Virtual Graduated Exposure Practice Can Be Effective

CBT and GE

Cognitive Behavior Therapy (CBT), which has become the most widely accepted treatment for Paruresis, uses a model of graduated exposure (GE) based upon public in-person practice with a “pee buddy” from a local support group or an empathetic friend or family member, a model which has shown itself to be highly effective. In March of 2020, however, that model became difficult if not impossible to use as social venues closed down and personal contact outside of immediate family became severely limited, and the idea of virtual GE practice, following the same general procedure but done over video chat from a home bathroom, came to be used as an alternative.

How effective is Virtual GE?

But is it viable, and is it effective? The answer, I believe, is yes, as long as realistic goals and expectations are set. I am not mental health professional, I am just a volunteer for the IPA, but in my roles as a support group leader and a one-to-one mentor for the organization I have logged in hundreds of hours of virtual GE practice (on both sides of the camera) over the span of six years, and so I think I can throw some weight behind that statement.

Why choose Virtual?

First (other than because of Pandemic restrictions), why have people chosen to try virtual practice? A fundamental belief of the IPA is “You are not alone” and virtual practice has provided opportunities not only for those limited by the pandemic, but also for those whose geographic location is far from any support group, those who don’t have an empathetic friend or family member to practice with, those whose family or job commitments make scheduling even occasional practices difficult, and those who just aren’t ready yet to meet someone else with Paruresis face to face but believe that they could do so virtually. From first-hand experience, and based on the experience of others, I can attest to the fact that having a camera in the bathroom while you pee produces remarkably similar anxieties and stresses to public restroom situations, and the resulting successes (and the learning experience of misfires) all contribute to the progression of recovery in remarkably similar ways as well.

A Stepping Stone

That said, Paruresis is a social phobia and eventually those practices must also take place in public settings, so virtual practice is best used as a steppingstone to individual public practice, or in tandem with individual public practice, but not instead of individual public practice. In preparation for writing this summary I specifically asked as many of the men that I have supported in virtual practice situations as possible whether they have found this process to be useful and productive, and the answer has invariably been yes.

Here to Stay!

As with public practice, variables such as how often the practice takes place can make a big difference in the outcome, but all of them are glad that they invested themselves in this process. I believe it will remain a valuable CBT technique for many people long after the Pandemic has become history.

Courtesy, David Kliss, IPA Board Member
May, 2021

Image credit: Dion Burn from Pixabay