Maze-Out: A Serious Game to Enhance Treatment for Eating Disorders. A Randomized Controlled Trial.

Objective: This study evaluated the effectiveness of Maze Out, a serious game (SG) codesigned 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. Effects on ineffectiveness, insecurity, and personal recovery were also examined.

Method: A randomized controlled trial (RCT) was conducted at 11 centers in Denmark between July 2022 and December 2023. A total of 133 adult participants (≥ 18 years) with a registered ICD-10 ED diagnosis were randomized (1:1) to receive Maze Out plus TAU or TAU alone for 15 weeks. Assessments were conducted at baseline, 8 and 15 weeks. The primary outcome was self-efficacy, while the secondary outcomes included self-image, feelings of ineffectiveness and insecurity, and personal recovery. Data were analyzed using linear mixed-effects models under 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, indicating meaningful interaction with the game.

Discussion: Although no overall effects were found in ITT analyses, improvements in personal recovery and self-image support the potential of Maze Out as a feasible and acceptable adjunct to TAU. Further research should assess long-term and subgroup-specific effects.

Trial registration: ClinicalTrials.gov identifier: NCT05621018, and the protocol was published (Guala, Bikic, Bul, Clinton, Mejdal, et al. 2024).