In this episode of Breaking the Rules, we unpack one of the most confusing and frustrating parts of OCD treatment: extinction bursts.
If you’ve ever started exposure therapy and felt like your intrusive thoughts suddenly became louder, more intense, or more frequent, you’re not alone. Many people interpret this spike in discomfort as proof that therapy isn’t working — when in reality, it can be evidence that change is actually happening.
We explore what extinction bursts are, why they occur when people begin changing compulsive behaviors, and why the brain often reacts with a kind of “hissy fit” when long-standing patterns are challenged.
This episode focuses on helping both clinicians and individuals understand that the initial surge in anxiety, intrusive thoughts, or urges isn’t failure — it’s often the brain’s attempt to pull you back into familiar safety behaviors.
We also discuss practical ways clinicians can prepare clients for extinction bursts, coach them through these moments, and help them recognize these experiences as part of the change process rather than a sign that treatment is going wrong.
In this episode we discuss:
🔖 Chapters
00:00 Introduction
01:20 What Is an Extinction Burst?
03:00 Why the Brain Reacts When Habits Change
05:10 Why ERP Can Feel Worse Before It Feels Better
07:00 How Clients Misinterpret Extinction Bursts
09:00 Why Psychoeducation Is So Important
11:00 Coaching Clients Through the “Hissy Fit” Phase
13:30 Curiosity vs Resistance During ERP
15:00 Using Data Carefully in OCD Treatment
17:00 Measuring Coping Rather Than Distress
18:30 Reframing Extinction Bursts as Evidence of Change
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