo 2018, 10). Experiencers interact with everyday culture: listen to music while exercising, wear clothes or watch television without really thinking about it actively (Virjonen and Rouhelo 2018, 9-10). Partakers take part, doing something to get closer to culture; they go to a theatre, church, concert, or museum either alone or in a group. The role of a partaker depends on the subject being active doing something or going somewhere (Tomka 2013, 261). Actors do art or culture themselves (Pirnes and Tiihonen 2010, 208). They act, dance, sing, paint, write, or do other kinds of art or culture individually or in a group. This is usually enabled by a professional that facilitates a group (Virjonen and Rouhelo 2018, 9-10). Simon (2010, 19-20) describes more levels of cultural agency than these three, but the main idea is similar. According to her, the attraction in being a participant/actor is the fulfillment of the person's needs to contribute and succeed. She also states that some people want to engage from a distance and enjoy observing, but also that an individual can function on more than one level of cultural agency (2010,(26)(27).
The tripartition to experiencers, partakers, and actors is problematic in RPGs because it only involves the target group, or "clients," and does not say anything about the facilitators, professionals, or game masters. It leaves the organizers outside of the picture. That is why it is important to add another slot, enablers, to the list (Lehto 2019b). Then again, the idea of enablers doing more than e.g. actors is not unproblematic either. In addition, in the context of RPGs, the tradition is to have a low threshold for shifting roles (player, game master), and that all partakers are equal. Nevertheless, the roles of a game master and a player are different. Therefore "enabler" should not be following the "actor" as a fourth slot, but as a separate one from the triplet, and rather should be portrayed as its own group alongside the other three.
The perspective of cultural agency transforms the focus to the doing --and how that affects individuals or groups --instead of the art or culture itself. This could offer an interesting possibility to research other leisure activities, such as sports or RPGs, in the light of cultural agency. According to previous studies, participation, doing something meaningful, and functioning as a part of something bigger, which are all elements found also in RPGs, increase an individual's well-being (Pirnes and Tiihonen 2010, 207;Virjonen and Rouhelo 2018, 9-10).

Performance studies
Nordic larp as art or performance is a topic addressed in both RPG studies and performance studies, but also for instance in reminiscence work and oral history (see Carlson 2004;Arlander 2015, 7-25;Hoover et al. 2018;Stenros 2010;Kelley 2010;Lampo and Huuhka 2015, 329;Snow 1993;Kuusisto-Arponen 2012;Lehto 2019a). Allan Kaprow's Happenings and un-art (as he called it) has inspired discussion about the differences and similarities between theatre, art, larp and performance. Stenros (2010) reflects on whether Nordic larp can be seen as art, theatre, or performance even though it is also a game. According to him, these approaches are valid, but none of these alone quite catch the whole picture. Kelley (2010) writes about Kaprow's pieces and Nordic larp-reminiscent performances as art, although Kaprow himself called them "un-art," which also raises thoughts about Nordic larp as art or performance. Whose privilege is it to define whether larp is a performance or art? Lampo and Huuhka (2015, 329) suggest that performance studies should be applied to the larp research due to their bodily presentation and discursive performativity. Larp and performance have also been used in similar ways as methods in reminiscence work in an attempt to increase participants' well-being (see Snow 1993;Kuusisto-Arponen 2012;Lehto 2019a).
Although both Lampo and Huuhka (2015, 328) and Hoover et al. (2018) mention also other kinds of RPGs, claiming that they can be interpreted as performance, such research is difficult to find. This is not surprising, since larps are the most popular topic in the Nordic tradition of RPG studies (Stenros and Harviainen 2018, 115 and 124). In some ways, larps are more reminiscent of art than the other forms of RPGs. For instance, larps are photogenic and visually interesting, which is one of the reasons why they have been documented more than tabletop RPGs. Then again, they are more public than traditional tabletop RPGs, which are commonly played in small groups in a closed environment. Still, even tabletop RPGs are played in public nowadays and they are accessible to audiences online. The presence of an audience and publicity brings an element of performance to the otherwise closed setting. In addition, both playing and game mastering tabletop RPGs can be considered acts that reflect the artists' or players' own culture. These acts are created with imagination and express important ideas or feelings, which is the Merriam-Webster English dictionary definition of art. Then again, as Stenros (2010) says about Nordic larp: RPGs are not solely art and approaching them as such is not unproblematic.

Erotic role-play
Another topic where role-playing games and well-being are both present is the research of sexual identity, sexual well-being, BDSM, and erotic role-play. According to Brown and Stenros (2018), tabletop RPGs in general do not have a lot of rules for sexual or erotic play, but erotic role-play is popular in electronic RPGs. During the last decade, sexuality and erotica has also increased in popularity as a topic in Nordic larps. Erotic larp has been compared to sexual role-play or BDSM in previous research. Erotic larp and BDSM offer similar possibilities for self-exploration, which is beneficial for participants' well-being and even can be therapeutic (see Bowman 2010, 8;Hébert and Weaver 2015;Van Der Walt 2014, 8-9;Lindemann 2011;Sihvonen and Harviainen 2020).
Then again both BDSM and larp are physical, involve role-play, and in some erotic larps, they might resemble one another immensely. Harviainen (2011, 62) even claims that BDSM is a form of larp, because both play with power dynamics agreed on beforehand, and after the game, the everyday power structures are restored. The similarities he pinpoints are interesting from the well-being point of view because this kind of power play alongside the support of a community are major attributes in BDSM that impact participant's well-being positively (Van Der Walt 2014, 12-13;Lindemann, 2011).
According to Harviainen (2011, 59), all BDSM has an element of role-play in it. The main difference between erotic larps and BDSM is that in larp, sex itself is simulated in different ways. Larps where sex is played are very rare (Brown and Stenros 2018, 431-432). The intention of arousal, or physical pleasure is a key factor in BDSM, whereas it is not in a larp (Harviainen 2011, 63, Sihvonen andHarviainen 2020).

Problematic vs. therapeutic gaming
RPGs and psychology have been studied, but the emphasis has been on online RPGs rather than larps or tabletop RPGs. Both Fuster et al. (2012) and Yee (2006) write about psychological motives in online role-playing games and their psychological and social impacts on players. According to Männikkö (2017), one of the qualities a problematic player looks for in a game is role-playing. Männikkö connects problematic playing to increased preference to interact online rather than in person (often caused by social and psychological problems). According to him, playing a role deepens the gaming experience, offering social contacts and escapism at the same time. Scott and Porter-Armstrong (2013) claim that playing massively multiplayer online role-playing games such as World of Warcraft are strongly associated with both helpful and harmful impacts on adolescents and young adults' psychological wellbeing, stating that further research is needed. Nardi (2010, 13) specifies that focused play offers a refuge, or escape, from the real world. Snodgrass, Lacy, Dengah and Fagan (2011) suggest that the key is not only in seeking meaningful social interactions in the game environment, but how and with whom the players interact. They state that playing World of Warcraft with real-life friends allows gamers to transfer in-game accomplishments and experiences to real life, and this tends to turn out beneficially for the player's offline lives. They also tend to be more aware of their offline communities, relationships, and responsibilities. The players who socialize solely online evolve problematic gaming habits more likely.
Analog RPGs and psychology have also been connected by Bowman and Lieberoth (2018). They create an overview on RPGs from the perspectives of neuroscience, motivation, personality, attitudes, psychoanalytic theories, conceptuality, and developmental, cognitive, behavioral, clinical, and social psychology. They present terms and concepts that have been developed to better grasp the psychological aspects of role-playing and discuss some core psychological questions of RPGs, such as whether role-playing is psychologically dangerous. According to Bowman and Lieberoth (2018), there does not seem to be RPG-specific psychological dangers. Instead, interest in using RPGs in the field of health care and therapy has increased, particularly in USA, but also in Australia and Europe, and a growing number of therapists are interested in using and developing RPGs as a tool in therapy (see Bean et al. 2020;Causo and Quinlan 2021).

Health education
RPGs and well-being overlap slightly in the study and practice of health care. In these studies, RPGs are commonly presented as a form of (art-based) participatory learning, not as a source of well-being (see Bowman and Standiford 2016;Karppinen et al. 2014;Hyvärinen et al. 2014.) These studies do present a mutually beneficial working field for RPG researchers and especially RPG developers in the field of health pedagogy, although its nature has been more practical than academic. Other research and field reports about pedagogical RPGs, especially larps, also imply a connection to well-being, although it has not been at the center of research (see Bowman and Lieberoth 2018).

DISCUSSION
As presented above, there are several interesting studies related to the topic of RPGs and well-being that indicate that RPGs do indeed impact well-being. These works are often case studies or examine abstract topics such as character versus self, immersion, and being in character. They often measure human experiences, happiness, or emotions.
Until now, the research has been done mainly from the perspective of either RPGs or arts and well-being. The lack of connection leads to a situation where already existing practices need to be reinvented, valuable research reaches only half of the people it should reach, and opportunities for fruitful discussion and practices are being missed. Especially the questions about role, self, and immersion in the field of well-being would benefit immensely from a stronger connection to RPG studies. Then again, it would be interesting to compare RPGs to theatre, performance, or storytelling in the context of well-being and ask what makes them impactful. RPG researchers might find useful approaches to measuring human experiences from the study of arts and well-being. They can challenge each other's views and concepts in a fruitful way, such as in the case of RPGs and cultural agency (Lehto 2019b). This kind of constructive, interdisciplinary discussion might lead to new and updated scientific theories.
What is not yet clear, is how, why, and what features in RPGs affect well-being. Answering these questions is essential if RPGs are to be applied in healthcare or therapy in a similar manner that arts are currently being used. Methods and approaches commonly used in the study of arts and wellbeing could be applied when answering these questions. Then again, understanding the complexity of RPGs is equally important.
For example, Viola Spolin's theatre games were first used in other forums just as RPGs are currently used. Later their impact on participators was researched more and eventually they were brought to health care (Spolin 1963; Spolin Games Online 2018). Spolin represents a common approach to arts and health that emphasizes the pragmatic nature of the field: the research begins with a case study of an already existing practice, leading to a purposeful and goal-orientated use of something entertaining. The same approach could be applied to RPGs and well-being, but it requires both knowledge of the topic and the way it is purposefully applied.
In my opinion, researching RPGs and well-being requires understanding and expertise for the complex nature of RPGs; the multiple layers and levels of well-being; and for the multiple ways the arts are being used to increase well-being. This could be accomplished in an interdisciplinary team and would provide useful information. This kind of knowledge could be applied in health care and could enable new interdisciplinary opportunities for academic discussion.

CONCLUSION
RPG studies and the research of art and well-being are both young interdisciplinary fields of research. Both are heterogeneous and commonly approached from traditions of sociology, education, game studies, information studies, and performance studies with approaches such as pragmatism, relativism, and critical realism. Definitions of the key concepts vary according to the perceptions of the researchers. Both are dispersed and lack obvious choices in methodology.
The variation in the definitions of the key concepts such as well-being and RPGs lead to the situation where a variety of studies can be interpreted as studies about RPGs and well-being. The most essential overlaps are in (1) practices of sociodrama and replication therapy; (2) social, cultural, and digital capital; (3) leisure time research; (4) performance studies; (5) the topic of erotic role-play; (6) problematic online gaming; and (7) health education. The works are often case studies or examine abstract topics such as character versus self, immersion, and being in character. They often measure human experiences, happiness, or emotions.
In these studies, it becomes evident that RPGs do indeed impact well-being. What does not become clear is how, why, and what features in RPGs affect well-being. Until now, the research has mainly been done from only one perspective: either RPGs or arts and well-being. In order to fully understand the impact RPGs have on well-being, an interdisciplinary connection needs to be established. Doing so would offer both fields useful practices, interesting perspectives, new opportunities for publication and academic discussion, and increased knowledge. Eventually, this could lead to the usage of RPGs in healthcare and therapy. Kerttu Lehto is a community educator, culture and landscape researcher (M.A.), and Ph.D. researcher at Tampere University's doctoral programme of Information Studies and Interactive Media. Her Ph.D. work is about role-playing games (RPGs) and well-being. Simultaneously, she works at Turku UAS Project Management Office as a Senior Advisor, working in several arts and well-being related projects, including the Taikusydän National Arts & Health Coordination Centre in Finland. She attended and organized her first larps and started playing tabletop RPGs in 2006, has studied them since 2013, and been a larp entrepreneur since 2017. In her previous work, she has applied and studied larp in e.g. reminiscence and youth work. Her latest project, SÄRÖT, is about developing Nordic larp as a method for mental health work.