{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:53:28Z","timestamp":1789487608150,"version":"build-2803163510"},"reference-count":70,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007437","name":"TrygFonden","doi-asserted-by":"publisher","award":["154851"],"award-info":[{"award-number":["154851"]}],"id":[{"id":"10.13039\/501100007437","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005860","name":"Helsefonden","doi-asserted-by":"publisher","award":["21\u2010B\u20100130"],"award-info":[{"award-number":["21\u2010B\u20100130"]}],"id":[{"id":"10.13039\/501100005860","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Eating Disorders"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2010efficacy, self\u2010image, and engagement in individuals with ED. Effects on ineffectiveness, insecurity, and personal recovery were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A randomized controlled trial (RCT) was conducted at 11 centers in Denmark between July 2022 and December 2023. A total of 133 adult participants (\u2265\u200918\u2009years) with a registered ICD\u201010 ED diagnosis were randomized (1:1) to receive Maze Out plus TAU or TAU alone for\u200915\u2009weeks. Assessments were conducted at baseline, 8 and 15\u2009weeks. The primary outcome was self\u2010efficacy, while the secondary outcomes included self\u2010image, feelings of ineffectiveness and insecurity, and personal recovery. Data were analyzed using linear mixed\u2010effects models under both intention\u2010to\u2010treat (ITT) and complete\u2010case approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ITT analysis revealed no significant differences between the groups on primary or secondary outcomes. Complete\u2010case analysis, however, showed significant improvements in personal recovery (mean difference 5.81 [95% CI 0.25\u201311.37];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040) and reductions in negative self\u2010image, including self\u2010blame (\u221213.06 [\u221224.18 to \u22121.95];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021) and self\u2010neglect (\u221214.59 [\u221228.01 to \u22121.17];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033), in the intervention group. Engagement was high, indicating meaningful interaction with the game.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Although no overall effects were found in ITT analyses, improvements in personal recovery and self\u2010image support the potential of Maze Out as a feasible and acceptable adjunct to TAU. Further research should assess long\u2010term and subgroup\u2010specific effects.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT05621018, and the protocol was published (Guala, Bikic, Bul, Clinton, Mejdal, et\u00a0al. 2024).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/eat.24458","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T05:08:09Z","timestamp":1747631289000},"page":"1558-1571","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Maze\u2010Out: A Serious Game to Enhance Treatment for\u00a0Eating Disorders. A Randomized Controlled Trial"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3096-0080","authenticated-orcid":false,"given":"Maria Mercedes","family":"Guala","sequence":"first","affiliation":[{"name":"Psychiatric Research Unit, Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6393-4084","authenticated-orcid":false,"given":"Aida","family":"Bikic","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Research Unit of Child and Adolescent Psychiatry University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8984-9921","authenticated-orcid":false,"given":"Kim","family":"Bul","sequence":"additional","affiliation":[{"name":"Research Centre for Intelligent Healthcare Coventry University  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3536-6059","authenticated-orcid":false,"given":"David","family":"Clinton","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics (MEB), Centre for Eating Disorders Innovation (CEDI) Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mejldal","sequence":"additional","affiliation":[{"name":"Psychiatric Research Unit, Institute of Clinical Research University of Southern Denmark  Odense Denmark"},{"name":"Open Patient Data Explorative Network Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene Nygaard","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Psychiatric Research Unit, Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4255-5544","authenticated-orcid":false,"given":"Ren\u00e9 Klinkby","family":"St\u00f8ving","sequence":"additional","affiliation":[{"name":"Psychiatric Research Unit, Institute of Clinical Research University of Southern Denmark  Odense Denmark"},{"name":"Center for Eating Disorders Odense University Hospital  Odense Denmark"},{"name":"Research Unit for Medical Endocrinology Odense University Hospital  Odense Denmark"},{"name":"Clinical Institute University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8569-4165","authenticated-orcid":false,"given":"Anette S\u00f8gaard","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Psychiatric Research Unit, Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23266"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.74"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/\/0033\u2010295x.84.2.191"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa6602_5"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.2.022305.095337"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1348\/147608303770584719"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2012.04.037"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7898"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23933"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2009.09020247"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2022.4"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2019.113"},{"key":"e_1_2_12_14_1","volume-title":"Cognitive Behavior Therapy and Eating Disorders","author":"Fairburn C.","year":"2008"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2015.08.011"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/cyber.2015.0265"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201800567"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2016.00215"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12161"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-019-0247-1"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/0300443011660108"},{"key":"e_1_2_12_22_1","first-page":"1","volume-title":"Eating Disorder Inventory\u20103 (EDI\u20103). 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