Personally, I find little use for the X card, but most of the public games I run are PG-13, AL based, standard fare. They are meant to be laid back and low stakes. Then I like OSR games which emphasize puzzle solving and interacting with the environment moreso than connecting emotionally with the characters.
Proponents of safety tools mentions that even in low stakes adventures, if you're playing with complete random strangers, you can hit a theme that's unnerving from them whie you thinkk it's laid back and low stake. For example, here (Safety Tools for Tabletop RPGs - Tips and Ideas for Tabletop RPG GMs) they mention in the most common taboo list sexuality, racism, dentists, clowns, spiders and snakes. While I am pretty sure two items of this list wouldn't fit in a laid back RPG as you imagine, you wouldn't be afraid of throwing the random giant snake or spider in your dungeon (or clown in your tavern).
As such, the emotional state you describe isn't one I've encountered in my gaming, nor is it common among my players. Might that be true for other people who find it an odd addition to their games? Hypothesizing more so than describing here.
Not sure. I have never had a use for this kind of tools because I game with friends I know so we are on the same page. It includes roleplaying things that would certainly made other people flee from our table -- given the reaction on this board toward slavery, I gather that most would be horrified by the idea that our average middle ages lord has serfs, and our average roman patrician has slaves. So I don't think it's the theme that implies increased need for these tools.
Also, not all tools relate to "difficult" themes. The Open Table Policy, for example (Safety Tools) [An open-door policy is exactly what it sounds like, players can leave the table or leave the game [...] This can apply to things as simple as restroom breaks, taking phone calls, or going to another room for an emotional cool-down. Everyone at the table deserves the respect to take care of their own needs.] is more a tolerance toward people having priorities over the game than problem with the theme of the game.
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