How to Overcome Your Paruresis

I've had paruresis since I was 13 years old. In 2014, I began actively confronting my fear and made significant improvements. In this article, I want to share what I’ve learned from that journey and describe the path out of fear.

The Treatment of Choice

The treatment of choice for paruresis is cognitive behavioral therapy (CBT). CBT is used to treat many anxiety disorders and has also proven highly effective for paruresis. In a study by Prof. Hammelstein, 80% of participants no longer met the criteria for clinically significant paruresis after just twelve sessions.

CBT for paruresis typically consists of two phases. The first focuses on examining your anxious thoughts; the second centers around gradually facing real-world restroom situations.

CBT is usually guided by a licensed therapist, but it’s also possible to work through CBT concepts on your own. More on that later.

Questioning Negative Thoughts

The core idea behind cognitive behavioral therapy is that our thoughts shape how we feel and behave.

In the case of paruresis, this means that tension and anxiety in public restrooms are fueled by exaggerated negative thoughts. The first intermediate goal is therefore to identify and replace those thoughts.

Let’s walk through this process using a typical negative thought as an example.

Imagine you’re entering a public restroom and the following thought comes to mind:

“If I’m in the restroom and can’t pee, the others will notice and make fun of me.”

How do you feel with this thought? Perhaps intimidated and helpless?

How would that thought influence your behavior? You’d likely try to avoid others and make yourself as inconspicuous as possible.

In CBT, you would now challenge this thought: Are my assumptions realistic? How would I react if I were one of the others in the restroom?

You’d likely conclude that it’s pretty unlikely anyone else in the restroom is paying attention to you. They’re probably too absorbed in their own world to notice how long you’ve been there or whether they hear anything. And even if someone did notice, they wouldn’t say anything — and they’d forget about it quickly.

Once you become aware of these kinds of negative thoughts and successfully replace them with more realistic ones, you’re ready for the second step.

Gradually Confronting Yourself in Public Restrooms

With the understanding that your fears were exaggerated, you can begin facing public restroom situations. The goal: visit “challenging” restrooms and see for yourself that your original fears don’t come true.

It’s important to proceed with care. You may have avoided certain restrooms for a long time or only used them under intense stress. The idea is to start with relatively easy restroom environments so you don’t overwhelm yourself. Once you’ve had some positive experiences there, you can move on to more difficult ones.

In each case, the aim is to endure and manage the tension until you’re able to urinate. Once you’ve mastered that “level,” you move on to the next—and so on.

Support on the Path Out of Fear

For cognitive behavioral therapy, you should look for a psychotherapist who works with this method. There are several online directories that can help you find therapists in your area.

If you’d prefer to start working on the problem on your own, my self-help program WeMingo can support you with CBT-based tools. It helps you identify negative thoughts based on real-life situations you’ve experienced and guides you in formulating more constructive alternatives.

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Describing the path here was relatively easy. Of course, walking it yourself is much harder — especially if you’ve been dealing with this issue for many years or even decades. In that case, old thought and behavior patterns are deeply ingrained, and change takes a lot of patience. But it’s worth it, and it’s never too late! Even small improvements will significantly improve your quality of life.