Why OCD Gets Worse Before It Gets Better (Extinction Bursts)

About this episode

This episode explores the phenomenon of extinction bursts in OCD treatment, helping listeners understand the initial increase in anxiety as a sign of change rather than failure.

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: What extinction bursts are and why they…

People in this episode

Hosts: Dr Celin Gelgec, Dr Victoria Miller

Topics covered

• OCD treatment
• extinction bursts
• exposure therapy
• anxiety management
• neural patterns
• psychoeducation

Keywords

• OCD
• extinction bursts
• exposure therapy
• intrusive thoughts
• compulsive behaviors
• anxiety
• neural patterns
• psychoeducation

Mentioned in this episode

Books & works: Breaking the Rules

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