I am looking for a therapy to cope with my compulsive daydreaming.

Hello! Thank you very much for your question. 

I think that if you have already been diagnosed with ADHD and GAD then you know how difficult it is to manage those "what if" thoughts that can turn into full-on daydreams with the anixety and then also the distraction-based or impulsive daydreams with ADHD. Most people daydream, maybe even everyday. But, certain individuals possess the ability to daydream so vividly that they can experience their presence in the imaginary environment of their creation. While experiences of such vivid, active day-dreaming may seem odd to some, they’re extremely commonplace for a lot of people — and, in some cases, depending on a number of factors like severity and frequency, may suggest a psychiatric condition called maladaptive daydreaming, or MD. In addition, these individuals also experience constant compulsions to switch to the fantasy several times during the day, which has led experts to believe that it is a behavioral addiction. However, this is still an evolving area of research, and is yet to be formally recognized as a disorder by the American Psychiatric Association (APA). Those who suffer from this condition reportedly spend almost 60 percent of their waking hours in imaginary worlds of their own creation — but, without losing touch with with the real world, and realizing that it is a fantasy they are immersing themselves into.

MD is a form of dissociating oneself from the real world, and getting absorbed into fantasies and mental imagery comprising vivid alternative universes, usually involving elaborate scenarios — that the individual prefers over reality. People suffering from this condition consider it a disorder because it often interferes with the individuals’ social, academic or professional life, especially so, if they begin to replace human interactions with fantasy.

The fifth Diagnostic and Statistical Manual, or DSM-5, does not recognize MD. So, in the absence of DSM-5 criteria for its diagnosis, there is Somer’s Maladaptive Daydreaming Scale (MDS) to help determine whether an individual is experiencing MD — MDS is a 14-point scale that rates five primary characteristics of the condition: Content and quality (detail) of dreams; Individual’s ability to control their dreams and/or the compulsion to dream; Amount of distress caused by daydreaming; Individual’s perceived benefits of daydreaming; Extent of interference of daydreaming with the individual’s ability to carry out their daily activities. In addition to these, people may also be asked to rate how often they experience MD. Interestingly, researchers on the subject have noted that people suffering from MD also report higher rates of attention-deficit and obsessive-compulsive symptoms along with a history of depression and/or anxiety disorders (as is your presented case, I believe)— although experts are still not sure why.

Experts believe that MD is, generally, a coping mechanism in response to trauma, abuse or loneliness that leads the maladaptive daydreamer to conjure a complex imaginary world for them to escape into in times of distress, or loneliness, or maybe, even helplessness in real life. It is an escapist method of avoiding real interactions with families, friends or colleagues. Experts believe that cognitive behavioural therapy, or talk-therapy that helps people manage their day-to-day problems by changing the way they think and behave, can address their compulsive need to slip into their imagination. In terms of medication, one study had found that fluvoxamine, a drug commonly used to treat OCD, can help control MD as well, which tells me that you are on the right path with medication as well as seeking out CBT therapy. Over the years, a number of online communities of self-diagnosed maladaptive daydreamers have also emerged to help each other out. I think seeking out social supports either virtually or in person is a good defense against this daydreaming as well. If you are interacting with someone or doing something actively, there is less potential for your dayrdreams to take over or grow.

When the medical community formally recognizes the disorder, perhaps, there will be more streamlined and nuanced approaches to treating those held hostage by their daydreams — in fact, in 2014, a Texas student named Cyan Reed had even launched a petition on Change.org urging the APA to acknowledge MD as a disorder. As you stated, maladaptive daydreaming still isn’t an officially recognized condition, but it’s clear that people around the world are experiencing the same symptoms: the hypnotic movements, the plots and characters, and the crippling inability to focus on the real world. As a clinician, there is hope to find out much more about this condition and help the medical profession learn to address it.

I think in the meantime however structuring your day with activities, seeking out a CBT therapist on BetterHelp, engaging social supports, and reminding yourself that you are doing the best you can right now in these very trying times can help change your compulsatory daydreaming. I think meditation can also help, as it guides us to generally see the thoughts or images or feelings that pop up but then redirect our focus to something else. It is a difficult process to do--redirecting thoughts--but I think if you were able to practice this technique with meditation it would prove to be easier to access when the daydreams begin to arise and/or build. 

I hope this helps! I trust you know that we at BetterHelp are here for you every step of the way. I wish you all the best! Take care :)