Progressive Exposure
Using Progressive Exposure to Overcome Shy Bladder
The use of progressive exposure to overcome shy bladder is a delicate process. Remember, you do not cure anxiety by building up anxiety. The process of overcoming shy bladder is gradual or progressive. Moving too fast can build anxiety. On the other hand, moving too slow can accentuate it.
If you are the sufferer, an appreciation of the following general steps would be useful. But the guidance of an expert in the field is required in actual implementation. You would need an expert to (a) guide you and (b) look at your blind spots.
General Step #1. Be aware of your anxiety levels in front of the urinal
Psychological awareness is key. Rate your anxiety levels in front of the urinal as low, medium or high. Some experts go the extent of rating anxiety levels between 1-10. Whichever works for you is fine.
Knowing your anxiety levels is absolutely important. Why? At any stage of the progressive exposure process, you need to pull out of a particular procedure when your anxiety level is high or close to high. After pulling out, relax and attempt the same procedure again later.
On the other hand, do not pull out when the anxiety level is low. This prolongs the process and may even accentuate the anxiety. Remember; pull out only when anxiety level is high or close to high. Avoid high anxiety. But get past low anxiety and the lower band of medium anxiety.
No one else can decide when to pull out but you. So, know your own anxiety levels.
General Step #2. Be aware of your urgency levels.
Physiological awareness is also key. Urgency refers to the physical urge to go and relieve yourself. Again, rank this as low, medium or high. You may also choose the 1-10 scale, which may be more appropriate for this matter.
Most sufferers know only Levels 1 and 10 (bursting feeling). But they are clueless about how it feels anywhere in between. So, this may require again some experimentation. In the privacy of your own home, drink at least a liter of water. Then feel the urge to relieve yourself after around an hour. Familiarize yourself with the feeling as the urgency surges up.
Be familiar, most importantly, with Levels 7 to 8. This is where you feel a strong urge to relieve yourself. But it is something that does not yet feel too uncomfortable. It is something however that you know would get to the uncomfortable level (or Level 10) in around ten minutes. Do the experiment a few times until you feel confident that you know Levels 7 to 8.
A faster way of doing this is to pee for only around 3 seconds. Then, just hold it. It may be difficult, but just do it. Here you would have drained enough urine to bring down the urgency to around Level 5. Then, drink more water. Urgency should surge up to Levels 7-8 in a few minutes. By then, relieve yourself again for around 3 seconds. Repeat the process for around 45 minutes until you are absolutely familiar with Levels 7 to 8.
General Step #3. Design your hierarchy of challenges
This is something that you must extract from your experiences in front of the urinal. You would need to design this along with an expert. But the following guide questions may help:
– Guide Question A: In which circumstance did you find relieving yourself the easiest? Describe the location, your body position, the people around you and the surrounding activities at that time.
(i) For the location, where exactly where you? Was there a door behind you? Was it locked or open? Was it your home, a private location outside of home, or a public place?
(ii) What was your body position? Were you standing or sitting? If standing, were you standing on the floor or on top of something? What was it you were standing on? If sitting, what material were you sitting on? What was its texture?
(iii) If a person was around you, who was that person? Was he a friend, family or stranger? How physically proximate was that person to you while you relieved yourself? If the person was at a distance, were you within that person’s line of sight?
(iv) What went on around while you relieved yourself? Was the place quiet or noisy? What was the sound you were hearing in that location, if any? Was there time pressure?
– Guide Question B: In which circumstance did you find relieving yourself absolutely difficult, if not impossible? Again, describe the location, your body position, the people around you and the surrounding activities. Answer the same questions above to extract the details from your memory.
– Guide Question C: What were the circumstances in between at increasing levels of difficulty? Describe at least eight more circumstances in increasing levels of anxiety. The increase in anxiety should be in small increments.
The resulting list of circumstances would now constitute your hierarchy of challenges. The hierarchy varies from person to person. What may be difficult for someone is peanuts to you, or vice-versa. This is why it is important to develop your own.
Nonetheless, do not shortcut the process. Too easy a hierarchy, and you short-change yourself. Too difficult and your anxiety surges up on Day 1. High Anxiety is precisely what the progressive exposure wants to avoid at every stage, including the first stage.
One more thing, the hierarchy of challenges is not cast in stone. You would find along the way that in order to jump from one level to the next, you would need to reduce one factor in order to compensate for the leap in anxiety caused by another factor. For example, in leaping from a private location to a public location, you may find that it would help to tell companions to allow you to take all the time you need and not pressure you.
General Step #4. Start from easy, then move on to the next level of difficulty
Treat this like a video game, just for fun. Be an absolute expert on the easy stage, then move on to the next level of difficulty. Master that level, then again move on to the next.
Have the patience to let go when anxiety goes high. Have the patience to wait until urgency reaches Levels 7-8. Then have the perseverance to go through the routine, day in and day out, until it gets done. In short, do not quit!
As you move on from one level to the next, have a winning mindset coupled with presence of mind. Always be mindful of your anxiety and urgency levels. If the importance of this alertness is not clear to you, go back and read General Step #1 and #2 above.
As mentioned in the beginning, be more of the turtle and less of the hare in the process. An expert or good self-help program can also guide you through the process. Have a confident and winning mindset, but relax. Aim to finish the game, but relax through at each stage.
If you or someone you love is struggling with paruresis or a shy bladder click below to read about what you can to help!