What is the most effective treatment for Maladaptive Daydreaming Disorder(MDD)?

I'm 34 and I believe I've Maladaptive Daydreaming Disorder(MDD) even though I've been diagnosed with OCD(because MDD is not in DSM yet). I've had this for more than 20 years. I've been getting treatment for OCD. I tried many SSRIs for over a year but they didn't help. Right now, my psychologist is taking me through systematic desensitization. What else can help me?
Asked by Rakesh

Hello Rakesh,

I am glad you reached out for support at this time.  I am sorry you are struggling in this moment.  I would encourage you to start to work with a therapist to help you learn skills to help you overcome your struggles.  If we were to meet I would first talk to you about the counseling process through our site and how together we could help you obtain your goals going forward, how I work as a counselor and how I would try to help you through the counseling process.  

I would also take the first session to get to know you by asking you a few questions to get a better understanding of your struggles so that I am able to focus on a plan and goals to work on going forward. I want you to know that you are not alone during this time even though you may feel like you are alone at this time.  During the therapy process, you can have support 100% of the time as you are able to reach out and talk to a therapist 24 hours a day 7 days a week.  

A few of the questions I would ask would include the following:

Can you tell me more about your past history?

How long have you been on medication?

How long have you been in therapy?

What are some struggles you have been having with your daily living?

I am going to send you some skills and tools to help you during this time of struggle you are having.  If we were to work together we would be going over these and more tools to help you through your struggles and be able to ask for support from others.

I understand you are in therapy at the moment and do not want to step on the other therapist's toes or skills they have been working with you on.  I will send you some skills that maybe helpful for you without confusing you on what to use from each therapist.

These skills can help with identifying maladaptive thinking and intentionally making specific, strategic behavioral changes to achieve the desired outcome. Some are general skills, while others are more targeted to specific issues or needs.

Behavioral experiments

Behavioral experiments are designed to test thinking and identify thought patterns that influence behaviors.

By intentionally ‘trying out’ specific ways of thinking and observing the outcome behaviors, you will gain a deeper awareness of the patterns of thinking that may be holding you back from reaching your goals.

Thought records

Thought records are also designed to test the validity of our thoughts. Actually recording our thoughts provides a way for us to evaluate the evidence for or against a particular way of thinking – essentially, is it true or not true based on the situation? Thought records help to establish a more balanced way of thinking based on logic

what is as opposed to what you feel?


Exposure is a powerful technique used to help you to face your fears or phobias in a controlled way. Basically, having the client be exposed to the very thing they fear. It will, of course, be scary for them.

When used properly, exposure has been proven to be effective in the reduction of fears and phobias.

There are many exposure techniques and even more ways to implement them. Here are some of the more common and well-known techniques.

Situation exposure hierarchies

In this technique, the client make a list of feared objects or situations. The client then rates, on a scale of 0 to 10, how distressed they would be by each item. For example, a person who fears dogs might say “Not seeing a dog in the yard” is 0. “A dog licking my hand” might be their 10.

Starting with the least distressing, I can help you work through each situation in the list. This is a way of gradually increasing exposure and diminishing the distress of exposure.


Flooding also uses exposure hierarchies, but generally begins with the more difficult or distressing scenarios or objects. Caution should be used when choosing this technique, as it can elicit strong responses. This technique is best utilized as a part of a therapeutic intervention and most of the time done best in person

Systematic desensitization

This technique involves combining exposure with relaxation exercises. You are taught strategies to remain relaxed in situations that would normally elicit fear. Gradually, you start to associate your feared object or situation with relaxation rather than powerful negative feelings.


Journaling is a great way to gather information about thoughts and feelings. The journal can be used as a place to identify, describe, and evaluate moods, thoughts, scenarios, and responses. Having a place to ‘unpack’ and explore can lead to tremendous insight.

Cognitive restructuring – unraveling cognitive distortions.

Cognitive distortions are patterns of faulty thinking that convince us something is true when it is not. There are several types of cognitive distortions.

The plan would be to help you identify and challenge your distortions in thinking. This can also be accomplished through the therapist-client dialogue. The goal, of course, is to have you learn to do this on your own.

Here are five ‘thought challenges.  You can use these to take a closer look at your negative thought patterns.

1. What are the chances…?

The things you worry about may be very unlikely to happen. Would you be willing to put money on it happening?

2. What is the worst thing…?

The things you worry about might happen, but you are making way too much of them. Consider whether it would really be that bad if the worst did happen and realize that it might not be worth all that anxiety.

3. Am I right to think that…?

You might be missing important information that would help you with decisions. As you gather more information, your worry and stress may abate.

4. The five-year rule (‘the history game’)

This challenge has been applied to lots of situations within and outside of our work together to put events that have happened or will happen into perspective. Ask yourself, “Five years from now, will it really matter?”

5. What is this worth?

Consider just how important this thing you are worried about is. Life is too short to be spent worrying about things that just do not deserve that kind of time investment.

Functional assessment (ABCs)

A functional assessment tool allows the client to record the ABCs (antecedents, behaviors, consequences) of a situation. If you are wanting this tool, I will send you a worksheet for this.  This data allows both myself and you to begin to identify patterns of behavior.  


It’s easy to fall into familiar patterns of negative thinking. One way to counteract negative thinking is through reframing. Reframing is the act of replacing negative thoughts with positive ones as soon as the negative thought occurs.

Reframing disrupts the negative cycle of perpetuation and resets the focus on something positive. 

Relaxation and mindfulness

Three of my favorite relaxation and mindfulness practices are progressive muscle relaxation (PMR), meditation, and deep breathing. Each is a bit different in its implementation and intent.

PMR involves the systematic tensing and releasing of each muscle group, combined with deep breathing and mental imagery. Mindfulness meditation involves clearing the mind and focusing on the sensations and thoughts in the moment, observing them and allowing them to pass. Deep breathing is an action that is physiologically incompatible with anxiety.

Relaxation and mindfulness techniques gives you a new and different way to respond to distressing situations. This change of response can break the cycle of perpetuation. Relaxation also helps to quiet your mind so that you can think more rationally and logically.

The SOLVED technique

This technique is used to teach problem-solving skills. While there are many variations on this technique (and lots of other names for it), structured problem solving is a critical skill for clients to learn. The acronym SOLVED gives the client a tangible, memorable tool for working through the problem-solving steps.

S – Select a problem that the client wants to solve.

O – Open your mind to all solutions – brainstorm all the options with your client.

L – List the potential pros and cons of each potential solution.

V – Verify the best solution – decide which choices are practical or desirable.

E – Enact the plan.

D – Decide if the plan worked.

I hope that these skills have been helpful for you in the struggles you have been facing at this time.