Towards a Psychological Approach to Maladaptive Daydreaming: Introducing a New Formulation Framework
Maladaptive daydreaming can often go unnoticed in therapy - we explore a new formulation model drawing from cognitive behavioural theory to evaluate its development, maintenance and processes.
Have you ever worked with a client who seems disengaged from reality - not due to psychosis, but because they’re lost in a world of their own creation? A world so vivid and consuming that it interferes with their daily life, relationships, and goals? How do we, as therapists, help someone whose mind is their escape and their struggle?
Maladaptive Daydreaming (MD) is a mental health issue where a person experiences realistic daydreaming for excessive amounts of time to escape from reality and cope with emotional distress. This is a coping mechanism occurring as a response to adverse experiences like trauma, abuse or loneliness, particularly when experienced in childhood.
However, causes are not limited to these distinctions. MD is common for people with mental health conditions, including those with anxiety disorders, attention deficit hyperactivity disorders (ADHD), specific types of depression, obsessive-compulsive disorder (OCD) and dissociative disorders, used as an unhealthy way to cope and adapt to a problem and described by some as a compulsive behaviour.
Previous literature exploring this condition has been limited. Whilst it holds a strong grounding in definitions and general understanding of the concept, it remains youthful, with emerging pilot intervention studies and assessment criteria.
A new psychological formulation model, developed by Lucas & Bone (2025)1, presents a promising new framework that could revolutionise assessment and intervention in clinical settings.
We explore the strengths and potential limitations of this new formulation model for maladaptive daydreaming, and how this framework contributes to advancing understanding, assessment, and treatment of this condition.
When assessing the model, we will investigate:
· Does the model identify clear mechanisms (e.g., emotional triggers, cognitive distortions, behavioural reinforcements)?
· Does the model offer actionable strategies or intervention points for therapists?
Understanding The Context of Daydreaming - Healthy vs. Maladaptive
MD symptoms tend to fall into two categories – daydreaming behaviour, and how the person feels about their daydreaming. MD can be much more vivid and intense with lots of detail compared to ‘ordinary’ daydreaming. They tend to be complex with elaborate plots and repeated characters, sometimes compared to those in films and tv shows.
MD creates disconnect from the world around the person, creating emotional attachments to characters, scenarios and their imagined lives to replace painful real-life events and reactions.
Those who experience MD tend to experience negative feelings and effects, with daydreaming interfering with hobbies, relationships, work, education and general functioning of everyday tasks (negatively impacting the persons quality of life). Guilt and shame are also reported as a common experience, and due to the ‘compulsive’ nature of the condition, people struggle to reduce/completely stop daydreaming, consequently leading to further distress.
It is also reported that patients face problems with managing emotions, as well as trouble with executive functioning. It is important to investigate this phenomenon because despite insufficient research in this area, one study in Israel found that MD affects 2.5% of adults, and 4.3% of young adults (student sample)2, reflecting how large cohorts may be experiencing a condition that thus far has not been officially recognised, leading to so many people undiagnosed and untreated.
From the little we do know, it appears to be extremely disruptive to those who experience it and potentially life-threatening, with a recent study in the US reporting that suspected MD participants were more than twice as likely to have recently attempted suicide despite controlling for psychological distress, as well as associations with other factors such as loneliness, heavy drinking and psychotic experiences3.
MD tends to be more common in younger adults and teenagers, so its threat is concerning for the younger generation. The framework by Lucas and Bone aims to address a significant gap in understanding by offering a structured cognitive-behavioural model. MD is characterised as a compulsive cycle of vivid, immersive fantasies that interfere with daily functioning and cause psychological distress, so this framework aims to clarify the phenomenon and equip therapists with a resource for conceptualisation and intervention.
Core Mechanisms Underpinning Maladaptive Daydreaming
Lucas & Bone (2025) propose a cognitive-behavioural formulation that captures maladaptive daydreaming as a self-reinforcing cycle, driven by identifiable psychological mechanisms.
Emotional Triggers
MD is often precipitated by negative emotional states including loneliness, anxiety, boredom and stress, and these emotional triggers can lead to coping mechanisms like retreating into fantasy. There may be individual ‘critical incidents’ such as relationship breakdowns or job loss and bullying which reinforce escapist tendencies. These fantasies are positively reinforcing in the short term, providing immediate emotional relief.
“The daydream becomes a refuge when emotions in the real world feel overwhelming.”
Cognitive Distortions and Core Beliefs
MD centres around holding distorted and negative core beliefs and assumptions that are self-deprecating regarding the self, world and future, echoing Beck’s cognitive triad4. These negative beliefs, such as ‘Nobody likes me’, ‘I will never be successful’ and ‘Everyone is out to get me’ reinforce a cycle of self-deprecation, which fantasies and daydreaming attempt to counteract. The imagined world becomes an escape and comforts the individual by offering self-worth, validation and an idealised identity construction.
“Themes often centre on the life ‘I wish I had’ or the person ‘I wish I was.’”
Behavioural Reinforcement Cycles
Daydreaming behaviour is sustained through a feedback loop:
· Triggers (perpetuating factors e.g. music, emotions, media cues)
· Pleasurable immersion (fantasy offers connection to created others, skill, acceptance and admiration, self-assurance, pride in accepting oneself, motivation for the life you would like to have)
· Negative aftermath (internal states/appraisals of shame, guilt, loss of control, worry for future, disappointment as fantasy life will never compare, low self-esteem)
· Functional impact (reduced time to study or work, missed opportunities)
· Renewed withdrawal (disappointment in reality, particularly when comparing, causing yearning and return to the fantasy world and hypnotic behaviour to escape)
The cyclical nature ensures that when individuals attempt to reduce daydreaming, the lack of emotional reward in real life can lead to experiencing ‘withdrawal’ type experiences, resulting in ‘bingeing’ and comparing their real to idealised self.
Actionable Strategies and Intervention Points
A key strength of Lucas & Bone’s (2025) model is it can be used as a clinical formulation tool for therapists to use for case conceptualisation and therapeutic planning.
A. Visual Formulation Mapping
Visual formulation mapping allows therapists to co-construct a visual model with clients, consisting of:
· Pre-disposing factors (e.g. childhood experiences - Cognitive theory suggests the role of early life experiences contribute to beliefs/assumptions about oneself, hence creating absorption of mental fantasies and sensory/emotional lucidity.
· Triggers
· Cognitive distortions
· Fantasy/content themes
· Reinforcement cycles
This allows clients to observe a visual representation of behaviour, allowing for externalisation and a non-judgmental understanding of what it happening. This also allows the individual to draw their own conclusions and identify patterns, assisted by the therapist.
B. Addressing Core Beliefs
Targeting underlying beliefs through cognitive restructuring or schema therapy can assist in reducing the emotional drive behind daydreaming and fantasy immersion. By challenging thoughts in behavioural experiments surrounding only being accepted, loved and skilled in these fantasies, we can assist clients in acknowledging their real-life connections, support circles and successes.
C. Behavioural Interventions
· Identify and modify cues (e.g. use of headphones, isolation)
· Implement activity to replace daydreaming with meaningful engagement (e.g. social activities, a new hobby)
· Encourage ‘mindful immersion’ to build awareness around daydreaming urges
· Educate on the idea of short-term positive and long-term negative reinforcement cycles
D. Emotional Regulation Skills
Maladaptive daydreaming is frequently a response to difficult emotions, and so clients may benefit from:
· Emotion regulation skills (e.g. from DBT or ACT)
· Distress tolerance techniques
· Psychoeducation regarding emotional awareness and acceptance
E. Exploration of Fantasy Themes
Analysing themes and characters within fantasies can be extremely informative and beneficial through therapeutic exploration. What can they tell us about the client’s needs and desires? Are they being met in the real world? If not, how can we implement changes into the individual’s world to make their lives more fulfilling, and how can we assist in this? By investigating how imagined roles relate to real world deficits and traumas, we can create bridges between inner worlds and real-life change.
Clinical Implications
This formulation offers a flexible, individualised approach for CBT therapists to integrate into their existing practice. We can target real-world problems and enhance the individual’s well-being whilst encouraging disengagement in maladaptive coping styles, aiding in their personal understanding of unhealthy mechanisms. However, challenges remain:
· Not all clients possess a reflective capacity, which is problematic as client insight is required
· There are few empirically validated treatments for MD, so more research is required
· Additional training may be needed for therapists to confidently address MD directly
Nonetheless, this framework is a promising route forwards and a useful guide for therapists to use alongside existing CBT tools for emotional regulation, behavioural activation and schema work.
Moving Forward
The research concluded that there is substantial evidence to support the “classification of MD as a distinct dissociative mental health issue that causes clinical levels of distress and functional impairment.” Lucas & Bone’s model represents a pivotal step in recognising maladaptive daydreaming as a legitimate and treatable clinical concern. By clearly identifying mechanisms and interventions, this can effectively support clinicians’ service, supporting and scaffolding clients between the pain of reality and the pull of imagined perfection. Despite the need for more theoretical grounding and empirically validated treatments, this framework appears to be an exciting step in the right direction.
Discussion
What do you think? As therapists, how can we balance validation of the emotional role that fantasy plays whilst encouraging engagement with a more grounded life? We would love to hear your thoughts!
Author: Sophie Mouldycliff