The Impact of Defensive Denial upon Adjustment Following Traumatic Brain Injury

Individuals with a highly defensive personality style tend to present themselves in an overly favorable light and deny personal inadequacies. Following traumatic brain injury (TBI), denial may be an adaptive strategy to protect individuals from the overwhelming reality of their situation. However, persisting denial can interfere with the adjustment process and hinder the development of more adaptive coping strategies. A case study is presented of JK, a 45-year-old woman with a highly defensive personality style, who sustained a TBI. JK developed social anxiety and depression and was referred for psychological support following a progressive deterioration in her overall functioning. The treatment program was based on an individual-psychotherapy approach, with generalization of skills in a group-therapy setting. A comparison of pre- and posttreatment functioning indicated a significant reduction in her level of social anxiety, depression, defensiveness, and functional impairment. Independent neuropsychological assessments, conducted for medico-legal purposes, prior to and following the intervention, indicated a significant improvement in JK’s cognitive performance between periods of testing. The implications of this study are discussed in terms of the impact of defensive denial upon postinjury adjustment and therapeutic approaches.