Treatment of paruresis with in vivo desensitization: a case report

Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach

Paruresis is a social anxiety disorder characterized by a fear of being unable to urinate in the presence of others. This condition has not been covered in the social work literature, yet is a perfect example of a person-in-environment problem. This article explores the use of graduated exposure therapy during weekend-long workshops for the treatment of paruresis. One hundred one participants participated in workshops and were administered pretreatment, posttreatment, and 1-year follow-up treatment scales. Repeated measures analysis of variance indicated significant improvement in shy bladder symptoms. Significant improvement in global severity of shy bladder was observed posttreatment and at the 1-year follow-up point. Findings suggest that graduated exposure therapy improves self-reported global severity of shy bladder symptoms and that these gains were maintained at 1-year follow up.

Cognitive Treatment Through Positive Self-Verbalization: A Multiple Case Study

This article deals with the modification of self-statements as a specific strategy in cognitive therapy. A method is described in which patients modify their self-talk by reading aloud positive self-statements that are incompatible with original self-deprecatory thoughts. Next, several cases are presented that illustrate how this intervention can effectively be integrated in the treatment of various disorders. In the discussion, the indications for using this intervention are considered and compared to other cognitive strategies.

Paruresis (psychogenic inhibition of micturition): cognitive behavioral formulation and treatment

Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present. Despite knowledge that paruresis can significantly impact on occupational functioning, social functioning, and quality of life, there exists a paucity of research into effective treatments. Although cognitive conceptualizations have been advanced for other anxiety disorders, there has not been a comprehensive cognitive behavioral model of paruresis. This article presents a revised cognitive and behavioral conceptualization of paruresis, drawing on empirical evidence from other anxiety disorders. Using this conceptualization, a cognitive-behavioral intervention strategy is outlined, with clear targets for cognitive and behavioral strategies.

Is "shy bladder syndrome" (paruresis) correctly classified as social phobia?

Paruresis manifests in an inability to urinate in public restrooms followed by a considerable avoidance behavior. According to DSM-IV TR this disorder is classified as social phobia. A sample of N = 226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups. Regression analysis separated by groups shows that the interference with everyday life can be mainly explained by paruretic symptoms (in the paruretic group) or by social anxiety and depressive symptoms, respectively (in the social phobic groups). These results question the classification of paruresis as simply being a form of social phobia.

Psychogenic urinary retention ('paruresis'): diagnosis and epidemiology in a representative male sample

BACKGROUND

Although research interest in social phobias has expanded during the last decade, a special subtype of social phobia known as paruresis, which manifests in the inability to urinate in public rest rooms, is rarely mentioned. The aim of the present study was to achieve for the first time an estimation of point prevalence in a representative male sample (n = 1,105).

METHOD

Due to the lack of well-established screening instruments for paruresis, the Paruresis Checklist (PCL) must be tested for reliability and validity. An empirically based cutoff score must be determined by using the subjective interference with everyday life as an external criterion.

RESULTS

Reliability of the PCL seemed to be sufficient, and adequate evidence for validity was found. Using the empirically based cutoff score of the PCL, 2.8% of the sample was diagnosed as suffering from paruresis. In contrast to other forms of social phobia, paruresis is not associated with a lower educational or occupational level.

Monotherapy treatment of paruresis with gabapentin

Paruresis, the difficulty or inability to urinate in the presence of others, is a highly prevalent (7-32%) social anxiety subtype that is both chronic and pervasive. Paruresis negatively impacts quality of life. Treatment strategies have focused on psychological interventions. To date, standard social anxiety pharmacotherapies utilized in the treatment of paruresis have shown minimal efficacy. A PUBMED search revealed no references to paruresis treatment with selective serotonin reuptake inhibitors or gabapentin. This case report presents the first instance of successful monotherapy treatment of paruresis with gabapentin. The patient's relative medicine noncompliance resulted in an on-off-on treatment design with a dose-dependent response. Efficacy persisted throughout a 7-month treatment course. Gabapentin should be studied further for its potential use in the treatment of paruresis.

Extended, strategic therapy for recalcitrant mind/body healing: an integrative model

The development of the power therapies, behavioral medicine, and short term interventions have reported such success even with trauma cases that it is relevant to question the justification for lengthy psychotherapy. Yet some patients with complex mind/body conditions impervious to medical treatment/hypnosis may require extended, multi-modal, integrative therapy. This paper details a single complex case of paruresis as a prototype for illustrating a holographic treatment model for recalcitrant conditions: Component features of the proposed model presented include: 1) the sequential utilization of hypnobehavioral and analytic approaches; 2) uncovering work providing access to the somatic ego state associated with the illness condition; 3) the extended treatment time frame required for deep psycho-physiological change; and 4) the stages of counter-transference expectably evoked by such patients (e.g. urgency, exuberant optimism, frustration, discouragement), and the transformation of such reactions to achieve maximum therapeutic efficacy.

Cognitive-behavioral therapy for paruresis: a case report

This article reviews directive interventions for paruresis, the inability to urinate in the proximity of others. As in treatments for other anxiety disorders, historical interventions have included the use of paradoxical intention and several different forms of exposure. The results of pharmacological treatment have not proven promising. Although a multidimensional treatment model has been recommended, little attention has been paid to treating cognitive components of the problem. In this paper, a single case is described in which cognitive components of the problem of paruresis were evident. A cognitive approach and exposure in vivo were applied. Measures of successful trials were obtained over 18 weeks. The combination of cognitive interventions and gradual exposure was effective in reducing paruresis. At follow-up 6 mo. later results had been maintained. The results of this case suggest more attention to the cognitive components is appropriate in the treatment of paruresis, as was stated previously for other specific social phobias.