Why OCD Gets Worse Before It Gets Better (Extinction Bursts)
Breaking the Rules: A Clinician's Guide to Treating OCDShow Notes
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
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