By Wanda Fischera
Maladaptive Daydreaming (MD) remains a complex and often misunderstood experience in therapy. MD can feel overwhelming, with so many different factors influencing it. That’s why a new paper from Dr Amy Lucas and Dr Alexandra Bone, clinical psychologists based in the UK, is crucial. It introduces a framework that provides us with a structured way to understand MD on an individual level. This framework helps break down one’s maladaptive daydreaming experience into manageable pieces, including early life experiences and aspects that keep you caught in the cycle of daydreaming.
Many people with MD feel unseen in therapy. This new formulation model offers a way to feel more understood—and to help clinicians understand you, too. Formulation is often used at the beginning of therapy to create a shared understanding between a client and therapist, to map out the client’s story, and then to inform the intervention. It gives us insight into how a problem developed, what perpetuates it, and what its impact is on the individual. For other mental health difficulties such as depression, social anxiety or obsessive-compulsive disorder, psychological professionals routinely utilise these formulation models to benefit clients, create a shared understanding in therapy, and develop a therapeutic plan.
I find that this part of the formulation can validate all individuals with MD—both those who have experienced trauma and also those who feel they may not have a “valid” reason to develop MD, as they have not experienced trauma. This narrative is often present in the MD community, which is no surprise; as with any other mental health difficulty, such as anxiety or depression, experiencing trauma as a child is likely to contribute to the development of mental health challenges, but it is often not the sole reason for these.
In this article, from the perspective of a clinical psychologist, I want to share what a formulation is, how it can help you gain better insight into maladaptive daydreaming on an individual level, and why it’s important for the future of psychological therapy.
What is a Formulation?
You may be having a similar experience to someone else: you spend the same amount of time daydreaming, you have similar daydreaming themes, you have a similar background, you engage in the same kinaesthetic movement, and you like similar things in your daily life, and so on. But would you say that you have the same life story? Probably not!
Your experiences, genetic differences, context, environment, and relationships have shaped you, which makes you completely unique. That’s why a formulation—a standardised and specific model for a certain problem (i.e., MD)—can be a tool to identify an individual’s story, connect the dots, and develop a coherent narrative. It provides a helicopter view of how maladaptive daydreaming plays an important role in one’s life: how it has developed, what it provides, and what it obstructs.
It is often a tool used by psychologists instead of relying solely on a specific diagnosis. Based on a formulation, which is a working hypothesis developed until it seems to fit your experiences (rather than the other way around, as with a diagnosis), we can then think of ways to end the cycle that keeps us stuck.
For people with MD, this is especially important because MD isn’t just a simple daydreaming habit. Research is ongoing into conceptualising MD within the family of other mental health difficulties, and some studies have pointed towards it being a behavioural addiction, a dissociative disorder, or a compulsion. This formulation allows us to explore what MD is for you as an individual and how it impacts you—without needing to put this behaviour into a specific category. You will have your own knowledge, wisdom, and experience about the role daydreaming plays in your life, how it has changed over the years, and how it interferes with your life at present.
The process of creating a formulation isn’t just about understanding maladaptive daydreaming—it can also be a powerful experience of understanding yourself better and, in turn, being understood by your therapist. For individuals with MD, developing insight into their condition can provide clarity and a sense of hope.
Formulation in Action
How MD May Have Developed for You
Formulation is often a visual tool that helps us map out the different factors that feed into and perpetuate one’s difficulties. Starting from the discovery of the inner fantasy world that involves a high sense of presence and is vivid as a child, we can map out how one’s ability to immerse themselves may develop into a daydreaming habit that interferes with their daily life and causes distress.
The authors share the visual map of the formulation that takes us from our early life experiences that set us on a path that paves the way for MD for some (such as trauma, isolation, emotional dysregulation), which also influence our core beliefs and assumptions (i.e., about ourselves, others, the world). This initial, foundational part of the formulation helps us understand how our early life has influenced how we see and experience the world.
Core beliefs refer to some of our bottom-line beliefs about the world that come easily to us and are often resistant to change initially. For example, a core belief about the self could be “I am worthless”, about others could be “people are cruel”, and about the world could be “the world is unfair”. These beliefs and automatic assumptions would then, predictably, make it difficult to open up to others and trust them, and we might expect the worst to happen to us in our daily life—leaving us unmotivated to make changes or expect the best, as our expectations are that things won’t work out in our favour. Whilst this is a simplified example, it is understandable how our early experiences and core beliefs may pave the way for isolating ourselves and feeling alone, perhaps developing a daydreaming habit that interferes with our daily lives.
The next part of the formulation—the precipitating factors—refers to any factor such as a life stressors, emotional state or situation that are present before immersion. Such factors may relate to boredom, isolation, stress, difficulties in creating and maintaining relationships, or the environment we are in that allows for immersion.
How MD is Maintained for You
Having explored the factors that help us understand how maladaptive daydreaming may have developed for you, it is also important to investigate how it is perpetuated in the present and how it influences your life.
The ‘vicious flower’ in the middle of the formulation map allows us to view maladaptive daydreaming as a complex process that includes various rewarding and pleasurable aspects, among other factors, that make it difficult for people to “just stop daydreaming”.
The authors offer various aspects to explore that can contribute to maintaining a maladaptive daydreaming habit. These include the pleasure and relief it brings, and the attachment to characters. On the other hand, aspects that make it difficult to reduce MD include the powerful yearning to daydream, and the difficulty sustaining attention in the real world. Additionally, your environment is factored in—such as being exposed to triggers (e.g., music, fantasy material) that influence you, and maintaining hypnotic behaviours that facilitate immersion. This cycle therefore depicts the temporary benefits and what drives immersion.
The formulation also allows space to explore the emotional aspect of daydreaming, where emotions are elicited through the stories as they can offer a safer outlet (e.g., to feel anger towards another) or an opportunity to feel different emotions (e.g., pride, belonging) – and overall, a safe space to feel. Furthermore, discussing daydreaming themes and characters—which are deeply personal—is also factored into the cycle of daydreaming, allowing space for making links between fantasy and reality and perhaps going deeper into the meaning of the daydreams.
The Impact of MD on You
At the bottom of the formulation map, the impact of daydreaming is explored—how you experience life as a person with maladaptive daydreaming, and what it means for you. By mapping out the different elements of your MD habit, you’ll be able to see how they interact with each other.
One of the most important aspects that I believe can be missed in therapy without this formulation—one that appreciates the distress associated with MD—is the “cycle of secondary impact.” This captures the complexity of how one might feel about the habit (e.g., “waste of time”), their views of themselves and their identity, and the overall distress surrounding the behaviour (e.g., shame, beliefs about uncontrollability). These feelings can further drive people into deeper fantasy immersion and attempts to escape the “real world,” reinforcing a sense of failure in controlling the habit and perpetuating the distress. This cycle can also exacerbate other difficulties, such as social anxiety, low self-esteem, depression, and emotional dysregulation.
A completed formulation map that feels like the right fit puts you in a better position to identify areas where change is possible. This formulation map bridges the gap between assessment and treatment. In therapy, a therapist or psychologist may be able to correctly identify maladaptive daydreaming (or you may have brought it up yourself); however, how it is conceptualised in therapy and where change could be suggested has lacked clear guidance—until now.
This framework fills that gap, offering a guiding and foundational tool for therapists to create more effective intervention plans. While the formulation itself follows Cognitive Behavioural Therapy (CBT) principles, it is flexible enough to complement other therapeutic approaches. A qualified and experienced clinician can use this model to help you work toward overcoming MD, using evidence-based techniques to target areas you identify together as ready and appropriate for change.
Final Thoughts
This new formulation framework is a vital step forward in the understanding and treatment of Maladaptive Daydreaming. It not only helps individuals with MD gain a clearer understanding of their experiences, but also provides a valuable tool for clinicians to offer personalised, effective care based on unique experiences. With more research and wider adoption of this framework, this could mark the beginning of a much-needed development in how we help people with MD lead more fulfilling lives.