The March BABCP Article of the Month is from the Cognitive Behaviour Therapist and is entitled “Introducing a psychological formulation model of maladaptive daydreaming“ by Amy Lucas and Alexandra Bone

Our journey began with Amy’s doctoral thesis, delving into the uncharted depths of Maladaptive Daydreaming (MD) and ‘dark fantasy’ (Lucas, 2021). The phenomenon refers to a compulsive cycle of immersive and vivid fantasy that provides short-term reward, self-mastery, and relief from emotional distress, but has detrimental effects on daily functioning and wellbeing in the long term (Bigelsen et al. 2016). Witnessing the isolation and suffering caused by lack of awareness and understanding within the mental health field, we felt compelled to join our respective interests in altered states of consciousness and help to drive change.

Once a hidden realm, MD has emerged from obscurity since its official recognition in the literature (Somer, 2002). This year marks a pivotal turn as researchers, clinicians, and advocates call to establish its position as a dissociative disorder in psychiatric manuals (Soffer-Dudek et al., in press). This comes following the public launch of the International Society for Maladaptive Daydreaming (ISMD) and an increase in self-help trials and publications designed to empower people with MD (PwMD) – not just to understand – but overcome their struggle (e.g. Herscu et al., 2023; Borcherds, 2024). Despite growing recognition and data, limited frameworks exist to guide clinical practice. Our paper thus introduces the first cognitive-behavioural formulation model of MD (Figure 1) intended for use within therapeutic professions.

Figure 1. Maladaptive Daydreaming Formulation Model

Our model depicts a longitudinal process of development that leads into a vicious cycle occurring at two levels: a short-term positively reinforcing maintenance cycle and a longer-term negatively reinforcing pattern of habitual escape that occurs due to real-world impact and appraisal. It is also the first framework to propose a theoretical relationship between ‘core beliefs’ and MD.

We developed the model by integrating existing evidence and theory about MD and related phenomena. It was reviewed by leading experts in the field and three contributors with lived experience, to whom we are extremely grateful. Feedback was positive, suggesting the model accurately captured and organised the complexity and depth of the MD experience, facilitated the development of insight, and fostered a sense of hope with regards to creating change. Indeed, the data we collected from contributors was so rich that we are hoping to write a follow-up case study.

It is crucial that the model be tested further in research with larger sample sizes and in real-world practice to ensure its efficacy, validity, and applicability. It could additionally aid in the development of future treatment protocols and trials. However, as theoretical understanding of MD develops further, our framework may also need to evolve.

Undertaking this research has been an exciting and dynamic process and we are keen to hear feedback from the field. Such encouraging enthusiasm and gratitude from our contributors are what motivate us to take more leaps to disseminate it as widely as possible. Our ultimate hope is that this model can advance how clinicians and therapists engage in collaborative assessment, formulation, and intervention planning, to help those who have been without adequate support for so long.

References

Bigelsen, J., Lehrfeld, J.M., Jopp, D.S. & Somer, E. (2016). Maladaptive daydreaming: Evidence for an under-researched mental health disorder. Consciousness and Cognition, 42, 254-266. http://dx.doi.org/10.1016/j.concog.2016.03.017

Borcherds, K. (2024). Extreme Imagination. Cherish Editions.

Herscu, O., Somer, E., Federman, A., & Soffer-Dudek, N. (2023). Mindfulness meditation and self-monitoring reduced maladaptive daydreaming symptoms: A randomized controlled trial of a brief self-guided web-based program. Journal of Consulting and Clinical Psychology, 91(5), 285-300. https://doi.org/10.1037/ccp0000790

Lucas, A. (2021). Understanding the lived experience of maladaptive daydreaming. [unpublished doctoral dissertation]. Canterbury Christ Church University, Salomons Institutes of Applied Psychology.

Somer, E. (2002). Maladaptive daydreaming: A qualitative inquiry. Journal of Contemporary Psychotherapy, 32, 197–212. https:// doi.org/10.1023/A:1020597026919.

Soffer-Dudek, N., Somer, E., Spiegel, D., Chefetz, R., O’Neil, J., Dorahy, M. J., Cardeña, E., Mamah, D., Schimmenti, A., Musetti, A., Boon, S., van Dijke, A., Ross, C., Nijenhuis, E., Krause-Utz, A., Dell, P., Gold, S., Pietkiewicz, I., Silberg, J., Steele, K., Moskowitz, A., Draijer, N., Thomson, P., Barach, P., Kinsler, P., Maves, P., Şar, V., Kruger, C., Middleton, W. (in press). Maladaptive Daydreaming Should Be Included as a Dissociative Disorder in Psychiatric Manuals: A Position Paper. British Journal of Psychiatry.

Other relevant links

International Society for Maladaptive Daydreaming (ISMD) Website: https://maladaptivedaydreamingsociety.com/

International Consortium for Maladaptive Daydreaming Research (ICMDR) Website: https://daydreamresearch.wixsite.com/md-research

Author bios

Dr Amy Lucas is a Clinical Psychologist working within community and inpatient mental health services in Hertfordshire and London, UK. She is President of the International Society for Maladaptive Daydreaming (ISMD) and a collaborating researcher at the International Consortium for Maladaptive Daydreaming Research (ICMDR). Her specialty interests include altered states of consciousness (e.g. fantasy, psychedelics, dissociation), trauma, and anxiety.

Dr Alexandra Bone is a clinical psychologist and CBT therapist working in the NHS in Oxleas Mental Health Foundation Trust in an Early Intervention in Psychosis service. In addition to supervising research in the area of psychosis, she has developed an interest in Maladaptive Daydreaming, and hopes to continue further research in this area. Her other specialty interests include trauma, dissociation, and family therapy.

From Richard Thwaites, Editor-in-Chief of tCBT: Why I chose this article

There’s a real limit on the research out there relating to what has become known as maladaptive daydreaming (MD). This fascinating paper plays a crucial role in moving the field of MD forward by providing a potential formulation/model that captures what is currently known. We look forward to the field developing and are pleased to play a part in this.