Abstract
Objective:
This study evaluated the effectiveness of Maze Out, a serious game (SG) co-designed by patients with eating disorders (ED) and clinicians as an adjunct to Treatment as Usual (TAU) for improving self-efficacy, self-image, and engagement in individuals with ED. Additionally, the study examined its impact on feelings of ineffectiveness, insecurity, and personal recovery rather than directly targeting broader eating pathology.
Method:
A randomised controlled trial (RCT) was conducted at 11 centres in Denmark between July 2022 and December 2023. A total of 133 participants adults (≥18 years) with a registered ICD-10 ED diagnosis were randomised (1:1) to receive Maze Out plus TAU (intervention) or TAU alone (control) for 15 weeks. Assessments were conducted at baseline, 8 weeks, and 15 weeks. Primary outcome was self-efficacy, while secondary outcomes included self-image, feelings of ineffectiveness and insecurity, and personal recovery. Linear mixed-effects models were used for data analysis, applying both intention-to-treat (ITT) and complete-case approaches.
Results:
ITT analysis revealed no significant differences between the groups on primary or secondary outcomes. Complete-case analysis, however, showed significant improvements in personal recovery (mean difference 5.81 [95% CI 0.25-11.37]; p=0.040) and reductions in negative self-image, including self-blame (-13.06 [-24.18 to -1.95]; p=0.021) and self-neglect (-14.59 [-28.01 to -1.17]; p=0.033), in the intervention group. Engagement was high, with 91% of the participants using the game for at least 15 minutes. The median total playtime was 55 minutes (IQR: 31, 86), with a median of 13 missions completed (IQR: 8, 18), indicating meaningful interaction over the 15 week period.
Discussion:
While Maze Out did not demonstrate overall efficacy in ITT analyses, improvements in self-image and personal recovery highlight its potential as a feasible and acceptable adjunct to TAU for ED patients. Future studies should explore its long-term effects and utility in specific ED subgroups.
This study evaluated the effectiveness of Maze Out, a serious game (SG) co-designed by patients with eating disorders (ED) and clinicians as an adjunct to Treatment as Usual (TAU) for improving self-efficacy, self-image, and engagement in individuals with ED. Additionally, the study examined its impact on feelings of ineffectiveness, insecurity, and personal recovery rather than directly targeting broader eating pathology.
Method:
A randomised controlled trial (RCT) was conducted at 11 centres in Denmark between July 2022 and December 2023. A total of 133 participants adults (≥18 years) with a registered ICD-10 ED diagnosis were randomised (1:1) to receive Maze Out plus TAU (intervention) or TAU alone (control) for 15 weeks. Assessments were conducted at baseline, 8 weeks, and 15 weeks. Primary outcome was self-efficacy, while secondary outcomes included self-image, feelings of ineffectiveness and insecurity, and personal recovery. Linear mixed-effects models were used for data analysis, applying both intention-to-treat (ITT) and complete-case approaches.
Results:
ITT analysis revealed no significant differences between the groups on primary or secondary outcomes. Complete-case analysis, however, showed significant improvements in personal recovery (mean difference 5.81 [95% CI 0.25-11.37]; p=0.040) and reductions in negative self-image, including self-blame (-13.06 [-24.18 to -1.95]; p=0.021) and self-neglect (-14.59 [-28.01 to -1.17]; p=0.033), in the intervention group. Engagement was high, with 91% of the participants using the game for at least 15 minutes. The median total playtime was 55 minutes (IQR: 31, 86), with a median of 13 missions completed (IQR: 8, 18), indicating meaningful interaction over the 15 week period.
Discussion:
While Maze Out did not demonstrate overall efficacy in ITT analyses, improvements in self-image and personal recovery highlight its potential as a feasible and acceptable adjunct to TAU for ED patients. Future studies should explore its long-term effects and utility in specific ED subgroups.
| Original language | English |
|---|---|
| Pages (from-to) | 1558-1571 |
| Number of pages | 14 |
| Journal | International Journal of Eating Disorders |
| Volume | 58 |
| Issue number | 8 |
| Early online date | 19 May 2025 |
| DOIs | |
| Publication status | Published - Aug 2025 |
Bibliographical note
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in anymedium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.© 2025 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.Keywords
- E-health
- anorexia nervosa
- bulimia nervosa
- coproduction
- eating disorders
- play
- randomized controlled trial
- serious games
ASJC Scopus subject areas
- Psychiatry and Mental health
