What is the best way create a truly terrifying game?

Where the horror and fear comes from a slowly unfolding existential terror, leading to a moment in the end, where the players (through their characters) are faced with an ending that pulls back the curtain, and forces them to look upon the truth.  

That despite all their powers, they are in fact, just as weak and powerless as anybody else, and that the world is far stranger and more terrifying that they could have ever imagined.  

So, how do you do it?  How do you create something truly terrifying?

You can go a lot more terrifying than just feeling weak and powerless.  For one thing, if you don't keep the flame of hope kindled, you risk the party embracing nihilism and just accepting the end of the world.

But I suppose if you want to erode their confidence, find what gives them confidence and slowly take it away.  For example, many PCs are confident the DM won't let them die permanently.  Let one of them do so, and that goes away.  They might be confident the gods wouldn't permit something truly horrible to happen.  Kill off a god (convincingly, so they believe it).  And so on. 

But as I said, you can go scarier by keeping hope alive: for every major setback they suffer, let them achieve a minor victory, so there continues to be a good reason to think real victory is possible.

I think it comes down to two things: control and certainty. You have both already touched on this rather well but I do want to share my thoughts as well. 

I think that either you can create horror in the setting or horror with specific characters or creatures.

You can suddenly change the setting. I did this for a halloween one shot. One moment the players were camping on the road and the next they were transported to a strange land where the shadows got closer and closer. The NPC cook was dragged off and they had to create a bright light to push through the darkness.

When you use the surroundings you want to suggest what is out there rather than tell your players. This lets their imagination do the work. It is all in your description. The very land could be the danger or something unseen within it. I think the extremes work well for this kind of thing. It could be somewhere truly alien and the fear comes from the unknown or it could be somewhere familiar and the scary thing is that what ever is out there has no rules and it can get you even where you feel safest. 

If I have a monster or something that I have to describe, I like to go for a bit of body horror. However sometimes using wisdom saving throws that they have to pass to not look can also be good. 

What ever you decide to do I think it is about having a force that can be survived but not defeated. The goal of a truly terrifying campaign may not be to defeat the BBEG but to get out alive.

In the end it depends on how immersed your players get. I find I can never truly immerse myself so I won't be as scared of something in a campaign as some one who can. If you don't get the reaction, don't feel bad, it could be down to this. 

It has been said time and time again that D&D translates poorly in terms of horror.  A group of Adventurers with all sorts of abilities, most of them related to combat, isn't really the sort of thing you see in your typical horror story.  The elements are all there.  Ravenloft in all its incarnations shows that.  In D&D the dead walk.  Werewolves lurk in the woods.  Hags gather around cauldrons to brew up evil spells and cast curses.  Fiends can be summoned.  You can make pacts with unfathomable horrors...  The list goes on and on.

I think what I would do is start sending different players private messages.  Nothing all that important at first.  Possibly helpful things.  "There is a secret door in the room, behind the bookcase."  Different messages to each player, or maybe just one player gets them for a while.  As time goes on, the little voice in their character's head starts saying things that either don't make any sense, are incorrect, or imply that the other characters are doing bad things.  "The purple Rogue took an extra gem."  Only the party Rogue wears green.

Have two of the characters get the same message, saying that a third character keep looking at them with an odd expression.  Send the player running the third character a message telling them that their character should smile a lot.  Have saving throws made and don't announce any results, or tell one of the players that their character "feels funny" no matter what they rolled.  Ask for Initiative and then don't have anything happen.  Tell the players that the shadows in a room look *off* somehow, but closer examination doesn't find anything.  Or maybe it does.  Have the voice point out a trap.

Keep trying to foster confusion at the least, and distrust if possible.  Give them useful stuff from time to time, but try and lead them into riskier situations with them.  Have the voice ask "Am I going mad?"  Have it call them the wrong name, possibly the name of one of the other characters.  Have the voice scream "Stop screaming!"  Give all the players a note that says "One of the characters has been replaced with a Doppelganger.  Have your character prove that it isn't them."

Make the characters doubt their senses, never let them know what is real.  Have one see a familiar face but when they try to get a closer look that npc is gone.  Or someone is there, wearing the same clothing, but the wrong face.  Change one of the character's faces.  Have npcs run away from them screaming for no apparent reason.  Have a black cat follow the characters around, one that even when killed keeps coming back.  Is it the same cat?  Maybe, maybe not.

It will take a while, but if the tone of the game is kept serious, dark, and creepy while this is going on, it could work.  You could even have a Sanity Score that needs to be checked against to keep the character from becoming more and more insane.  There are rules for insanity in the DMG.  I don't recommend it honestly.  I feel that such things are firmly in the realm of roleplaying and characters should not suffer mechanical effects from them.  It's also slightly disrespectful to people who really *do* have mental disorders.

The villain behind it all could be all sorts of things.  Mind Flayers come to mind.  Those are perfect for this sort of thing.  Maybe an Elder Brain has some reason it wants the characters tormented.  It could be an honest to whatever Elder God whispering in their minds, and if they want to go that route, they could take levels in Warlock with it as their Patron.  It could be a ghost.  It might not even be malevolent.  It could be someone who is just desperate to accomplish something and unable to control their abilities or communicate clearly.  I'd go with an Evil villain, but the option is there.

I’ve run a number of horror RPGs, and the two elements that I’ve found consistently important to creating horror aren’t what you’d think.

#1 is player buy-in. If people don’t know they’re meant to be scared, or don’t want to be scared, they won’t be scared. But if they’re ready and willing, expecting to be afraid, their own brains will create a lot of the creepiness for you. It’s especially good if you can get people to stay off their phones (that’s good for RPGs in general really). And one very important thing is to leave a lot of time before and after you start playing. That way, players can get their jokes and laughs out before the game, so when it’s time to play they’re ready to take it seriously, and they can decompress afterwards. If you do it right, you’ll all need that.

#2 is atmosphere. Horror in RPGs is less about the story you tell and more about how you tell it. Keep your voice low and monotone, like a creepypasta podcast, so the players become quiet, having to avoid crosstalk in order to hear. Dim the lights, add some candles, and turn on some creepy ambience or music. And this last tip is strange, but trust me, it works: mild discomfort is a powerful tool for horror. Turning the thermostat down a bit and using hard kitchen chairs instead of living room seats puts everyone subtly on edge, jumping at shadows.

And one last note: even more so than regular horror, RPG horror is founded on anticipation. You can’t jumpscare your players, so keep that dread taut for as long as you can. (Speaking of which, I know you’re looking at D&D, but consider the Dread RPG. It’s become my favorite tool for tabletop horror.)

(Contrary belief) You can't. D&D doesn't do terror.

Stephen King wrote about the three types of terror: The Gross-out, the Horror, and the Dread.

In D&D, the Gross-out is met with laughter and pleasure, not with terror. When PCs see zombies explode into disgusting slime, the response is "WOOT!". The Horror (otherwise known as The Unnatural) is normal. Spiders the size of cats and the dead walking aren't unnatural, they are part of the normal workday of a PC. Dread is even worse. When you try to set a scene where there is Some Evil Presence behind the PC, but the PC knows if they turn around there Won't Be Anything There… the player says "Can I make a Perception roll?" 

A core theme of Horror is powerlessness, which is the opposite of D&D. A PC is a badass, able to kick butts and take names, even if those butts are aberrant or monstrous or undead. Everything I do makes my PC stronger, each level adds significant new abilities. If my PC dies, I just generate a new one, usually at the same power level of the old one. 

I do, however, have an off the wall suggestion. Run D&D backwards.

In typical horror, the heroes get progressively less powerful and more injured through the story. So, run this in D&D by getting the players to create, say, 6th level characters on max XP. Every time they would get XP in a normal game, instead subtract it. When they get to the XP for level 5, their PC loses their 6th level abilities. And so on. If they reach 0 XP then they are dead (or insane or possesed) - permanently out of the game. The goal becomes to solve the adventure before all the PCs reach 0 XP.

If you want to go in for Lovecraftian horror, you could take a look at Sandy Petersen's "Cthulhu Mythos" books for 5e. Now disclaimer, although I would like to eventually get the main book, I have not done so yet, so I can't speak to how good or bad the book itself is. But it is an attempt by Petersen (the original creator of Call of Cthulhu) to translate the Cthluhu horror stuff into 5e D&D mechanics. Maybe there is stuff in there that could help you do more horror in your D&D.

I do agree with several others above, though, that D&D does not translate well into true horror -- certainly not Lovecraftian horror. For the points made in Greenstone's post -- that the types of themes you see in horror like powerlessness, fear, dread, don't really work well in D&D, especially once the characters go above 3rd or 4th level. They are just too powerful. But maybe the Chtulhu Mythos book will deal with that. Again, I have not read it and don't own it (though I'd like to, eventually, being a recent convert to Lovecraft fandom). I suggest reading some reviews above it before getting it, since it is fairly 'spensive.

One of my DMs has created a "disease" that causes one to be very ill and possesses the mind so the victim is prone to violent outbursts.  The consequences of this in the kingdom and the fear of catching the "disease" or someone in your family is pretty terrifying.  Many commoners that catch the disease are not "engaged" by the "system" until they have assaulted someone, and this means they get thrown in jail.  Any treatment they receive is administered while they wait in jail.  Only affluent folks that seek medical help early are treated in the relative comfort of their homes.  But they need folks to watch over them in case they have one of the "fits."

No what if the "disease" led to lycanthropy or vampirism?  And who is behind the spread of this "disease?"  It doesn't seem to spread through casual contact or entire towns and cities would have it already.

I don't think it's possible to translate movie-horror to D&D, because movie horror features, perfectly timed music, jump scares, drawn out silence, clever camera angles - it all comes together to give a visual approximation of horror, and we don't have the visuals in D&D, it's all tokens, models and theatre of the mind - descriptions!

To translate the horror of books is more possible, as it works through description rather than imagery, but it also functions in a different way. Whilst the themes and story of a horror book might leave you with chills afterwards, and perhaps jumping at small noises or turning the lights off and then running up the stairs before the monsters get you, its primary thing is the compulsion to keep reading. When they see some blood on the floor, trailing off into a room, you are compelled to read on and find out what it is all about. If they do so at the end of a chapter, you read another chapter. The book drags you through it by your own morbid curiosity, slashes at your heartstrings as people you're attached to are killed (or worse), and then leaves you at the end feeling thrilled to have read it and wishing you could keep doing so.

D&D is a different kettle of fish entirely. The reason you might be scared for the welfare of a character in a book is because you can relate to them, they are likeable, and you know they are outmatched by the horror they are facing. Nobody expects the teens to actually kill Jason in any of his movies. You know they will fail, and are drawn on by morbid curiosity and a glimmer of hope that they might actually succeed. If you're lost in the story, and not too busy laughing at the grisly deaths!

I would say the key things I would be trying to build up to make some horror (and this is is all hypothetical as I haven't yet run any horror stuff) are:

• Attachment. The players need to become attached to other who can be snatched away. Make them really snag the heartstrings - an elderly dwarf who's carrying her husband's ashes to a mountain, a loveable dog who insists on playing fetch - reinforcing the bond to the players by having the dog pick one player and always try to play with them - that sort of thing. Give them things they'll love, and then snatch them away.
• Repetition - establish a pattern for them to come to expect. When they meet the dog, it wants to play. When they walk past the trees, the wind blows. Keep everything consistent and establish "normal". If they meet the dog once, and then next time it becomes possessed or dead, there's some loss. If they have met the dog repeatedly, and the dog becomes attached to whoever enjoys the "play with the dog" scenes the most, and it always brings them a toy to throw, then it becomes so much more sinister for them when they see the dog, and the dog whimpers, cowers and shuffles further under the table.
• The Unknown. Have as much of the horrifying stuff happen out of sight or out of control. A shadowy figure on the second floor stabs an NPC, and is gone before they get there. People disappear completely with nothing but a scream.
• Disorientation. It takes preparation to split the party, but if it suits the theme, splitting them up can add an element of desperation to the proceedings. One example might be if the party go from one room to another, and the door swings shut after the first. The second group go in, and find themselves in an empty room. When the first player enquires as to where the yare, you just say "no-one came in behind you". This might be that the first player went into the room and, as the door shut, was taken to a mirror dimension. Perhaps every mirror in the place leads to it. Perhaps they're inscribed with runes, and each rune goes to a different dimension. Make the layout of each dimension slightly different to really mess with them, so they can't just go with the rest of the party and try to regroup. Or maybe they have gone forward or back in time.
• Powerlessness - Perhaps they don't have their equipment and have to try and find it before they escape - no material components to spells, no weapons, nothing fancy. Make them feel vulnerable. You have a spell slot but nothing to cast it with.
• Revelation - Don't lie, but don't tell the whole truth. if the party walks into a room and they are suddenly split into two groups in two almost identical rooms, then start talking as if you had already told them that they were splitting up. Make it seem like this is perfectly normal. When the party says "wait, aren't we in the same room", say "well, you look around and it's only the two of you in here.", and watch them try to work out how they got separated. The players need to work out that things have gone badly ,rather than being told it explicitly. You can't tell everyone everything and then keep the suspense, but likewise if they look for something ,you can't lie about whether it's there or not.
• Wrong-footing. Don't have everything go wrong no matter what. Let good things happen or the players will only expect the bad, and the bad won't seem bad. Depending on how you want it to go, you might even let them "escape", maybe even for an entire session so they think about other things - but then they see a shadow move, and realise the shadow-people were tracking them all this time, and now they've caught them. That kind of thing.
• Closure. Don't give them any. If they escape the evil palace with the shadows that try to eat them, that's good enough. They will never know what caused it, or even what the monster in the shadows was. Leave them guessing and unsure. Perhaps describe, from time to time, the shadows lengthening where they're resting and keep the description synonymous with the descriptions you used in the palace. Make them jump to weapons, thinking that the shadows are back for them. Then make it just a shadow. Remember that you, as the DM, are their eyes and their ears. Your job is to tell them what they see, not what's really there. Telling someone roleplaying as a character who's just experienced carnivorous shadows that the shadows look like they're reaching out to them is a fair description of the horror their characters should be feeling at it all.

I have a few scenarios loosely plotted out for the course of the campaign, and I am hoping that I can create something of a feeling of horror for the group. I just need to do a lot of bulking out, and probably guide them through umpteen other things I've already loosely planned to throw at them!

This thread was really helpful! I'll make sure to use a lot more of these ideas in my next campaign

I'm actually putting together a horror one-shot for a single player game, which I will be trying out some of my ideas in to see if they really work!

I don't think it's possible to translate movie-horror to D&D, because movie horror features, perfectly timed music, jump scares, drawn out silence, clever camera angles - it all comes together to give a visual approximation of horror, and we don't have the visuals in D&D, it's all tokens, models and theatre of the mind - descriptions!

I'm not a huge fan of typical horror movies for these reasons -- Hollywood horror relies too much on artificial contrivances like jump-scares. I don't think that's actually horror. Reflex-responses are not horror. Scary, maybe. But horror is, to me, deeper...

For all that his movies are not considered horror, but rather suspense, I think Hitchcock had more the right of it when it comes to horror. He apparently explained to Tippi Hedren when filming The Birds, and she questioned some of what was not being shown in that movie, that the human mind's imagination could conjure up things that are infinitely worse than anything a director could possibly put on screen. His technique, therefore, was to leave you guessing, to leave more of it to the imagination, rather than showing you all the details. Hitchcock's movies tend to be disturbing, rather than "scary," I am relatively new to being a Lovecraft fan, but I've now read most of his stories and Lovecraft does exactly the same thing -- he leaves it to your imagination. He even uses words like "indescribable" or "unutterable" to describe his horrors. Leaving it completely to your imagination. This may not be jump-scare fodder (you can't really have jump-scares in a short story or novel anyway), but it can definitely be disturbing, creepy, etc.

I say all this because I think that everyone above is correct about how impossible it would be to provide the Hollywood version of horror to your players. However, I think it is perfectly possible to provide a Hitchcockian or Lovecraftian version of horror to players, if you keep in mind their main rule of horror -- which is not to over-describe or show anything, but most of it to the players' imagination. This clearly can work, after all -- for there is an entire RPG, Call of Cthulhu, based on Lovecraftian horror and thousands of people play it each week. But one must think more like Hitchcock or Lovecraft to achieve horror in an RPG, I suspect, rather than like the jump-scare movies.

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I don't think it's possible to translate movie-horror to D&D, because movie horror features, perfectly timed music, jump scares, drawn out silence, clever camera angles - it all comes together to give a visual approximation of horror, and we don't have the visuals in D&D, it's all tokens, models and theatre of the mind - descriptions!

I'm not a huge fan of typical horror movies for these reasons -- Hollywood horror relies too much on artificial contrivances like jump-scares. I don't think that's actually horror. Reflex-responses are not horror. Scary, maybe. But horror is, to me, deeper...

For all that his movies are not considered horror, but rather suspense, I think Hitchcock had more the right of it when it comes to horror. He apparently explained to Tippi Hedren when filming The Birds, and she questioned some of what was not being shown in that movie, that the human mind's imagination could conjure up things that are infinitely worse than anything a director could possibly put on screen. His technique, therefore, was to leave you guessing, to leave more of it to the imagination, rather than showing you all the details. Hitchcock's movies tend to be disturbing, rather than "scary," I am relatively new to being a Lovecraft fan, but I've now read most of his stories and Lovecraft does exactly the same thing -- he leaves it to your imagination. He even uses words like "indescribable" or "unutterable" to describe his horrors. Leaving it completely to your imagination. This may not be jump-scare fodder (you can't really have jump-scares in a short story or novel anyway), but it can definitely be disturbing, creepy, etc.

I say all this because I think that everyone above is correct about how impossible it would be to provide the Hollywood version of horror to your players. However, I think it is perfectly possible to provide a Hitchcockian or Lovecraftian version of horror to players, if you keep in mind their main rule of horror -- which is not to over-describe or show anything, but most of it to the players' imagination. This clearly can work, after all -- for there is an entire RPG, Call of Cthulhu, based on Lovecraftian horror and thousands of people play it each week. But one must think more like Hitchcock or Lovecraft to achieve horror in an RPG, I suspect, rather than like the jump-scare movies.

I think what you describe is the kind of thing I was going for.  Maybe I should watch some old Hitchcock movies to see how he did it, and how I might be able to transfer that into a TTRPG.  

Slam a gun down on the table and say "Roll for initiative."

Anyway, no, I kind of don't think you can make an RPG truly scary like what you're describing. I mean, you can make stuff kind of spooky, but I think the best you can get is like, haunted-house spooky. Like the ones that pop up around Halloween that people pay to go into for fun. Except you don't get paid.

Maybe I should watch some old Hitchcock movies to see how he did it, and how I might be able to transfer that into a TTRPG.  

Hitch is always worth watching.

Not sure anything he did will translate directly into an RPG, though. Same with Lovecraft. The point is to keep the "horrors" more in the imagination of the players, rather than having them be explicit or in their faces.

Hm, somehow give the characters a family that over time becomes very important to the players and that they truly fear should get hurt?

This is purely hypothetical and I have no intention of ever doing this, but I wonder if it might make for something of a horror module within a game:

You give the players two pieces of meta knowledge: 1: We are now playing a high-danger horror module. 2: One character will die in this module. And you could give them the option to buy into this module or not - they can walk away if this prospect is not worth potentially dying for.

Whether you actually come good on this threat of death is dependent on whether you want to pull this on them again (which in turn will depend on whether you are playing in a group that embraces character death as part of the game or feels it's a bad thing). If you are doing it only once, or the players are strongly attached to their characters and hate it when they lose them, then don't feel the need to engineer this death. If they are open to dying & making new characters, then don't pull your punches.

This setup, assuming you could pull it off without seeming like a massive ****** (which I don't think would be easy) will inform the players that the thing they care most about in the game - their character - is what's at risk. Their behavior will probably become more serious and intense, and provided you've got them captured (inside an inescapable haunted mansion, for example) then they will still have to perform the tasks to escape and/or defeat the baddies, but they will know that one of them could die, and that this isn't a story with a happy ending.

For extra heartbreak, you can have an optional section at the very end. If they all survive to the end, then it's revealed that the only way to escape the place is for one of them to sacrifice themselves. Perhaps they thought that they were going to beat the module and all survive. Again, this depends entirely on the players and what they would be accepting of - if they are very strongly attached to their characters, have custom minis and sheets and 3 short novels of backstory, don't pull this sort of thing!

I am currently trying to do just this using an aboleth. Currently I am presenting the townsfolk to the players, they are meeting a variety of NPCs, from shop keepers to members of the council and the merchant guild, to street kids and the town guard. 

Slowly, as the aboleth enslaved the town, the NPCs will change, I am trying to do this as an invasion of the body snatchers type thing, they will see the personalities change, see there attitudes towards them change, and finally have friends and colleagues turn on them, attacking them trying f to force them out of the town.