The question about how to treat "Shy Bladder" was recently raised on a mailing list which I subscribe to and a number of the responses suggested that CBT is a good treatment approach.
Difficulty urinating in the presence of others actually is a common problem but people usually cope with it rather than seeking treatment. The problem usually can be understood as a Social Phobia (the sufferer usually is concerned about what others will think and experiences enough anxiety to inhibit urination). CBT which addresses the individual's fears and also includes some form of in-vivo exposure usually works well.
One reference which was recommended is: McCracken, L M.& Larkin, K T. (1991). Treatment of paruresis with in vivo desensitization: A case report. Journal-of-Behavior-Therapy-and-Experimental-Psychiatry, 57-62. Abstract;Describes the use of in vivo desensitization with a 37-yr-old man exhibiting chronic paruresis (the inability to urinate in the presence of others). Relaxation skills training was also employed. Measures of urination delay and subjective units of distress were obtained at pretraining, during training, at a generalization trial, and at a follow-up assessment. There was shorter delay in urination, greater urine output, and less subjective anxiety following treatment. These effects were also demonstrated during a generalization posttest in which the patient was exposed to an unknown observer. A follow-up trial involving exposure to a 2nd unknown observer indicated that treatment effects were maintained at 7.5 mo following treatment.
Treatment such as this which is based on a desensitization paradigm can work well, but it can be important to think carefully about what to desensitize them to. Most of the clients who I have worked with have actually feared that they will be unable to urinate. Ironically, their anticipatory anxiety and their fear that they will be unable to pee gets them so anxious that that they can't pee. If they can reach the point where they no longer fear being unable to pee, then they will have less difficulty peeing.
Therefore, after identifying their fears and addressing them cognitively, it often is important to decrease their fear of standing at the urinal and being unable to pee by having them intentionally stand at the urinal (unzipped), not pee, and tolerate the anxiety. After sufficient in-vivo exposure (so to speak) they discover that failing to pee doesn't produce the dramatic consequences they fear, their anxiety fades, and the problem usually is successfully alleviated.
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