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.Funding
The study is funded by TrygFonden (grant nr.154851), Psychiatric Research Foundation, Region of Southern Denmark (grant nr.2110064) and Helsefonden (grant nr. 21-B-0130). The funding bodies were not involved in the design, data collection or analysis of the current trial.
| Funders | Funder number |
|---|---|
| TrygFonden | 154851 |
| Helsefonden | 21‐B‐0130 |
| Psychiatric Research Foundation |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
-
SDG 3 Good Health and Well-being
Keywords
- E-health
- anorexia nervosa
- bulimia nervosa
- coproduction
- eating disorders
- play
- randomized controlled trial
- serious games
ASJC Scopus subject areas
- Psychiatry and Mental health
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