The FlexED project is funded by the National Institute of Mental Health and represents a collaborative effort between the University of Duke, North Carolina, USA (P.I.: Dr. Rhonda M. Merwin) and the University of Cyprus (ACThealthy lab, Prof. Maria Karekla). The purpose of this project was to firstly, develop diverse and representative avatars, through an iterative user- testing process to inform their inclusion in a digital, gamified acceptance and commitment therapy-based early intervention for eating disorders. Secondly, the project aims to increasing psychological flexibility in young women with high risk of developing an eating disorder. Regarding the development of avatars, initial avatars were established by the research team, which were then iterated and tested with end users. Based on user feedback, avatars were modified and finalized. The participants (N = 14) were Greek-speaking females aged between 18 and 21 (M = 20.36). The individuals were asked to watch avatar introduction videos and rate the likability, relatability, diversity, and body realism of each avatar. Additionally, the participants reported their most and least preferred avatars for gameplay. Finally, the individuals provided open-ended feedback on appearance and emotional connection with the avatars and possible improvements for increasing their suitability and appropriateness for inclusion in future interventions. The most frequently selected avatar was Tiara, with 50% of participants choosing her for gameplay, reporting that “She looks interesting/cool” and “I would like to hang out/be friends with her”. Isabella and Anna were the least likely to be selected, with participants rating Isabella as the least interesting avatar and reporting that Anna looked the least like them. When asked if the avatars represented real women’s bodies, 78.57% of participants reported successful representation, with the rest reporting partial success. Additionally, all participants reported finding the avatars diverse, likable, and relatable. Finally, only one participant found an avatar unacceptable, reporting that Olivia’s lower body did not match her upper body. Currently, the project is ongoing. A gamified mobile phone application containing eight sessions aimed to increase psychological flexibility in young women with high risk of developing an eating disorder, is being tested in the US population.
Last Updated on February 7, 2026
