How to Overcome Paruresis: What Really Helps, and What Doesn’t

Bernd

Sep 29

11 min read

Several years passed between the day I first read the word paruresis and the point when I really started to change something systematically.

At some point I knew what I had. I’d read forums, tried various tricks, and often told myself I’d somehow manage next time. At the same time, I had organized my everyday life around paruresis so well that hardly anyone on the outside noticed.

If you’re searching for how to overcome paruresis right now, you may know this phase. You know by now that your problem has a name, you want to change something, but you’re not really sure where to start. And you’d probably prefer some trick that solves the whole thing quickly.

I understand that very well. Paruresis is annoying, and you’d rather spend as little time on it as possible. That’s exactly why many people look for shortcuts, specific tricks or a technique that will finally work on the next trip to the restroom.

From everything I’ve learned myself over many years, lasting change works differently. Paruresis isn’t just the actual block in the restroom. It also includes expectations, thoughts, avoidance, safety behaviors, anticipatory anxiety and many small decisions that eventually run completely automatically. These patterns have often developed over years.

That’s why there’s no miracle cure that makes them disappear within a few days. The good news, though: what you’ve learned, you can also change yourself.

For the Paruresis Training Academy, the path consists of three core parts: recognizing your own paruresis behaviors, changing them methodically and step by step, and then keeping at it long enough for the new behavior to become more and more natural in everyday life.

There is no miracle cure for paruresis

I spent a long time looking for a simple solution myself. Maybe the right breathing technique, distraction, relaxation, a certain thought, a stronger urge to go, alcohol, just not thinking about it, or finally pulling myself together next time.

Some of these things can make a single trip to the restroom easier. But that doesn’t mean your paruresis will change in the long run.

If over many years you’ve learned to avoid certain situations, plan ahead, or pay especially close attention to your body under certain conditions, it has eventually become a pretty stable pattern. That sounds sobering at first, but at some point this realization actually helped me. I no longer had to search for that one secret trick I apparently hadn’t found yet.

Instead, I could start to see paruresis as a learning process. What was learned over years can also be changed again, step by step.

What usually doesn’t help in the long run

Many of the strategies we develop with paruresis make complete sense. They usually come about because they work in the short term. They mainly become a problem when we expect them to change the underlying pattern for good.

Just pulling yourself together

“This time it has to work.” Almost everyone with paruresis probably knows this thought.

The more important a trip to the restroom becomes, however, the more pressure can build. You watch yourself even more closely, wait for it to finally start, and a normally automatic bodily process suddenly turns into a task that absolutely has to be completed. More willpower rarely solves this problem.

Forcing yourself into the hardest situations

The opposite approach sounds logical at first: if I’m afraid of a situation, I just have to confront it as much as possible.

Exposure does play an important role in paruresis. But that doesn’t mean training should be as hard as possible. If you keep forcing yourself, without structure, into situations that are currently far outside your training range, you often mainly create performance pressure and frustration. Maybe it works sometimes anyway, maybe not. Either way, it often stays unclear what you’re actually supposed to learn from the situation.

That’s why exposure for paruresis is more than just “grit your teeth and push through.”

Training without structure

Frequent restroom training alone doesn’t guarantee progress, either. Many people make attempt after attempt in public restrooms. Sometimes it works, sometimes it doesn’t. For a few weeks they try a lot, then hardly anything happens for months.

Experiences like these can be valuable, but they don’t automatically add up to a structured learning process. This is exactly where the method makes a difference.

Only thinking or talking about it

On the other hand, in my experience it also isn’t enough to try to solve paruresis only in your head.

You can understand very precisely where your fear comes from, which thoughts play a role and why you put yourself under pressure in certain situations. That understanding can be incredibly important. But if your behavior in real restroom situations never changes, a large part of the old pattern stays in place.

For me, mind work alone without new experiences in everyday life is just as incomplete as restroom training without understanding what’s actually happening in your head and in your own behavior.

Ignoring paruresis and carrying on as before

This is probably the approach I lost the most time with myself.

You make arrangements. You drink less, go to the restroom one more time just in case, wait for good moments, know your safe restrooms and plan trips or events accordingly. This often works surprisingly well, and that's exactly why you sometimes don't even notice how much your everyday life has already adapted.

Dealing with paruresis as little as possible feels sensible at first. Unfortunately, the underlying patterns usually don't go away because of it. Avoidance and safety behaviors can even become more and more natural, because there are hardly any situations left in which something different gets tried.

So for many people, paruresis doesn't simply shrink on its own over time. It tends to grow.

Believing you're the only person with this problem

This thought can also block change for years. I myself thought for a long time that no one else had this strange problem and that probably no one would take me seriously anyway.

That quickly leads to a cycle: you feel ashamed, don't tell anyone, and so you never meet others who have it. That in turn confirms the feeling that you really are alone with it.

Only when I later met others with paruresis, attended workshops and engaged with paruresis more intensively did I realize how similar many of our experiences are.

Believing you can only train with a buddy

A training partner can be helpful and can be used very effectively for certain exercises. But a buddy isn't a requirement for working on paruresis.

Especially in your own everyday life, situations come up regularly in which behavior can be observed and changed. That makes it possible to build in training much more often and more easily than if every exercise depended on a second person. For people who don't want to tell anyone about their paruresis, this is especially important.

Why tricks, avoidance and safety behaviors are so tempting

Paruresis is exhausting. If for years you've been thinking before every longer appointment about whether you should go to the restroom first, you probably don't want to spend extra free time analyzing your paruresis.

That's why we look for shortcuts. And that's also why avoidance and safety behaviors develop.

If you know a certain restroom is easier, you go there. If you believe drinking little makes a difficult day easier, you drink less. If a certain strategy helps you urinate, you use it. That's normal human behavior, and in the short term it often even works really well.

It becomes a problem when more and more conditions are needed for a restroom situation to feel doable at all. Then everyday life increasingly revolves around creating those conditions.

So safety behaviors don't have to disappear completely. In especially difficult situations, they can be used deliberately and make total sense. The long-term difference lies in whether you consciously decide when to use something, or whether your behavior is automatically steered by paruresis.

Two sides of the same paruresis: mind and behavior

This was one of the most important realizations on my own journey.

You can understand a great deal about paruresis and still keep avoiding the same restroom situations. At the same time, you can do a lot of restroom training and still go in every time with the same thoughts, expectations and the same enormous pressure to perform.

That's why, for me, thought training and behavior training belong together.

On one side is the work on what's happening in your head: Which situations do I judge as dangerous? What do I believe other people think about me? Which disasters am I already playing through hours or days in advance? How much pressure am I creating myself?

On the other side are experiences in everyday life. Behavior has to change there too, so that the new understanding eventually turns into a different experience.

If you only work on one side, the other often stays surprisingly stable. But if you gradually work on both sides, the foundation that paruresis was built on over years starts to crumble.

That's exactly why the Paruresis Training Academy has two different workbooks: Rethinking Paruresis deals with the thought and behavior patterns around paruresis, while Training Paruresis in Everyday Life focuses on practical restroom training.

The following overview shows you what this path is basically about. The concrete how, meaning how to analyze your own patterns, structure your training and put the exercises into practice, goes much deeper.

If you want to learn the method yourself from home, I recommend starting with these workbooks.

The path to change has three steps

1. Recognize your own paruresis patterns

Before you can change something, you first have to see what already happens automatically today. That's harder than it sounds, because after many years with paruresis, a lot no longer feels like avoidance or safety behavior. It just feels like everyday life.

Maybe you automatically drink less before an appointment, go one more time at home just in case, or immediately check how many people are there when you enter a restroom.

Maybe you wait for the right moment without consciously thinking about it anymore.

Thoughts can also be automated long ago: "Now it has to work," "Someone's waiting," "I can't take too long" or "If it doesn't flow now, I've got a problem."

So the first step is to make your own patterns visible at all. That includes the head work as much as the behavior.

2. Change the patterns through structured paruresis training

Then the practical change begins.

An important and publicly well-described approach is graduated exposure. Difficult situations aren't chosen at random but increased step by step. You start with situations that are challenging but basically trainable, and gradually move toward more difficult conditions.

Another well-known principle is the difficulty ladder. Situations are roughly ranked by how demanding they currently are. This helps you shape training not just by feel or chance, but with a clear direction. Many paruresis exercises are based on exactly this basic idea of seeking out difficult situations step by step and repeatedly.

But that only describes the what.

How to build your own difficulty ladder in a meaningful way, which situations to choose, how to handle safety behaviors, which order makes sense and how to put difficult training days in perspective: that is the actual method. In my experience, this method largely decides whether individual restroom attempts turn into systematic training over time. You'll find this method explained step by step in the workbook Training Paruresis in Everyday Life.

3. Keep at it and reinforce the new behavior

A good training day can be incredibly motivating. Suddenly something works that was difficult for a long time, and for a moment you may think you've made the breakthrough. Then, a week later, a situation comes along that doesn't work again.

Progress with paruresis is rarely a straight line. We're trying to change behaviors that have often developed over many years, and that's why new behavior also needs repetition and time before it becomes more and more natural.

Keeping at it doesn't mean training as hard as possible every day or having to do everything perfectly in every situation. It means returning to the new direction again and again.

Sometimes that can also mean deliberately using a safety behavior again in an especially difficult everyday situation. The key difference is that it stays a conscious decision and doesn't automatically dictate every situation again.

With enough repetition, new behaviors can gradually take hold and become more natural.

Paruresis therapy: How is it different from training?

If you're looking for ways to overcome paruresis, you'll probably also come across the term paruresis therapy.

Psychotherapy can be useful for paruresis, especially if there is also strong social anxiety, depression or other psychological strain, or if you want professional psychotherapeutic support.

Cognitive behavioral approaches deal with thoughts and judgments as well as behavior. The research literature on paruresis describes graduated exposure, cognitive interventions and behavioral experiments, among other things. Research specifically on paruresis is still relatively small, though, which is why sweeping claims about the one best treatment path wouldn't be credible.

What matters most to me is that change doesn't stay limited to conversation. Talking about paruresis, understanding the connections and questioning thoughts is an important part. At the same time, at some point something has to be different in everyday life too if situations are going to change for good.

The Paruresis Training Academy does not offer psychotherapy. Its offerings are designed for self-help, self-reflection and independent training, and can also be used alongside psychotherapy.

I had to learn this path myself first

I wish someone had explained these connections to me earlier. Instead, I had to piece a lot of it together myself over the years.

I've had various experiences with therapy, attended several paruresis workshops, engaged intensively with international self-help organizations and their approaches, and had countless conversations with others who have paruresis. Along the way I also noticed that it wasn't one single method that changed everything for me.

Only when I started taking both sides seriously did a clearer overall picture emerge for me. I had to understand which thoughts and expectations were carrying my paruresis, and at the same time change my behavior in real situations.

For me, this combination is the key today: rethinking paruresis and acting differently.

This path later gave rise to the Paruresis Training Academy. I want to pass on, in a structured and understandable way, the knowledge I had to piece together over many years from therapy, workshops, research literature, self-help and conversations with others who have paruresis.

It's not about a miracle method or a promise that paruresis will be gone within a few weeks, but about a clear way to work on both sides of the problem.

What's realistic when overcoming paruresis

Progress can unfold very differently. Some situations suddenly get easier, others stay difficult for a long time. It can happen that something works that seemed impossible before, and shortly afterward you block again, of all places in a supposedly easier situation.

That's frustrating, but it doesn't mean you're back at the start.

For me, overcoming paruresis also doesn't mean being able to guarantee at some point that you can urinate immediately in every restroom in the world under all conditions. The more interesting question is how much influence paruresis still has on your life and how you deal with it.

Are you constantly planning ahead, drinking less, canceling things or leaving events early? Does the next restroom decide whether you take a trip? Or can you handle a difficult situation without everything revolving around paruresis again afterward?

Progress doesn't only show in the restroom. It shows in your life getting more room again.

If you want to learn the method yourself

If you want to learn the method from home, these are the two workbooks for it.

Rethinking Paruresis deals with the cognitive side. You learn to better recognize and understand your thoughts, expectations and behavior patterns around paruresis before you start practical restroom training.

→ Check out Rethinking Paruresis

Training Paruresis in Everyday Life then focuses on behavior. The workbook helps you build your restroom training in a structured way and carry the principles of gradual change into your everyday life on your own.

→ Check out Training Paruresis in Everyday Life

For me, both sides belong together: first understanding what keeps your paruresis going, and then having new experiences in everyday life step by step.

All the best and remember: starting is the most important thing. You are already doing it.