Finding meaning in the Maze (Out): a co-produced reflexive thematic analysis of patients’ reflection tasks

BACKGROUND: Eating disorders (EDs) are complex psychiatric conditions often marked by difficulties in emotional awareness and self-reflection. Serious games (SGs) are emerging as digital tools that may support patient engagement and insight. Maze Out is a co-produced SG developed for EDs treatment, incorporating in-game reflection tasks. This study explores how patients with EDs responded to the reflection tasks in the SG Maze Out. Through this examination, we aim to illuminate how patients make sense of themselves and to generate insights that may inform the further development of therapeutic approaches. METHODS: This descriptive qualitative sub-study of a randomized controlled trial analyzed 584 open-text responses from up to 133 patients with EDs from the Region of Southern Denmark, aged 18 years and older. Data was collected during gameplay and analyzed using reflexive thematic analysis. Five co-researchers with lived experience of EDs participated in two co-analytic workshops during the analysis to strengthen the interpretation. RESULTS: Three overarching themes were identified: A Mirror for Change, Ways Through, and Meeting Others. Across these themes, patients reflected on decision-making, emotional regulation, and self-perception. Though often brief, responses indicated high emotional complexity and insight. Some described adaptive coping strategies and hopeful future perspectives, while others struggled with unmet needs and harsh self-evaluation. CONCLUSIONS: The findings suggest that the reflection tasks in Maze Out supported emotional processing, self-awareness, and hope among patients with EDs. The involvement of co-researchers contributed to a richer and more contextually grounded interpretation of the data. Maze Out may offer a meaningful supplement to traditional treatment by creating accessible and engaging opportunities for structured reflection.