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.