Automatic Negative Thoughts (ANTS) and Their Effect on Paruresis

It’s a sad fact that while paruresis isn’t life-threatening, it is a serious condition to those who struggle with this crippling form of anxiety. Shy bladder syndrome, as paruresis is often called, is characterized by dominating assumptions about what people may think while the sufferer uses the bathroom.  These Automatic Negative Thoughts (ANTS) cause him or her to avoid using the toilet in situations where other people may be present.

How ANTS Modify Behavior

ANTS are essentially the nagging, nasty little thoughts that plague us in certain situations.  They are the self-deprecating “always” and “nevers” that pop into our minds, often so quickly that we hardly notice.  They are mean-spirited absolutes, the kinds of thoughts that say, “I don’t have a spouse yet, therefore I’ll always be alone.”

In the case of someone suffering with a bashful bladder, they may say, “If I use that urinal, someone will judge me.” Unfortunately, the way ANTS work is that by establishing a negative thought pattern, they program the mind into working to fulfill the expected outcome.  They program people into interpreting (or misinterpreting) the reactions of those around them to support the negative idea.  Rather than seeing a friendly smile on the face of the person that walked into the restroom, a person infested with bathroom anxiety ANTS sees a fake, judging smile and wonders what kind of ugly things the person is thinking.

This kind of mental and emotional programming is clearly unhelpful, but thankfully there are a number of tools that we can use to clear these pesky thoughts from our minds and end their dominance over day-to-day life.

Cognitive Behavioral Therapy for Paruresis Relief

Mindful living can go a very long way toward reducing the impact of negative thoughts.  CBT, or Cognitive Behavioral Therapy, is founded upon the idea that the thoughts which pass through our minds – even fleetingly – will create beliefs about and pre-set reactions to ourselves and the people around us. This programming will then affect any feelings or behaviors which spring from the original source.

This means that even brief, unconscious thoughts can have a very real impact upon our day-to-day lives.  Whether that is a good thing depends largely on what you allow yourself to think.  If your thoughts are skewed toward negative feelings or emotions like judgment, hostility, or fear, your thoughts are then programmed to “tune into” these feelings more easily.  It becomes harder to notice and appreciate the good things in your life.

Cognitive therapists can help clients with paruresis and other fear-based conditions by helping them identify what kind of ANTS are plaguing their minds, and giving them the tools to transform them into helpful, positive thoughts. They help clients re-establish realistic beliefs about the world through a process of questioning their viewpoints.  In the end, many clients are able to walk away from CBT with a worldview that is more completely synchronized and in consensus with reality.

Four Questions That Can Put ANTS in Perspective

Elisha Goldstein, PH.D., licensed psychologist and co-author of A Mindfulness-Based Stress Reduction Workbook (New Harbinger, February 2010), provides some wonderful tips for drastically reducing the impact that Automatic Negative Thoughts can have over a person’s behavior.  Freedom from ANTS begins with taking stock of just how little truth these negative thoughts contain.

Unless there’s an entirely unrelated set of issues going on, sufferers of paruresis encounter their biggest problems with negative thoughts when encountering an uncomfortably public bathroom situation.  Despite the very obvious fact that everyone on the face of the planet must use the bathroom many times a day, the thought of being judged by others while doing it creates such intense anxiety that the bladder absolutely will not cooperate.  This is embarrassing at best, and could potentially cause physical damage if the bladder is too often allowed to become full almost to bursting.

Dr. Goldstein’s method of dealing with these anxiety-producing thoughts involve a simple, four-step STOP method:  “Stop, Take a breath, Observe that these thoughts are going on, and Proceed with these four questions.”

These are Dr. Goldstein’s “questions to help challenge compelling thoughts:”

1. Is it true?

2. Can you absolutely know that it’s true?

3. How do you react when you believe that thought?

4. Who would you be without that thought?

Once you’ve determined the truthful answers to these questions, you will be well on your way to gaining mastery over thoughts that you may not have even realized were hurting you.  In other words, you don’t have to be the person you are just because your thoughts tell you it’s so.

Everyone is bothered by ANTS at some point, but they don’t have to become problematic.  The key is to re-frame negative thinking into positive thinking, and to establish a firm grasp on the likely reality of the situation.  Simply getting into the habit of questioning one’s thoughts can have a dramatic impact on one’s mental and emotional health.

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