The first scientifically validated treatment programme for maladaptive daydreaming disorder

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On 13 January 2023, the Journal of Consulting and Clinical Psychology published an article by Oren Herscu, Eli Somer, Asaf Federman and Nirit Soffer-Dudek entitled “Mindfulness meditation and self-monitoring reduced maladaptive daydreaming symptoms: a randomized controlled trial of a brief self-guided web-based program”. This is significant for maladaptive daydreamers because it’s the first randomised controlled trial of a potential treatment for maladaptive daydreaming disorder to be published in a peer-reviewed journal.

Why does this matter? Firstly, because peer-reviewed journal articles are the main way science moves forward. When researchers in any branch of science discover something interesting, that finding is of no use until it’s shared with the world. So publishing articles is an essential part of conducting scientific research. But, for other scientists to be able to trust that the research findings are accurate and useful, there has to be an assessment process. Peer-review is considered the gold standard by which scientific research is validated. When an article is submitted to a peer-reviewed journal, the journal editors will ask at least two independent experts to assess the research to ensure that it has been conducted rigorously and that the conclusions are supported by the data. Only after these independent experts are satisfied that the research is sound will the article be published. Scientists and clinicians therefore trust that articles published in reputable peer-reviewed journals are accurate and reliable.

Second, this article reports a randomised controlled trial. Again, this is something that’s considered a gold standard in the world of scientific research. In a randomised controlled trial, participants in the study are divided randomly into groups, and one of those groups is designated the “control” group. The people in the control group don’t receive the treatment the study is assessing. Therefore, if the treatment group(s) have better outcomes than the control group, it’s a strong indication that the treatment made the difference. Without the control group, it’s impossible to say whether any improvement happened by chance, because the condition tends to spontaneously resolve over time, or because of some other factor that had nothing to do with the treatment being investigated.

So, the authors of this study have not only developed a potential treatment for maladaptive daydreaming disorder, but they have also proved that it works and published that proof in a form that other researchers, clinicians and therapists will take notice of. For maladaptive daydreamers, this is a huge step forward.

The thing that I find really exciting about this study is the treatment programme itself. Participants in the study were given access to an online course that taught two techniques in the context of overcoming maladaptive daydreaming: mindfulness and self-monitoring. Each week for eight weeks, participants completed an online lesson (50-75 minutes at a time of their choosing) followed by homework assignments. The participants filled in a range of questionnaires (including the MDS-16, which is used to assess maladaptive daydreaming) at the beginning and end of the course and again after six months. The results were impressive – one-third of those who completed the programme saw a significant improvement in their daydreaming; one-quarter improved so much that they no longer met the criteria for maladaptive daydreaming disorder. Yes, that means a lot of people didn’t see huge improvements, but scientific studies tend to set the bar for “significant improvement” quite high, so it’s likely that many of those who didn’t improve “significantly” still noticed some benefit. And the improvement rates in this study compare favourably with those of similar treatments for other addictions.

Until now, many people, myself included, have believed that most maladaptive daydreamers will require therapy to make a lasting improvement in their daydreaming. This can be a problem. In many parts of the world, therapy is not readily available, and even if it is, it can be prohibitively expensive for those whose addiction to daydreaming makes it hard to hold down a well-paid job. And, since maladaptive daydreaming is still not in the DSM, finding a therapist who knows anything about the condition is a challenge. So for those that can’t access therapy, the idea that an online treatment programme, not involving any one-to-one time with a therapist, can produce measurable improvements is very exciting.

Hopefully, at some point, this scientifically validated daydreaming-specific treatment programme will be available to anyone struggling with maladaptive daydreaming disorder. But the key part of the programme, mindfulness training, is already freely available. I am sure there are many excellent mindfulness courses online, but the one I usually recommend is the MBSR course. I did the related MBCT course many years ago, and it completely cured my depression in eight weeks – something antidepressants and CBT had spectacularly failed to do. I have had a daily mindfulness practice ever since. Mindfulness is also one of the four pillars of DBT, although in DBT the focus tends to be on present-moment awareness rather than cultivating a daily practice. In my experience, both are helpful.

Mindfulness is, in many ways, the opposite of daydreaming, and that makes it a hard skill for daydreamers to master. But the participants in Herscu et al.’s study have proved that it’s something we can learn do, if we’re motivated enough, and it can help maladaptive daydreamers to take control over their daydreaming. So, if you’re struggling with maladaptive daydreaming disorder and you can’t access therapy, I strongly recommend giving mindfulness a try – because, now, we know that it works.

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