Psychotic disorders affect more than 21 Mio patients worldwide; because of the typically young age at illness onset and their disabling effects on various aspects of functioning, they pose a significant public health problem.

Despite extensive research on new compounds, there have been no major breakthroughs in the pharmacological treatment of psychotic disorders in more than 20 years. Only about 40% of patients have a good symptomatic outcome; moreover, rates of functional recovery are as low as 13.5% and have not improved over the past decades despite the introduction of several new antipsychotics. Psychological treatments have shown promise in improving outcomes. However, their dissemination is limited by applicability and motivation/adherence issues. In response to these limitations, several ‘new wave’ psychological treatments have adopted a low-threshold approach by addressing specific factors contributing to the emergence and maintenance of circumscribed symptom clusters. A prominent example is metacognitive training, which addresses reasoning biases associated with the emergence and maintenance of delusions.

Although metacognitive training has shown good efficacy in treating delusions and positive symptoms in the research setting, its effectiveness is dependent on treatment adherence, which constitutes a major challenge in patients with psychotic disorders. The present project aims to address this treatment gap by using a video game (‘Choice maze’) specifically developed to function as a delivery method for metacognitive training in these patients. The efficacy of the video game will be assessed in 36 patients with psychotic disorders with a randomized, rater-blind, controlled design. The primary outcome is delusion severity, while secondary outcomes include measures of reasoning biases as well as usability, acceptability and adherence.

Therapeutic gaming is an exciting and rapidly growing research field that takes advantage of advances in psychological theory and computer technology, with great innovation potential. Given that a significant majority of the population, irrespective of age or sex, plays video games, a therapeutic game incorporating the entertaining and immersive aspects of a commercial video game is conceivably an ideal means to maximize dissemination of psychological treatments for psychotic disorders.