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

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 happen
• Why OCD often gets louder when compulsions start changing
• How long-standing habits create powerful neural patterns
• Why many people misinterpret extinction bursts as therapy failure
• The role of psychoeducation in preparing clients for this phase of treatment
• Coaching clients to observe and ride out the “burst”
• Using curiosity instead of self-judgment during difficult moments
• Why discomfort during treatment can actually be evidence of progress
• Helping clients track patterns without becoming trapped in distress monitoring
• Reframing extinction bursts as a sign of meaningful change

🔖 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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