Denial: Unravelling the Psychology of Avoidance
Denial, in psychological terms, is a complex defence mechanism that helps individuals reduce distress when confronted with painful or threatening realities. It can be conscious or unconscious, functioning as a temporary protective barrier against feeling emotionally overwhelmed r. Understanding denial is important in many areas including mental health, addiction and trauma recovery. It’s a protective barrier, often maladaptive, that shields us from overwhelming distress.
The Neurological Basis of Denial: How the Brain Protects Itself

Neuroscience gives us a glimpse into how denial works. Research shows the brain actively filters and processes information to maintain psychological balance. Studies using neuroimaging techniques like fMRI show denial may involve interactions between the prefrontal cortex and limbic structures like the amygdala. The PFC, responsible for executive function and reality testing, may modulate emotional responses by regulating activity in the amygdala, the brain’s primary centre for processing emotions and threat . This neurological process may reduce the emotional impact of distressing information, reinforcing avoidance behaviours
Also the dopamine reward system, responsible for motivation and reinforcement, can contribute to denial by biasing information processing. The brain tends to prioritise information that aligns with pre-existing beliefs while minimising contradictory evidence, reinforcing a distorted perception of reality.
Denial as a Defence Mechanism: A Psychoanalytic Perspective
From a psychoanalytic view, denial is considered one of the earliest and most basic defence mechanisms. Sigmund Freud said it operates at an unconscious level, protecting the ego from overwhelming anxiety by rejecting the external reality. His daughter Anna Freud expanded on this idea, saying denial is a way to avoid uncomfortable truths.
Denial works by distorting an individual’s perception of reality so they can act as if a traumatic event, distressing thought or uncomfortable feeling doesn’t exist. While denial may give you temporary relief from distress, it can stunt your psychological growth and prevent you from facing underlying issues. This is especially true for trauma where denial can prevent processing of traumatic memories and contribute to post-traumatic stress disorder (PTSD).
The Spectrum of Denial: From Healthy Coping to Unhealthy Behaviour

Denial exists on a spectrum, from healthy coping to unhealthy behaviour. In some cases denial can be a temporary buffer so you can gradually absorb shocking information. For example, in the immediate aftermath of a traumatic event, denying the full extent of the trauma can help you function and cope with immediate demands. But when denial becomes chronic and pervasive it can lead to major psychological and social impairment.
Unhealthy denial can show up in many ways, such as refusing to acknowledge a medical diagnosis, minimising a substance use disorder or denying responsibility for harmful behaviours. Such denial can prevent you from getting the help you need or making necessary changes in your life, perpetuating the cycle and exacerbating the problems.
Denial in Trauma and PTSD: Blocking Access to Painful Memories
In trauma, denial is a way of blocking access to painful memories and feelings. People who have been traumatised may unconsciously suppress or distort their memories to avoid reliving the traumatic event. This can show up as difficulty recalling specific details of the trauma (dissociative amnesia) or a general feeling of detachment from the experience (emotional numbing).
Denial in trauma can really hinder the healing process as it prevents people from processing the trauma and integrating it into their story. Unresolved trauma can lead to all sorts of psychological symptoms including anxiety, depression and PTSD. Trauma focused therapies like CPT and PE aim to help people confront and process their traumatic memories in a safe and supportive environment so they don’t need to deny and can heal.
Addiction and Denial: A Match Made In Heaven
Denial is a hallmark of addiction, often described as a symbiotic relationship where the addiction feeds the denial and the denial feeds the addiction. People with substance-use disorders often minimise the problem, deny the negative consequences and rationalise their behaviour. This denial can extend to family members and loved ones who may also deny coping with the addiction.
The neurobiology of addiction reinforces denial. Chronic substance use can change brain circuitry especially in areas related to reward, motivation,impulse control and self-awareness. This can lead to compulsive drug seeking behaviour despite being aware of the negative consequences. The dopamine system central to reward processing becomes dysregulated and drug related stimuli becomes overvalued and other sources of pleasure become devalued. Additionally, prefrontal-limbic dysfunction impairs decision-making and cognitive control, further reinforcing denial by weakening an individual’s awareness of the severity of their condition. This neurobiological shift can further distort perception and reinforce denial.
Cognitive Biases and Denial: Distortions in Information Processing
Cognitive biases, patterns of deviance from the norm or rationality in judgment, help sustain denial by shaping how information is interpreted and retained. Confirmation bias, for example, causes us to favour information that supports our existing beliefs. This bias can keep denial going by filtering out information that challenges our distorted view of reality, while optimism bias leads to an underestimation of risk associated with maladaptive behaviours.
Other cognitive biases that contribute to denial are optimism bias (overestimating the likelihood of good outcomes and underestimating the likelihood of bad outcomes) and attribution bias (attributing bad outcomes to external factors and good outcomes to internal factors). Knowing these cognitive biases can help clinicians and ourselves recognise and challenge the distorted thinking that keeps us in denial.
Denial: How to Recognise it in Yourself and Others
Recognising denial is the first step to addressing it. Denial can show up in many ways:
- Minimising the problem
- Justifying harmful behaviours
- Blaming others for bad outcomes
- Avoiding uncomfortable conversations
- Getting defensive when confronted with concerns
- Being emotionally disconnected or numb
In others, recognising denial requires observation and empathy. We need to approach people with kindness and non-confrontational tactics that can reinforce their denial. Creating a safe and supportive environment can help people explore their feelings and start to acknowledge the reality of their situation.
Overcoming Denial: Therapeutic Approaches and Strategies for Confrontation
Overcoming denial requires a multifaceted approach that addresses the psychological and neurological factors that underpin it. Therapeutic interventions like motivational interviewing is a structured approach that guides individuals towards recognising denial without confrontation, fostering autonomy and self-reflection. . Cognitive therapies can help you identify and challenge the cognitive biases and distorted thinking patterns that support denial.
Trauma focused therapies like EMDR (Eye Movement Desensitisation and Reprocessing) can help reduce avoidance patterns associated with trauma by reprocessing distressing memories in a way that decreases the emotion associated with them, while potentially reducing the need for denial as a coping mechanism . Creating a safe social environment where you can express yourself and get honest feedback is also key. Ultimately overcoming denial requires self reflection, honesty and being willing to face the uncomfortable truth.
At Highlands Recovery we understand the complexities of denial in the context of behavioural medicine. Our approach combines biomedical, psychological and environmental science to address substance use disorders, trauma and stress related disorders. Our biopsychosocial model ensures each client gets comprehensive and personalised care for long term recovery and well being.
Reviewed by: Dr. Emma Bardsley

Dr Emma Bardsley is a neuroscientist with a PhD from Oxford and a post doctorate from Auckland University, along with an undergraduate degree in Pharmacology from King’s College London. She has lectured extensively on neuroscience, physiology, and pharmacological interventions, bridging foundational research and its clinical applications. With a strong record of publications in high-impact journals and extensive experience in scientific writing, editing, and peer review, she excels at translating complex research into practical insights. Based in New Zealand and collaborating internationally, Emma is dedicated to advancing understanding and treatment in the fields of trauma, addiction, and recovery.
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