06.03 Defense Mechanisms

In this lesson, we’re going to take a look at defense mechanisms and why we need to know about them.

We hear all the time about defense mechanisms. But what are they? To be frank, they’re a way for us to cope with anxiety. There are healthy and unhealthy ways of dealing with confrontation or anxiety, and we’ll look at those today.

But in general, defense mechanisms are used to cope. They’re ways for people to deal with things that make them uncomfortable. There are lots and lots of defense mechanisms, and they vary in severity, meaning, how intense they are for the patient, and how they impact others.

What you need to recognize as the nurse is that when people use these, it’s how they’re dealing with anxiety. First, we’ll look at the different types and then we’ll look at how you can handle them.

Think of defense mechanisms as being on this spectrum. To the left, we have unhealthy defense mechanisms. The further right we go, the more healthy they are. People that cope better with confrontation or anxiety will be more on the right, and people who are can’t deal with anxiety appropriately will be on the left.

Let’s look at some examples of unhealthy defense mechanisms. There’s a lot more, but what you need to know is that the patient will do this in an attempt to disconnect themselves from the anxiety.

Denial is simply the rejection of reality. They don’t believe it’s happening, or they will try to convince themselves that it’s simply not true. An example of this would be an amputee who refuses to look at his surgical site. If he doesn’t look, it doesn’t exist.

Regression is another one. Regression is reverting back to habits of an earlier time in life, very commonly childhood. An example would be bedwetting for a patient faced with extreme stress or anxiety.

Projection is another unhealthy defense mechanism. Projection is misattributing or “projecting” the cause of anxiety on someone else. An example of this is saying someone is angry when in fact, the person saying it is the angry one.

The important takeaway here is that there is no effort to resolution. It’s simply a deflection of the truth, and the patient may not recognize or reject reality.

Moderate defense mechanisms are slightly more healthy, meaning they tend to cause less long term effects and have the ability to be resolved sooner. However, there is still room for progress for patients that use these.

Displacement is redirecting the anxiety toward others. For example, if you had a patient who was given a terminal illness and they got mad at the doctor, and then they yell at their spouse. They’re recognizing that there is a problem, but they’re still not dealing with it head on.

Intellectualization is another. This is basically overthinking the process. Let’s use the patient with the terminal illness. They focus on the testing and the patho and the nuances of the disease instead of really learning to cope with how the disease will affect them. Still better, but not quite where we want them to be.

Undoing is one more in this category. This is an attempt to take back behaviors or thoughts. So let’s look at the patient that yelled at their spouse. They recognize they may have done it, and then offer the spouse praise all day on their appearance or character or what have you. Again, still better than unhealthy, but not where it should be.

Let’s look at healthy defense mechanisms.

What’s interesting about healthy defense mechanisms are that they may not even seem like defense mechanisms. There’s this negativity that’s associated with the term “defense mechanisms.” Remember, all they are is the ways that we deal with anxiety. So, think “healthy” ways here.

Sublimation is a great one. I use this one all the time. It’s basically a way for people to channel feelings into another method. So if I’m anxious or nervous, and I need to let off some steam, I’ll go to the gym. This is a super healthy way to channel anxiety.

Another is anticipation. We all anticipate things. You literally plan for something to happen. Again, there are healthy ways to do this, and unhealthy. But pre-planning for things that you anticipate to happen is a healthy way to cope with anxiety.

And finally there’s suppression. This is another great one to look at. This one CAN be tricky (I’m a pro, because I do this all the time). But this is the idea that the person has the wherewithal to recognize that the time and place may not be appropriate to deal with the anxiety, and they basically “put them aside” to deal with later. This isn’t an issue, as long as the feelings get processed eventually. If not, then it can be a less healthy way to deal with them.

Now that we’ve looked at the different types and where they fall on this spectrum, how do we deal with them as nurses?

Your first objective is to realize that people do these things as a response to a negative interaction, stimulus or anxiety. It’s how they’re coping with the situation. Some responses are healthy and some are unhealthy, and some fit in between. Use your physical assessment, plus verbal and nonverbal cues to clue you in that the patient is anxious about something.

Communicate with your patient. Focus on the cause of anxiety and ask questions. Because people already “in defense mode,” it’s important to be therapeutic but the big thing here is to not to blame. And when I say blame, I mean to say, “Well you’re anxious because…” They may not recognize it as anxiety, so use this opportunity to allow them to discover what’s really going on. And if you need to, use your resources, like mental health providers. There’s another lesson on defense mechanisms in the mental health courses, so go check that out.

The other thing I want to point out is that it’s not your job to “fix” the patient and to employ new tools and tactics. Focus on relieving anxiety with tools from your own toolbox (i.e. guided imagery, finding resources, etc) and then get the patient help from the appropriate providers if you need to. I actually struggled with this in school, and in practice. I would find patients that would be dealing with some sort of anxiety or need of some tools, and I just didn't have it. I finally recognized that I just need to go get the right people Also, be sure to educate your patients. Sometimes their lack of education or misinformation is enough to ease their anxiety.

Today, we really focused a lot on communication and learning how to navigate our interpersonal relationships. Remember to focus on professionalism while helping your patient as well.


Ok, let’s recap for today.

Remember that when you recognize a defense mechanism, you’re really dealing with anxiety in the patient.

You have your spectrum of maturity for defense mechanisms. unhealthy focuses on unhealthy ways to cope.

More healthy is obviously more healthy, but with room to grow.

And healthy defense mechanisms are positive, healthy ways of coping with anxiety.

And really focus on using that therapeutic communication to foster your relationship and don’t focus on the anxiety; focus on digging deeper and being there for them.

That was a lot today for our lesson on defense mechanisms. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!