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Scott Webb (Host): Everyone uses defense mechanisms. And many times, we don't realize that we use them. When we use them unconsciously, it's to protect ourselves from negative thoughts or feelings. In essence, they save us from having to feel anxiety, stress, or pain. They help us to feel better about ourselves in the moment. And so you might ask isn't it a good thing to have defense mechanisms? The answer depends on the situation, of course. Not all defense mechanisms are healthy. And to answer this question and more, we have Tom Cleereman, Director of Outpatient Services at Sierra Tucson. He's a Licensed Clinical Social Worker with over 30 years of experience, and he's going to help shed some light on healthy versus unhealthy defense mechanisms and how you can start to break free from unhealthy defense mechanisms and find new ways to cope and respond to anxiety, stress, or pain.   This is Let's Talk Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one best addiction treatment centers, 2020 in Arizona by Newsweek. I'm Scott Webb. Tom, thanks so much for your time today. We're talking about defense mechanisms. So, let's start here. What are defense mechanisms and which are the most common?

Tom Cleereman, LCSW (Guest): According to Wikipedia, a defense mechanism is an unconscious psychological operation that functions to protect a person from anxiety producing thoughts and feelings. They're typically related to internal conflicts or other stressors that we have. There's actually four categories of defense mechanisms. The first category that I'm going to talk about is called pathological. Some defense mechanisms are pathological or extreme in nature. They tend to be overt and very evident to others. Examples of pathological defense mechanisms would include one that we know of as delusional projection. Delusional projection is one's irrational beliefs projected onto another. It's also defined as the mental process by which people attribute to others which is in their own mind. For example, someone using this defense mechanism might have a strong dislike for someone, but project an irrational belief onto that person thinking that person really doesn't like them.

So in effect, what a person irrationally despises about someone else may actually have more to do with the irrational beliefs of the person doing the despising in this case. Another example of a pathological defense mechanism is pretty common and used by most people, if not everyone, and it's called denial. Denial tends to be used unconsciously, and it typically involves a person refusing to accept reality because it's too painful to accept.

So, a good example for this is someone with alcohol addiction, may deny that they have a problem, despite clear evidence that their substance abuse is affecting their life. Oftentimes with denial comes minimizations, some examples to explain those, are I only drink on the weekends. I only drink beer. It's not like I drink hard liquor. I go to work every day. And my drinking doesn't affect that. So, it implies that their alcohol abuse doesn't impact them to the extent that it does. Another level of defense mechanisms is referred to as immature. And this level is actually characterized by acting out behaviors or it's seen as socially undesirable.

So, let's start with the acting out part. An extreme behavior of acting out is to express thoughts and feelings the individual feels incapable of expressing in a positive way. An example is someone who cuts themselves to relieve stress or to get their mind off of the traumatic thoughts. Another defense mechanism under this category is called somatization. This is a defense mechanism that is oftentimes in place to protect us from the overwhelming feelings of distress. Somatization is a condition that results in an unexplained physical symptoms and the symptoms lack any medical explanation. Some people's psychological distress may be so overwhelming that the distress may then find an outlet through the body converting to a physical symptom. An example of this could be someone who feels symptoms of discomfort and pain after having endured an emotionally traumatic event, despite never having an injury or a medical explanation for the perceived pain. The next level of defense mechanism is referred to as neurotic. People who have defense mechanisms in this category level, are dealing with stress by avoiding anxiety and guilt.

The defense mechanisms help to cope in the short term. However, they cause long-term problems in relationships, work and personal life. A good example of this is something called repression. It's a type of neurotic defense mechanism and it was actually coined or named after Sigmund Freud who proposed that repression is an unconscious blocking of an unpleasant emotion, impulses, memories, and thoughts from your conscious mind. Basically repressing certain traumatic life events may occur as a way to protect against strong emotions and distress about the trauma.

A good example of repression is a ten-year-old child who faced abuse by a parent. And later in life, he has little or no memory of the abuse occurring. Another good example of a neurotic defense mechanism is something we call reaction formation. Reaction formation it goes like this. The true belief causes so much stress that a person adopts the opposite belief, perhaps in an excessive way.

We may have all used this defense mechanism at one time or another. So, an example would be treating someone you strongly dislike in an excessively friendly manner in order to hide or mask your true feelings. Another example would be a young man who insists that he has the perfect relationship with his father. When in fact there are underlying challenges in their relationship that causes distress.

The fourth level of defense mechanisms is what we call them mature defenses. And they're commonly found among healthy adults. And they're quite common. Humor is a good example. When discussing a negative experience, it may likely be that we could use humor. It is seen as a tension release response for discussions that are too terrible to talk about. An example is the person who becomes overly emotional and tearful when he gives a eulogy for a friend who recently passed away, and then he turns quickly to the crowd and shares a humorous topic about the deceased friend and laughs. It doesn't mean that he's being inappropriate. It just means that his pain at the time might've been too much to handle. And the humor sort of created this defense for him to be able to tolerate it.

Another good example of a mature defense mechanism is withdrawal. It's quite kind and to withdraw from unpleasant or distressful situations. Our bodies are programmed to do this automatically and unconsciously, for example, touching the burner on a hot stove, produces an urgent automatic response to pull the hand away. We don't think about it. It just happens. So, an example of this defense mechanism would be that maybe during a distressful discussion, a spouse may suddenly withdraw or leave the situation. This could happen without even being directly involved. For example, a person who feels distressed watching another couple argue because it brings back memories of an abusive situation they've experienced in the past.

So, in this example, the mind takes over to lessen the pain or fear, and it causes the person to retract or withdraw. Defense mechanisms have a way to be both helpful and harmful depending on the situation.

Host: Yeah, it does sound like they can be both helpful and harmful. So, let's have you go through that. How can defense mechanisms be both helpful and harmful?

Tom: Well, a good example of this is repression. It's a defense mechanism that is seen as both healthy and unhealthy. Remember just a little earlier, I explain that an adult may repress memories of the abuse they endured as a child which some may find as useful in the moment, but that same adult has also maybe had trouble forming relationships and attachments, and they don't quite understand that it's related to their unresolved childhood trauma.

So addressing the underlying trauma may be a necessary component to forming relationship and attachments. Another good example of how defense mechanisms can be both helpful and harmful, it's the one that I talked about earlier, it's called denial. It might help you feel good in the moment. And sometimes it's good for blinding us to the real dangers, but those dangers are still lurking in the background. It maybe easier for a person to ignore the negative effects of excessive drinking than it is to consider that those effects are causing problems. And then to cut back on alcohol. If someone with an alcohol or drug addiction was able to see the true nature of their situations, they might be more likely to seek help.

So, denial is most harmful when it prevents you or a loved one from getting the help you need. Another good example is one that's called reaction formation. And I did talk a little bit about this earlier. It's a temporary coping mechanism, but it's unproductive in the long run. Remember we just spoke about a young man who insists he is having the perfect relationship with his father. This was the mind's way to cope with internal distress when he is around his father. Reaction formation ignores underlying beliefs or challenges that need to be confronted and addressed. And in this case, it can have a harmful effect on the person's state of mind over time. The defense mechanisms that are most harmful tend to be the ones that are closely associated with mental health, because those defense mechanisms may exacerbate the mental health condition while also stopping the person from seeking treatment.

Host: Yeah. And Tom, are there certain defense mechanisms that are more commonly associated with certain mental health disorders?

Tom: Yeah, I think, immature defense mechanisms are often seen in major depression and personality disorders. The acting out one that I talked earlier, you tend to see that more in a borderline personality disorder, maybe an anti-social personality disorder, or certainly an oppositional defiant disorder. Avoidance is a classic one and it's a defense mechanism in which people unconsciously avoid something that can cause distress. But we often see it in people diagnosed with post traumatic stress disorder.

And another good example is one that we see a lot with people who have substance use disorders. It's called rationalization. Rationalization is a very common defense mechanism where a person tries to explain an undesired feeling or behavior in a rational or logical way while ignoring the true feelings behind the behavior. An example of this would be my drinking isn't to blame that I ran that red light. Anyone would have chosen not to stop given how hard it was snowing at the time. It's a sort of a way to blame the situation on something else, because it's too difficult to look at the true reason, which is I might have a drinking problem or it was wrong of me to drink and drive. So, it's through treatment, that a professional can help someone recognize the defense mechanisms they use and create a specialized treatment plan that addresses defense mechanisms that are associated with their mental health concerns.

Host: Yeah, let's talk about that. When would someone require treatment for their defense mechanisms?

Tom: Well, I'm glad you asked that. The first thing I just really want to make clear is defense mechanisms can be normal and natural. They are often used without any long-term complications or issues. The fact that we use defense mechanisms, shouldn't be an automatic urgent response for us to think that there's an issue that we need treatment for.

For some people, however, defense mechanisms are related to underlying mental health conditions, such as trauma, anxiety, PTSD, and depression, and the failure to act on addressing them can lead to worsening symptoms. Sometimes we can address defense mechanisms through self-reflection or self-examination.

Pretty much that's the process that we would use to analyze our own internal thoughts and feelings. It really involves a closer look at our own cognitive, emotional and behavioral processes. In psychology, this is actually known as reflective awareness. It can be described as an internal discussion or communication or reflecting on oneself.

It's been shown to be very effective in recognizing the use of defense mechanisms. And then that allows us to take a step forward and look at alternate more healthy ways to address our fears, or our concerns. A recognition that we use defense mechanisms may be difficult for us though. We don't have a lot of insight. As I mentioned earlier, they're actually unconscious things that we do. So, the recognition may actually follow a reaction from someone else rather than being an internal discovery that we have. That's why it's so important to look for accountability, to know whether or not you need to seek help.

Friends and family members are good sources of information when it comes to finding out if we have a tendency to use defense mechanisms. Sometimes they let us know when we don't want to know. And sometimes that's all we have to do is ask. They can oftentimes see in from the outside and they can point out things that might be unconscious to us.

If you have defense mechanisms and you think they might be resulting from an untreated trauma or a mental health condition, then it's definitely time to seek professional help. Earlier I spoke about reaction formation, and I gave the example, the young man who believes he has a perfect relationship with his father. In a treatment setting, a therapist might help the young man to explore underlying challenges that cause that distress and that leads to the reaction formation. They can then work on developing coping skills to help resolve the distress in a healthy way.

Host: Yeah at times. So, it's good to know that there is treatment available and it does seem with defense mechanisms that we often do these things unconsciously and we do need to hear from friends, family, loved ones that we're doing these types of things, that we're using these defense mechanisms. So, when we talk about treatment specifically, what type of treatment is available?

Tom: Well, it's a very good question. And I think the key is that it needs to vary for every person. We never want to just say that one particular treatment is the best for everyone. Although there's some promising treatments out there that probably do work for a lot of people. So, some examples would be cognitive behavioral therapy. We refer to it as CBT. Or there is DBT, dialectical behavioral therapy. We have some other options like EMDR, Eye movement desensitization reprocessing. I think in order to really answer that question, it really depends on the person and it depends on the professional that's treating them and what their focuses and strengths are. So, what I would suggest in a situation like that is for the person to seek mental health attention first. And then see what kind of things are offered for treatment. It might just simply be that it's talk therapy to talk through some of the defense mechanisms that are being used and coming up with a way to develop coping skills so that you don't have to use them anymore.

Host: Yeah. One of the things I love Tom about hosting these podcasts for Sierra Tucson is that it causes me to sort of reflect on my own life. And so I've been spending some time as I've been listening to you, thinking about well, wait, do I do that? Maybe, maybe I do that one. And it's such a fascinating topic as you pointed out here today these are things that we do. We don't even realize that we're doing them. And it's good that we have people who can say, hey, by the way, you're using these defense mechanisms and great to know that there's treatment out there that's tailored to the individual, especially at Sierra Tucson, mind, body, spirit. So, Tom, as we wrap up here, anything else you want folks to know about defense mechanisms, why we use them, when we use them, how Sierra Tucson can help and so on.

Tom: I think the basic thing that I really want to give and the takeaway from the whole discussion is that defense mechanisms can sometimes be directly related to mental health needs. Chances are, if you've got an untreated trauma or you got untreated anxiety or depression, or your regularly using substances or abusing them, then you're likely going to have defense mechanisms that relate to these areas of concern.

The defense mechanisms actually can exacerbate and compound our mental health conditions. So, seeking treatment for mental health is the most important step in the addressing defense mechanisms. By attending therapy, I think most people can learn about the relationship between the mind and the body, as well as the spirit and further understand how emotions may be playing a part in their mental health. Only then can they begin to heal from a mindful place and not from an unconscious one.

Host: That's really well said. And as I've learned again from hosting these. You know, the biggest part, the biggest step, really for people is to take action, to be proactive. You know, to reach out, to want to help themselves, to seek the treatment that they need. So, Tom, thanks so much for your time today. You stay well.

Tom: You too. Thank you for having me on. I appreciate it.

Host: For more information, visit Sierratucson.com or call 800- 842-4487. Sierra Tucson, we work with most insurance and if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Let's Talk Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.