The neurological roots of this conditioning were explored in a previous study conducted by Dr. Clarkson and Dr. Conklin. Using MRI technology, the researchers monitored the brain activity of participants as they were shown images of their own front doors or other personal triggers, as well as "safe" images that carried no such associations. The brain scans revealed a striking pattern: when participants viewed images that triggered their urgency, a specific region of the brain known as the dorsolateral prefrontal cortex became significantly more active.
The prefrontal cortex is often described by neuroscientists as the "seat of cognitive control" or the brain’s executive function center. In the context of bladder control, this area acts as the supervisor that evaluates signals from the body and decides how to respond. It is the part of the brain that tells an individual, "Yes, you feel the urge, but now is not the time; you need to find a restroom first." When this executive center is overwhelmed by conditioned responses, the "latchkey" effect takes over. The researchers hypothesized that if they could strengthen the activity and regulation of this part of the brain during exposure to urgency cues, they could help patients regain the ability to override the conditioned urge.
To test this theory, the team recruited 61 women over the age of 40 who reported regular episodes of situationally triggered bladder leaks. The participants were randomly assigned to one of three intervention groups. The first group listened to a 20-minute mindfulness exercise. The second group received a non-invasive technique called transcranial direct current stimulation (tDCS), which uses low-intensity electrical currents to stimulate specific areas of the brain—in this case, the prefrontal cortex. The third group received a combination of both mindfulness and tDCS. During these interventions, all participants were asked to view photographs of their personal triggers to simulate the real-world scenarios that usually caused them distress.
The mindfulness component of the study was specifically designed by co-author Dr. Carol Greco, an associate professor of psychiatry and physical therapy at Pitt. While the exercise followed the structure of a traditional "body scan"—a common practice in mindfulness-based stress reduction where a person systematically brings their attention to different parts of their body—it was tailored to address the specific needs of those with incontinence. Unlike a standard body scan that might gloss over the pelvic region, this exercise included a specific, non-judgmental acknowledgment of bladder sensations. By teaching participants to observe the feeling of urgency without immediately reacting to it with panic or physical tension, the mindfulness training sought to break the automatic link between the cue and the leak.
The results of the pilot study were remarkably consistent across all three groups. After completing four in-office sessions over the course of five to six days, participants in every group reported a significant reduction in the level of urgency they felt when viewing their trigger photos. More importantly, the women reported a tangible improvement in their daily lives, noting a decrease in the actual number of urgency episodes and accidental leaks.
