The Journey of Playing: A Qualitative Evaluation of 'Maze Out,' a Serious Game for Eating Disorders

Background: A key barrier to adherence and engagement with digital mental health interventions is the lack of patient identification with these solutions, often due to designs that do not incorporate the patients' direct needs and perspectives. We investigated the experiences of Maze Out, a digital game co-produced by patients with eating disorders (EDs), clinicians in the EDs field, and game experts, when used as a therapeutic adjunct alongside treatment as usual (TAU). Methods: Seven patients over 18 years old with an ED diagnosis receiving TAU at treatment institutions in Denmark, along with two relatives, three clinicians, and two support workers (collectively referred to as caregivers), participated in semi-structured interviews. Data were analyzed separately for patients and caregivers. This study explores the overall experience of playing Maze Out, its impact on understanding interpersonal relationships with caregivers, and its potential to provide insights into EDs-related challenges. Additionally, we investigate whether Maze Out contributes to reducing the shame associated with EDs symptoms and behaviors. Results: Three themes emerged for patients: 1) ’Joy of Playing: A Place Where You Can Be Yourself’, 2) ‘Good Enough: Autonomy Without Shame’, and 3) ‘Aha Experience: Insight and Courage to Think Differently’. For caregivers, three themes were identified: 1) ‘Understanding the ED Universe’, 2) ‘A Place to Meet’, and 3) ‘Dialogue & Taboos’.
Conclusion: These findings suggest that digital interventions for EDs should foster joy and promote autonomy for patients. The game functioned as a transitional object, making the experience of EDs and its challenges more comprehensible and approachable. Tools like Maze Out can also help relatives, clinicians, and support workers gain a deeper understanding of the underlying causes of EDs, improving awareness and support.