CBT
Using Cognitive Behavioral Therapy as a Treatment for Paruresis
Many people with paruresis have overcome the disorder with the help of Cognitive Behavioral Therapy or CBT. It is a treatment that many experts in paruresis recommend. Those who are suffering from paruresis may find CBT as their ticket to a much improved quality of life.
Paruresis is the inability to urinate outside of one’s privacy. This is usually outside one’s own home. When such privacy is limited, curtailed or non-existent, the bladder simply won’t empty itself despite conscious efforts to urinate. Approximately between 3% to 6% of the population may have paruresis.
Some experts classify paruresis as a Social Anxiety Disorder. It simply implies that the cause is largely psychological, rather than physiological. The specific psychological causes are unique to each individual. They trigger involuntary physiological responses around the bladder that prevent urine from draining despite conscious efforts to urinate.
CBT addresses the two psychological levels of paruresis. Primary paruresis refers to the actual inability to urinate in a crowded or social situations. Secondary paruresis refers to the person’s poor self-image, self-esteem and state of mind as a result of the primary paruresis.
There are other treatments available. These include purely physiological interventions, such as breath-holding techniques. They also include deeply psychological ones, such as hypnosis. The treatment for one person may not work in the other because of the different set of circumstances underlying the condition.
Advocates of CBT argue that it is critical to treat both primary and secondary paruresis together. There is an interplay between the two levels that is crucial. The treatment of primary paruresis reinforces the treatment on the secondary paruresis, and vice-versa. Ignoring this interplay may limit the effectiveness of the treatments.
CBT has two components. The behavior therapy component addresses primary paruresis. The cognitive therapy component addresses secondary paruresis. Both components however need to be viewed like two pedals of the same bicycle. One component reinforces the other. But they are components of the same treatment.
Treatment of the primary paruresis basically consists of overcoming levels of difficulties one at a time. It’s like being at the center of several concentric circles. The center is one’s easiest zone. It’s the starting point. The concentric circle next to it is the next level of difficulty.
The levels of difficulty varies from person to person. The comfort zone can perhaps be the toilet at home with no visitor being entertained at the living room. The next level of difficulty may be the same toilet, but with somebody waiting at the living room. One person may find these starting points as difficult. Another may find them too easy.
Designing the levels of difficulty should be done with an expert in the field. It is important that the increments are small enough so as not to trigger greater anxiety. But it is as important that they are sized properly to deserve a celebration when successfully overcome.
The goal at any given time is to empty the bladder at the next outer level of comfort. This is to be done deliberately. For this reason, the person being treated would have to drink lots of water to trigger urination. Again, the amount of water varies from person to person. But one has to urinate when the urgency is just right, not too high and not too low.
The person himself has to be conscious of his or her anxiety levels. When trying to urinate and nothing happens after two minutes, the person has to get out of the toilet immediately. Staying too long and forcing the issue at that particular moment may just trigger additional anxiety. One should just instead relax at this point and redo the step a bit later.
Treating secondary paruresis is basically guiding one’s thoughts and judgments about primary paruresis. Thoughts can trigger all sorts of emotions that manifest later on physiologically. Tears for instance are a physiological manifestation of either joy or grief. An upsurge in adrenalin is a physiological manifestation of anger or fright.
The objective of CBT in treating secondary paruresis is to minimize or eliminate “echos” of the anxiety that has triggered primary paruresis in the first place. Among the first interventions in this component is to guide the person into properly accepting the presence of primary paruresis. Resisting, instead of accepting, causes “echo” anxiety that can limit a person even more.
Acceptance of paruresis can even directly lead to cure! A person who discovered his paruresis at age 15 endured it until age 33. He chanced upon articles in the internet about paruresis. Only then did he realize that paruresis was so widespread and well documented. His paruresis disappeared since that point and he often wondered how that happened…
The simply answer to that is, his anxiety had disappeared! Many people needlessly suffer alone. They think they are afflicted with some kind of a rare disease reserved only for the unfortunate. They think the world is too busy to even notice what they are going through. By knowing more about paruresis, they dismiss these anxiety-causing assumptions as untrue.
Recognizing paruresis as a natural response of the body is another empowering thought. Indeed, it is a natural involuntary response of the body to a perceived threat. With this realization, people with paruresis can begin to reinterpret reality around them. They can then properly re-label day-to-day situations as trivial, joyful, and exciting.
Breaking the silence is an empowering act. Telling loved ones about his or her paruresis already releases a person from the burden of carrying it alone. That’s one less anxiety gone. Moreover, breaking the silence allows people to understand one’s peculiar need and make room for it. That’s another anxiety gone.
But the most lasting benefit of breaking the silence is the realization that talking about one’s paruresis isn’t threatening at all. In fact, some people have gone a full 180 degrees. From the state of avoidance, they are now telling everyone — including strangers — about their paruresis, just like talking to them about the weather. That’s a manifestation of secondary paruresis totally gone!
Cognitive Behavioral Therapy does not typically seek to revisit the past or identify and analyze the causes of primary paruresis. CBT dismisses such tasks as unnecessary to implement a solution. Instead, CBT seeks to influence the person’s thoughts and behaviors to help him or her gradually overcome anxiety. It also helps the person to reinterpret reality from threatening to wholesome. Such treatment goes beyond helping people relieve themselves when they wish to. It helps people build a better life.
If you or someone you love is struggling with paruresis or a shy bladder click below to read about what you can to help!