A man in a suit stares at his reflection while touching the mirror.Denial, sometimes referred to as an acronym for “Don’t Even KNow I Am Lying,” is one of the most common defense mechanisms. Denial is widely recognized in mental health fields, and it is relevant in experiences of witnessing, inflicting, and/or surviving trauma. While denial can be quite effective in the short-term, it is often harmful in the long-term. Staying stuck in denial interferes with change.

WHAT IS DENIAL?

Denial is the refusal to accept reality in order to protect yourself from a painful event, thought, or feeling. It is a defense mechanism that gives you time to adjust to distressing life situations.

Denial can be present for anything that evokes vulnerability or threatens your sense of control. This could be illness, racism, addiction, anger issues, financial problems, or relationship conflicts. You can be in denial around something happening directly to you or something happening to another person. Denial can occur on an individual level and also on broader system levels, such as in family, social, or cultural contexts.

Denial is universal— everyone perceives events through personal bias. Yet the process of denial is complex, and it is (at least initially) mostly implicit and unconscious. However, you can recognize and challenge denial through an ongoing process of radical honesty and self-examination. This process can give you insight or encourage movement if you are stuck.

When undergoing self-examination, it often helps to use a holistic approach that includes mind, body, and soul.

Examining the MIND

Exploring your inner dialogue (self-talk) and outer dialogue are useful strategies in the self-examination of denial. Try to see if you are using cognitive distortions such as rationalizing, minimizing, and intellectualizing. These are used to alter the perception of reality, and they may suggest denial is ultimately at play.

Using the example of a conflict in a toxic relationship, consider the following:

These cognitive distortions are indicators that you may be stuck in denial. Also be on the lookout phrases or keywords which may signal that you’re engaging in a cognitive bias:

Examining what is being thought or said is relevant in the self-examination of denial. Examining the unsaid is also important. Consider what you are avoiding. What are you refusing to think about? What will you not talk about? What situation, past or present, won’t be acknowledged? What facts won’t you face? Honestly examine what you fear, then evaluate the potential negative consequences of not taking action.

Examining the BODY

Numbness, disconnection, and/or dissociation often occur with denial. These symptoms are suggestive of a trauma reaction in the nervous system: the freeze response. Somatic awareness can be a useful tool in addressing denial and the freeze response. Increasing somatic awareness means learning to feel your body and making your visceral experience more conscious.

To increase your somatic awareness, try the following exercise:

  1. Use the 5 senses (sight, sound, smell, taste, and touch) to externally orient to your environment.
  2. Notice what happens internally as you receive information from the environment through your senses (i.e. sound made your heart rate increase, sight was calming, etc.).
  3. Shift focus to identifying internal sensations (i.e. notice intensity, muscle, skin, temperature, constriction, expansion, and whole-body sensations).
  4. Bring to mind what you may be denying and notice what internal sensations you experience. If you are unaware of what you are denying, simply continue to notice sensations, as well as any thoughts, images, emotions, or impulses that arise.
  5. Stay with the experience, just noticing, until you experience sensations that are settling and pleasant, such as less constriction, more breath, and more presence.

Practice the exercise regularly. As your somatic awareness increases, continue to intentionally seek out sensations and practice staying with the discomfort.

Examining the SOUL

Denial has been described as a shock absorber for the soul. Attending to the soul refers to examining a deeper connection or relationship to yourself and others.

One sign of denial is when you constantly try to prove how good you are, that you are enough, or how much someone has or has not hurt you. Trying to prove yourself to the world may actually suggest that it is you who is not believing how good you are, your worth, or your hurt. Trying to prove yourself often presents as blaming, comparing, or defending. These tactics suggest that not only are you likely in a state of denial, you are also further disconnecting from yourself.

Individuals remain in denial and are unable to hear the truth until they are emotionally ready to cope with it. Individuals remain in denial and are unable to hear the truth until they are emotionally ready to cope with it. This often involves having a stable connection to oneself and others. You can deepen your self-connection and self-trust by revisiting past challenges that you have overcome. Take time to identify your abilities, successes, and strengths. You can deepen your connection to others by allowing yourself to express your fears. Consider opening up to a trusted friend or loved one, and/or participate in a support group.

Lastly, identify discrepancies between your values and your behaviors. The discrepancies may suggest denial. If you value love, for example, consider how your actions (or inactions) contribute to experiences of harm or hate. Make sure your internal and external resources are being used in accordance with your values, and reflect on your sense of greater meaning or purpose.

Therapy can be a safe place to get help for denial and other defense mechanisms. When denial has affected a marriage or relationship, couples counseling can be particularly helpful.

Blindfolded man with "racism" text on the blindfoldDenial has been said to be the trademark of addiction, and it has been long identified in the field of psychology. Denial is also relevant to experiences of trauma. These include witnessing trauma, inflicting trauma, and surviving trauma. Furthermore, white denial of racial trauma is the breath of racism.

What Is Denial and Why Do People Do It?

Denial is a refusal to accept reality in order to protect oneself from a painful event, thought, or feeling. It is a common defense mechanism that gives a person time to adjust to distressing situations. For example, a person with drug or alcohol addiction will often deny that they have a problem. People indirectly dealing with the addiction, such as family or friends of the addicted person, may also deny the severity of the issue.

It is possible to deny some aspects of reality while accepting other aspects. For example, a person may acknowledge there is an issue (such as addiction) while denying the need to take action (such as quitting the drug).

Denial isn’t limited to individuals. It has also been recognized on a cultural scale. Current examples include conspiracy theorists’ claims that the Holocaust never occurred or the renunciation of global warming.

Some experts theorize that denial occurs in linear, progressive stages. These types of denial include the following:

Denial is initially an unconscious adaptive response. It can also be one of the most primitive, meaning that while it can be very effective short-term, it is ineffective and potentially harmful in the long-term.  Staying in denial interferes with change.

How Denial Can Contribute to Racism

The stigma associated with being racist often fuels white denial—the refusal to accept that racism exists. Racism can be defined as the discrimination and/or oppression inflicted upon individuals belonging to a socially constructed racial category. Racism happens at three levels:

  1. Institutional—Discrimination through laws or social norms.
  2. Individual—When one person discriminates against a minority group.
  3. Internalized­—When a marginalized person believes stereotypes about their group and/or blames themself for any discrimination they face.

Racism requires the combination of prejudice, power, access, and privilege. It has been summarized as a pathology of power marked by ignorance.

The infamous photograph of the horrific lynching of Rubin Stacy in 1935 is a striking example of white denial. The photo shows a white child in the crowd dressed in her Sunday best. She is smiling while looking at the dead body of a black man hanging in the tree.

Transforming and healing the societal trauma of racism must include healing the numbness of people who benefit from racism.The child could be considered a visual representation of how the short-term coping response of denial evolves into a long-term strategy. The photo demonstrates how racism can be embedded in the culture we grow up in (institutionalized). It also shows how our belief system and our physiology can embody racism (individualized and internalized).

Studies on epigenetics reveal how trauma responses can be passed down through generations, not only through learning and conditioning, but also through genetics. One study shocked male mice while exposing them to the scent of a cherry blossom. The mice then showed a trauma response every time there was the scent, even without being shocked. The trauma response was also present in the mice’s children and grandchildren when they were exposed to the scent of a cherry blossom, even though they never experienced a shock. Their genes were altered.

The study suggests that a person may not have to directly experience a traumatic event to enact a trauma response. In other words, a traumatic response to a relevant trigger can occur even when a person doesn’t know what the original stimulus was. Regarding the photo, the loved ones grieving Rubin Stacy’s death could have passed down their trauma response to their descendants. Future descendants of the white child may embody her physiological response as well.

White denial, and the identified physiological response, may be relevant in the concept “the privilege of numbness”.  The term refers to emotional numbness as an adverse effect of racism. This numbness may enable white individuals to ignore or perpetuate a system of racism that benefits them without feeling guilt about others’ suffering. Transforming and healing the societal trauma of racism must include healing the numbness of people who benefit from racism.

When Ignorance Is Intentional

Conscious acts of denying can also appear when people face ethical dilemmas. A study examining shopping behaviors found that if consumers were specifically told that a product was made in an unethical way, the consumers wouldn’t purchase the product. However, when consumers were given the choice to hear the backstory on the product, most people chose to not know.

Researchers asked participants to rank jeans by picking two of four categories to do so:

  1. Style
  2. Color
  3. Price
  4. Whether or not child labor was used to make the clothing

More than 85% of participants did not choose child labor as a category for their consideration. These results suggest the vast majority of participants were “willfully ignorant.”  Researchers found the conscious act of denial was at least in part due to an unconscious fear of being upset by what would be discovered.

Next, researchers asked the willfully ignorant participants what they thought of consumers who chose to research a brand’s labor practices before making a purchase. The response? The willfully ignorant participants tended to degrade the ethical consumers, not just with criticism, but also with character attacks.

Why the hate? Research indicated the participants were unconsciously acting out due to their own guilty feelings. Perhaps even more concerning, a related study demonstrated that willfully ignorant consumers who degraded their ethical peers were less likely to support the social cause in the future.

Addressing Denial Through Self-Examination

Challenging denial is typically an ongoing process of self-examination and radical honesty. Denial is universal—everyone perceives events through personal bias. Therefore, confronting denial often starts at an individual level.

When challenging your own denial, remember to consider the following:

Sometimes confronting personal bias or past mistakes can feel emotionally overwhelming. A licensed therapist can offer confidential support without judgment. You can find a therapist here.

References:  

  1. Aizenman, N. (2016). Do these jeans make me look unethical? National Public Radio. Retrieved from https://www.npr.org/sections/goatsandsoda/2016/01/07/462132196/do-these-jeans-make-me-look-unethical
  2. Aldebot, S., & de Mamani, A. G. (2009). Denial and acceptance coping styles and medication adherence in schizophrenia. The Journal of Nervous and Mental Disease, 197(8), 580–584. doi:10.1097/NMD.0b013e3181b05fbe
  3. D’Angelo, R. (2011). White fragility. The International Journal of Pedagogy, (3) Retrieved from http://libjournal.uncg.edu/ijcp/article/view/249/116
  4. Kendi, I. X. (2018). The heartbeat of racism is denial. The New York Times. Retrieved from https://www.nytimes.com/2018/01/13/opinion/sunday/heartbeat-of-racism-denial.html
  5. Lewis, T. (2013). Fearful experiences passed on in mouse families. Live Science. Retrieved from https://www.livescience.com/41717-mice-inherit-fear-scents-genes.html
  6. Lynching of Rubin Stacy in Fort Lauderdale, Florida [Photograph]. (1935) Retrieved March 2019 from https://www.alamy.com/stock-photo-lynching-of-rubin-stacy-in-fort-lauderdale-florida-49908098.html
  7. Raheem, M. A., & Hart, K. A. (2019, March). Counseling individuals of African descent. Counseling Today, 61(9). Retrieved from https://ct.counseling.org/2019/03/counseling-individuals-of-african-descent
  8. Winn, M. E. (1996). The strategic and systemic management of denial in the cognitive/behavioral treatment of sexual offenders. Sexual Abuse, 8(1), 25–36. Retrieved from https://journals.sagepub.com/doi/10.1177/107906329600800104

Half-transparent photo of person with curly hair wearing hat and coat sitting on bench on cold dayThe influence of trauma in mental and chemical health treatment is getting more and more attention.

When we hear the word “trauma,” we tend to think of events that lead to death or injury. These events might include sexual violence, accidents, war crimes, and/or natural disasters. This is an accurate description of trauma. It also fulfills the criteria for a diagnosis of posttraumatic stress (PTSD).

But the transmission of the effects of trauma may be far broader and more complicated. Thus, it is important that the intricacies of trauma-related symptoms within interpersonal or systemic contexts continue to gain recognition. When we, as therapists and other helping professionals, increase our awareness of trauma and its varied symptoms, we can better serve people seeking our help.

How Is Trauma Defined in the DSM?

The fifth and newest edition of the Diagnostic and Statistical Manual of Mental Disorders broadened the definition of trauma to include direct or indirect recurring exposure to traumatic events. The broadened definition refers to two types of trauma.

Symptom criteria in the DSM-5 for a PTSD diagnosis includes four categories beyond trauma exposure.

  1. Intrusive symptoms, such as flashbacks or distressing memories
  2. Avoidance symptoms, including avoidance of internal or external reminders
  3. Negative alterations in mood or cognition. In other words, a person might have a persistent negative emotional state or negative beliefs about the self or the world.
  4. Hyperarousal symptoms, such as anger, reckless behavior, or difficulty concentrating

If some symptoms are present and interfere with typical function, but not all symptom criteria is met, a diagnosis of Other or Unspecified Trauma- and Stressor-Related Disorder may be given.

How Can a Broader Diagnostic Definition Help?

Exploration of trauma helps broaden the diagnostic definition. Recent findings in neuroscience may also be relevant to the understanding of the contextual factors in interpersonal traumas. Research has found that social exclusion and rejection are mediated by the same aspects as our physical pain system.

Human physiology does not differentiate between social and physical pain. Trauma-related symptoms may result when someone feels threatened or experiences physical harm or injury, either directly or indirectly. But experiences of social exclusion or rejection are likely to result in the same symptoms.

Transgenerational or Intergenerational Trauma

First identified in the 1960s, this type of trauma describes the symptoms experienced by descendants of Holocaust survivors. It occurs when trauma symptoms are present within generations of the same family, beyond the generation of the person who experienced the trauma. This particular trauma may also be present in the context of immigration-related traumas.

Research suggests symptoms may be transmitted to later generations when a parent’s unresolved grief, depression, anxiety, and/or other symptoms interfere with the ability to establish healthy or secure attachment with their children and consistently meet the emotional needs of their children.

Historical Trauma

This type of trauma also involves a subjective reexperiencing and recollection of traumatic events by an individual or a community over multiple generations. The term has origins in the 1980s and is based on the studied traumas of the colonization, relocation, and assimilation of the Native Americans.

The experience of historical trauma is absorbed into the cultural memory of the group, flowing from generation to generation. This is similar to the way non-traumatic aspects of the culture regenerate. Traumatic stress may be altered in each generation as members continue to witness the effects of trauma on previous generations. As a result, each successive generation may begin to exhibit unique symptoms of trauma.

Racial Trauma

In 2001, the U.S. Surgeon General identified racial trauma as the attributing factor to ethnic and racial disparities. This type of trauma considers the symptoms that may result when a person experiences racism. Some forms of race-based trauma include:

Trauma-related symptoms may result when someone feels threatened or experiences physical harm or injury, either directly or indirectly. But experiences of social exclusion or rejection are likely to result in the same symptoms.

Research indicates that the more subtle forms of racism lead to constant vigilance, or a kind of “cultural paranoia,” which may serve as a defense mechanism. Experiences of racism may be subtle, but the culmination of these types of race-based trauma often result in traumatization.

Systemic Trauma

In spite of the above knowledge of the many contexts of traumatic experiences, many socially relevant forms of trauma are not always considered traumatic, even by mental health care providers. This shows the relevance of systemic, or institutional, trauma.

Also known as institutional trauma or betrayal, this type of trauma is defined as the institutional action and inaction that can worsen the impact of traumatic experience. Systemic trauma regards the contextual features that give rise to, maintain, and impact trauma-related responses. There are parallels between the interpersonal and institutional trauma. These include factors of trust and dependency, as well as a lack of sustained awareness across contexts.

How Can We Improve Trauma Treatment?

As trauma professionals, it is necessary to acknowledge the above and incorporate systemic approaches in order to better assess, diagnose, and treat trauma. For instance, I ask you to consider an African-American whose current lived experience includes transgenerational trauma, historical trauma, racial trauma, and systemic trauma. Their trauma-related symptoms, such as anger or distrust, may then be interpreted by others—including those in power—as character flaws. This only heightens the trauma response, on every level.

It can be challenging to expand our paradigms of trauma. A broadened conceptual framework is necessary, both scientifically and ethically. This perspective extends the conceptualizations of trauma to consider the influence of environments beyond the person themselves. These might include the following:

When we consider all these factors, we can provide more specialized treatment to people seeking trauma treatment. Above all, we must remember that context matters.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Carter, R. T. (2006, December 1). Race-based traumatic stress. Psychiatric Times, 23(14). Retrieved from http://www.psychiatrictimes.com/cultural-psychiatry/race-based-traumatic-stress
  3. Goldsmith, R. E., Martin, C. G., & Smith, C. P. (2014, March 11). Systemic trauma. Journal of Trauma & Dissociation, 15(2), 117-132.
  4. MacDonald, G., & Leary, M. R. (2005). Why does social exclusion hurt? The relationship between social and physical pain. Psychological Bulletin, 131(2), 202-223.
  5. Phipps, R. M., & Degges-White, S. (2014, July 1). A new look at transgenerational trauma transmission: Second-generation Latino immigrant youth. Journal of Multicultural Counseling & Development, 42(3), 174-187.
  6. Smith, C. P., & Freyd, J. J. (2014). Institutional betrayal. American Psychologist, 69(6), 575-587.
  7. Williams, M. T., & Leins, C. (2016). Race-based trauma: The challenge and promise of MDMA-Assisted psychotherapy. Multidisciplinary Association for Psychedelic Studies (MAPS) Bulletin, 26, 32-37.

Person seated in yoga pose on ledge wearing athletic clothes, hair in bunEastern traditions have long recognized the importance of the mind-body connection for general wellness, and Western thought is beginning to follow suit. An increasing amount of research is emerging to support this link. Yoga in particular has become especially popular in recent years as a way to facilitate the mind-body connection and is now one of the most widely practiced forms of complementary health care in the United States.

Demonstrated to have benefit in the treatment of numerous physical health conditions and mental health concerns, stress and trauma-related issues among them, yoga is utilized by many to cultivate mindfulness through a combination of physical movement, breathing exercises, and relaxation. Yoga therapy, in fact, is a growing field of mental health treatment.

Yoga and the Stress Response

Many studies have observed the effect of yoga on the fight-or-flight response, which is the body’s natural reaction to stressful and life-threatening situations. The fight-or-flight response, intended to save us from immediate physical danger, can also be experienced when we encounter stress, such as a life change, a toxic relationship, or the challenges of addiction recovery. [fat_widget_right]

Chronic stress and levels of cortisol (the body’s primary stress hormone) that are consistently elevated underlie many physical and mental health issues. Regular practice of yoga, however, has been found to naturally decrease cortisol levels. This natural decrease of cortisol can give the body a chance to return to a state of restful awareness. Restful awareness allows the physical impact of the flight-or-flight response to normalize and gives the body the opportunity to heal.

Treating Trauma

During traumatic experiences, the body may become dysregulated by either over-activation or suppression of the fight-or-flight response. When this occurs, we become overloaded, and the result may be a state of mind that is too anxious, trapped, or some sort of fluctuation between the two. Trauma may be held in the body through heightened or dysregulated physiological states and somatic symptoms. The body itself, then, contains and manifests much of the pain experienced after a traumatic event. As has been said, “The issues live in the tissues.”

When working with individuals who have experienced interpersonal trauma, mental health professionals may find traditional talk therapy alone is not always the most effective course of action.

Trauma and its effects are so often entrenched and complex that a change in a cognitive frame or behavioral pattern ignores a very basic but critical element: the body.

A cognitive symptom of trauma exposure is difficulty or impaired ability to remember, verbalize, and/or process one’s experiences. Therefore, insight-based approaches often are not sufficient on their own. Furthermore, trauma and its effects are so often entrenched and complex that a change in a cognitive frame or behavioral pattern ignores a very basic but critical element: the body.

Techniques working to help increase awareness of internal states and physiological responses to both internal and external stimuli have demonstrated promise in addressing trauma in the body. Reorienting an individual to their body is often a key to unlocking their pain and building a path toward healing.

What Is Trauma-Sensitive Yoga?

An evidence-based practice designed to directly address symptoms associated with traumatic exposure, trauma-sensitive yoga focuses on body awareness in the present moment. Based on the theoretical underpinnings of attachment theory, trauma theory, and neuroscience, TSY helps individuals in treatment recognize choices relating to the body and develop the ability to take effective action based on the knowledge of these choices. The language used in treatment is invitational and emphasizes choice for the person in treatment. The experience is shared, and no physical assists are used.

Unlike traditional yoga, TSY always places emphasis on the internal experience of the individual, not on achieving proper form. The facilitator of the treatment will, while practicing with the individual, help them become accustomed to feeling their body in the present moment, whether by guiding them to feel the way their feet contact the ground or how a particular muscle contracts. Through this guidance, people in treatment can learn what to do about the experience in real time by taking effective action. Everything about the practice is optional, gentle, and designed to help individuals befriend their bodies.

The practice of yoga, with its focus on the mind-body connection, offers both symptom reduction and opportunities for people practicing yoga to heal and grow. Yoga, known to benefit the mind as well as the body, has been proven beneficial for addressing stress, trauma, depression, anxiety, addiction recovery, and even personal growth.

Beyond yoga’s other benefits, research has found individuals who combined TSY with psychotherapy were more likely to experience a decrease in trauma-related symptoms and an increase in positive traits and emotions such as grace, compassion, relating with self and others, acceptance, centeredness, and empowerment.

If you are interested in incorporating yoga into your wellness practices, self-care routine, or mental health treatment but are unsure of where to start, consider bringing it up with your therapist or counselor or primary care physician to see if this approach might benefit you.

References:

  1. Buric, I., Farias, M., Jong, J., Mee, C., & Brazil, I. (2017, June 16). Meditation and yoga can ‘reverse’ DNA reactions which cause stress, new study suggests. Frontiers in Immunology. Retrieved from https://medicalxpress.com/news/2017-06-meditation-yoga-reverse-dna-reactions.html
  2. Emerson. D., Sharma, R., Chaudhry, S., & Turner, J. (2009). Trauma-sensitive yoga: Principles, practice, and research. International Journal of Yoga Therapy, 19. Retrieved from http://www.traumacenter.org/products/..%5Cproducts%5Cpdf_files%5Cijyt_article_2009.pdf
  3. Garfinkel, M. (2006). Yoga as a complementary therapy. Geriatrics and Aging, 9(3). Retrieved from http://www.medscape.com/viewarticle/525187
  4. Jackson, K. (2014, November 17). Trauma-sensitive yoga. Social Work Today, 14(6). Retrieved from http://www.socialworktoday.com/archive/111714p8.shtml
  5. MacMillan, A. (2017, June 16). Yoga and meditation can change your genes, study says. Time. Retrieved from http://time.com/4822302/yoga-meditation-genes-stress
  6. McCall, T. (2008, June 20). Understanding the mind-body connection. Yoga Journal. Retrieved from https://www.yogajournal.com/teach/yoga-therapy-and-the-mind-body-connection-part-1
  7. Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193654
Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.