Therapy for maladaptive daydreaming disorder – part 1: ‘skills-based’ therapies

When people seek help for a mental health issue, the choice is usually medication, therapy or a combination of the two. Unfortunately, no medication has been shown to consistently help with maladaptive daydreaming, which leads many maladaptive daydreamers to consider therapy as a potential solution. But therapy can be scary if you’ve never done it before, and you might be wondering whether therapy can really help you overcome maladaptive daydreaming disorder.

There are different types of therapy. Based on my own experience, I think of therapy as being divided into ‘skills-based’ therapies and ‘problem-focussed’ therapies. In skills-based therapies, a therapist teaches you techniques that will help you better manage your mental health, whereas in problem-focussed therapies, you set the agenda and explore the issues that are most relevant to you. Part 2 of this post will look at problem-focussed therapies in more detail, but here we’ll explore the potential of skills-based therapies in treating maladaptive daydreaming.

The best-known skills-based therapy is cognitive behavioural therapy (CBT). CBT can be delivered either in a group setting or on a one-to-one basis (I’ve done both) and it teaches you to notice and challenge unhelpful thinking patterns. The aim is to break destructive spirals of worry and rumination.

I’ve also done another skills-based therapy, dialectical behaviour therapy (DBT), which I personally found more helpful than CBT. DBT is usually delivered in a group setting and focuses more on emotions than thoughts. Unfortunately, it tends to be expensive and, at least in the UK, is not widely available.

In my experience, both CBT and DBT can be of some help in managing maladaptive daydreaming. For many of us, our daydreaming became maladaptive when we started using it as an unhealthy coping mechanism to manage negative thoughts or emotions. CBT and DBT teach us healthier ways to cope, and can therefore reduce our dependence on daydreaming.

I was emotionally dysregulated for much of my life, and I suspect this is common among daydreamers. As soon as I felt any negative emotion, I would escape from it by diving into my daydream world. It was the only way I knew how to cope. As a result, I never learned how to experience, must less manage, negative emotions. One of the pillars of DBT is mindfulness (with a focus on present-moment awareness rather than meditation). Mindfulness teaches you to sit with negative emotions, to get curious about them rather than being overwhelmed by them. And then the other three pillars of DBT – distress tolerance, emotional regulation and interpersonal effectiveness – teach you to manage your negative emotions in a healthy way. By learning DBT, I was able to replace the unhealthy coping mechanism of daydreaming with the healthy coping mechanism of DBT skills, and, as a result, I no longer need to escape to my paracosm every time I feel bad.

Personally, I was less successful with CBT. CBT teaches you to notice and challenge unhelpful thinking patterns. It can be very effective in people who struggle with excessive worry or rumination. The problem was, as a daydreamer, worry and rumination were abstract concepts to me. Why would I spend time replaying a painful memory or imagining a worst-case scenario when I could be enjoying my paracosm? I had a lifetime’s practice of avoiding worry and rumination, so the CBT strategies I learned for dealing with them didn’t initially make a lot of sense.

CBT has a huge evidence base, so it tends to be the first therapy that most doctors recommend. But do consider carefully whether it’s right for you. If you use daydreaming to escape from negative emotions, DBT might be better. But if you use daydreaming to escape from intrusive or repetitive thoughts, CBT could be very helpful.

Both CBT and DBT involve learning skills. As such, the content of the sessions is likely to be set by the therapist, even if you’re working one-to-one. This means that you won’t need to discuss your daydreaming in detail. You might not even need to discuss it at all, which is great news if you find it difficult to talk about your daydreams. It also means that it doesn’t matter whether your therapist knows about maladaptive daydreaming. The focus is on learning healthy coping mechanisms rather than getting rid of your unhealthy ones.

The thing with skills-based therapies, though, is that just learning the skills isn’t enough. You have to actually apply them. And that takes effort and motivation. And the frustrating thing about mental-health problems is that the time when you most need to use your skills is the exact moment you least feel like making the effort. If you’re not 100% committed to getting better, a skills-based therapy isn’t going to work. You can’t just show up to the sessions and then carry on living your life the way you’ve always done. This isn’t like taking medication, where you can just swallow a pill each day and expect to feel different. You have to commit to making a change. When the urge to daydream shows up, you have to make the hard choice to act differently. And it takes time. Your maladaptive daydreaming didn’t appear overnight, and it’s not going away overnight either. But the advantage of using skills-based therapies to tackle your maladaptive daydreaming is that you’ll be learning techniques that will stay with you for life and which can help you manage many different kinds of mental health challenges. 

[Image by congerdesign from Pixabay]