By
Tylor Martinez, MS, LMHCA and Sarah Martin, BBC
Author Note:
This piece was developed collaboratively. With special thanks to Sarah Martin for her substantial contributions to both the research and writing.
What is Denial?
Denial is not all bad, all the time. Over the past century, denial has been understood and conceptualized in many different ways, which creates a challenge in giving it a simple definition (Livneh, 2009). The current consensus in psychology is that denial is a dynamic and unconscious defense mechanism that attempts to protect an individual from a real or perceived threat (Livneh, 2009; Travis, et al., 2011; Kramer, 2010; Cramer, 2025; Avramova & Mihaylova, 2024). Because of this definition, denial is often misunderstood and viewed as an entirely negative defense mechanism; therefore, understanding and identifying the differences between healthy and unhealthy denial can be useful for both the general population and clinicians.
Healthy
Healthy denial is developmentally appropriate, as it minimizes the signs and magnitude of a perceived threat but does not deny facts or reality altogether. This form of denial is conscious, flexible, and action-focused; helping an individual adapt to life’s challenges and assimilate new, even troubling information (Livneh, 2009; Travis, et al., 2011; Kramer, 2010; Avramova & Mihaylova, 2024). The focus is spent on what is in the individual’s control, rather on the individual’s perception of the information and potential outcomes. (Livneh, 2009; Kramer, 2010). Therefore, healthy denial is a normal coping mechanism.
Unhealthy
Denial is no longer healthy when it persists and distorts reality. In the hierarchy of defense mechanisms, denial is considered an immature, or primitive defense (Di Giuseppe, et al., 2021; Cramer, 2015; Kramer, 2010; Avramova & Mihaylova, 2024). Unhealthy denial becomes a maladaptive defense when negative emotions become too threatening. An individual will subconsciously focus on changing their internal state instead of focusing on necessary action (Livneh, 2009; Kramer, 2010). Ultimately, unhealthy denial includes a disavowal of facts that hinder individuals from addressing the real issue and accepting reality.
Coping Instead of Defending
The first step for anyone is learning to ask honest questions and practice self-awareness. Once an individual is able to identify denial, by taking inventory of the facts and noticing any fear they might feel, they are then empowered to respond differently. This is true even for older children. A study conducted with children and adolescents showed that the more they understood denial as a defense mechanism, the less likely they were to use it (Cramer, 2015). Therapeutic education teaches and encourages individuals to pay attention to what they are feeling, what unhealthy responses look like, and how to cope in healthier ways.
Grounding
While asking honest questions and exercising self-awareness is the first step to coping with denial, grounding techniques expands attention toward one’s physical surroundings. Although grounding does not eliminate internal thoughts or emotions, it does help an individual become present with life’s challenges. One way to practice grounding is by identifying five specific things that can be experienced through at least one of the five senses (taste, smell, touch, sight, and hearing). For example:
“I see my feet (1) taking steps as I walk on the path (2) and I see the leaves (3) on the tree (4) move as the wind blows through the branches (5).”
Acknowledging your surroundings while experiencing thoughts and emotions can help reduce reliance on denial.
Thought Defusion
Another effective mechanism is thought defusion, which helps an individual separate themselves from their thoughts rather than treating those thoughts as literal truths. For example:
“I’m sure I’ll be fine. I don’t really need to worry about the gas right now. I’ll figure something out later, and there’s no way I’m actually going to lose my job because it’s not that serious. I’ve made it to work before, so it’ll probably just work itself out in the morning.”
When an individual fuses themselves with a thought they begin to treat it as truth. In the case above, denial is used to create a sense of safety within the illusion of comfort that worrying about gas is unhelpful and everything will work itself out because it has before. This can be problematic because a person remains comfortable in the false belief that everything will be fine rather than acknowledging their emotions and addressing the problem.
One way to practice thought defusion is by saying, “I am having the thought that...” and then following it up with “But the reality is…” For example:
“I am having the thought that I will be fine and I don’t really need to worry about gas right now, but the reality is I do feel worried about gas and I am having the thought that I don’t know how I will afford it.”
Separating the self from the thoughts and emotions as well as continuing to ground in reality can help reduce avoidance of uncomfortable feelings and reliance on denial. The first grounding technique can also be incorporated into the “But the reality is…” statement by describing what you observe in your surroundings. For example:
“But the reality is that I feel worried about gas, and I am having the thought that I don’t know how I will afford it while I see my feet (1) taking steps as I walk on the path (2), and I see the leaves (3) on the tree (4) move as the wind blows through the branches (5).”
This practice helps bring awareness to the fact that thoughts, emotions, and real-life problems can exist at the same time as positive or neutral experiences in the surrounding environment, such as watching leaves move in the wind.
Mindfulness
The last method that can be useful is the mindfulness technique R.A.I.N. This technique helps reduce the intensity of negative feelings that may arise during times of distress, particularly when denial may be used to avoid uncomfortable emotions or experiences.
R — Recognize: Recognize the feelings you are experiencing by naming them out loud, silently to yourself, or by writing them down on a sticky note or index card.
A — Allow: Allow yourself to experience your feelings without judgment. Remember that your thoughts are simply thoughts you are having, and your emotions are feelings you are experiencing.
I — Investigate: Investigate your experience further by identifying any sensations that you notice in your body. Identify the most vulnerable part of yourself and/or the strongest emotion you notice. Then, ask yourself what that part of you or emotion needs. Does the emotion of sadness need comfort, reassurance, a solution, or words of encouragement? Does the vulnerable part of yourself need a hug, a conversation with a friend, or nurturance?
N — Nurture: Nurture the vulnerable part of yourself by being kind to yourself and showing compassion and understanding toward your experience. Take a break, write down your thoughts, create a to-do list, or do whatever you need to help your future self prepare for the next day while allowing your present self time to heal.
Conclusion
The truth is, we are all prone to use denial in unhealthy ways to protect ourselves. Whether it’s someone’s perception of us, or a serious cancer diagnosis, denial is a natural coping mechanism; and denial is not all bad, all the time. The major caveat with denial is that we often do not realize we’re using it unless we have learned to identify it.
References
Avramova, N., Mihaylova, I. (2024). Exploring ego defense mechanisms in preclinical dentistry students: a cross-sectional analysis. Journal of Educational Sciences & Psychology. 14 (76). 159-170. 10.51865/JESP.2024.1.16.
Cramer, P. (2015). Defense mechanisms: 40 years of empirical research. Journal of Personality Assessment, 97(2), 114-22. doi:https://doi.org/10.1080/00223891.2014.947997
Kramer, U. (2010). Coping and defence mechanisms: what's the difference?--second act. Psychology and Psychotherapy, 83, 207-221. https://doi.org/10.1348/147608309X475989
Livneh, H. (2009). Denial of chronic illness and disability: Part I. theoretical, functional, and dynamic perspectives. Rehabilitation Counseling Bulletin, 52(4), 225-236. doi:https://doi.org/10.1177/0034355209333689
Perry, J. D. C., & Perry, J. C. (2004). Conflicts, defenses and the stability of narcissistic personality features. Psychiatry, 67(4), 310-30. Retrieved from https://www.proquest.com/scholarly-journals/conflicts-defenses-stability-narcissistic/docview/220704703/se-2
Perry, J. C., & Plakun, E. M. (2009). Narcissistic and borderline personality disorders in a sample of treatment refractory patients. Psychiatric Annals, 39(4), 175-184. doi:https://doi.org/10.3928/00485713-20090401-05
Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry, 76(1), 32-52. doi:https://doi.org/10.1521/psyc.2013.76.1.32Perry, J.D.C., Perry, J.C., (2004),
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Travis, A. C., Pawa, S., Leblanc, J. K., & Rogers, A. I. (2011). Denial: What is it, how do we recognize it, and what should we do about it? The American Journal of Gastroenterology, 106(6), 1028-1030. doi:https://doi.org/10.1038/ajg.2010.466
