A brief article in the Spring, 1998 edition of the ADAA Reporter (the newsletter of the Anxiety Disorders Association of America) includes an article about treating shy bladder syndrome (paruresis) by Steven Soifer, MSW, Ph.D. The article cites statistics from the National Comorbidity Study which suggest that 7% of the population have difficulty urinating in public restrooms.
The article advocates a graduated exposure treatment approach where the client is instructed to come to therapy sessions with a full bladder and Lasix (a diuretic) is administered to increase urinary urgency (15-20 urinations in a 50-minute sessions). In a series of gradual steps the client goes from urinating in a private restroom with the door locked to urinating with the therapist in the restroom. At this point, treatment moves to restrooms outside of the therapist's office starting with relatively isolated public restrooms and gradually moving to busy, crowded restrooms. The article strongly asserts that the exposure should be very gradual, that one should never move beyond the client's level of tolerance, and that flooding should be avoided at all costs.
A success rate of 75-80 percent is reported after 8-12 sessions of reatment with nearly 50% being classified as showing marked improvement.
The article reports that there is an active Web site for persons with paruresis (they suggest using any search engine and searching for paruresis or shy bladder) and that an International Paruresis Association has formed recently (1-800-247-3864).
Comment: I believe that this type of graduated exposure will work and the success rates reported seem plausible. However, if treatment consists solely of very gradual exposure where the client does not face their fear of being unable to urinate in a public setting and does not develop skills for coping with significant levels of anxiety, there is a significant risk of relapse if the client ever needs to use a public restroom at a time when they are experiencing anxiety. I'll stand by my recommendations in the previous post in this thread. In-vivo exposure which includes both peeing in public restrooms and the client facing their fear of not peeing public restrooms should prove superior to in-vivo exposure which avoids the experience which the client fears.
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