For Therapists
How do I explain extinction bursts to clients without discouraging them?
Compare it to "muscle soreness after exercise"—a sign the therapy is working. Use metaphors like "the dawn is darkest before sunrise" and provide specific timeframes for when to expect improvement.
When should I not use extinction?
Avoid relying primarily on extinction with actively suicidal clients, those with psychosis, or when behaviors serve essential communication functions without alternatives in place.
How do I handle clients wanting to quit during extinction bursts?
Use pre-commitment strategies—have clients write future letters to themselves, increase session frequency during difficult periods, and develop specific plans for moments of wavering motivation.
How do extinction principles apply to attachment issues?
Inconsistent responses in early relationships can create attachment patterns that resist extinction. Therapy may need to address these deeper patterns through consistent therapeutic responses and explicit work on relationship patterns.
What's the connection between extinction and mindfulness?
Mindfulness complements extinction by helping clients observe urges and emotional responses without acting on them, essentially applying extinction to internal experiences.
For Clients (How to Answer Their Questions)
How long will the extinction burst last?
While it varies by person, most extinction bursts last 2-7 days of consistent practice. The intensity typically peaks around day 3 before gradually declining.
Will my symptoms completely disappear with extinction?
Rather than complete elimination, expect significant reduction and a changed relationship to remaining symptoms. Most clients report 70-90% reduction in distress and return to normal functioning.
Why do I feel worse before I feel better during extinction?
This is the extinction burst—a normal pattern where the behavior or emotional response intensifies temporarily when reinforcement stops. It's actually a sign that extinction is working properly.
If I give in during an extinction burst, what happens?
Reinforcing the behavior during an extinction burst can actually strengthen it more than before, making it harder to change in the future. This is why consistency is so important.
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Last week, a client looked at me with frustration. "I've been doing the exposure exercises for three weeks, but last night I had a panic attack worse than ever. Does this mean we're back to square one?"
She was experiencing an "extinction burst" – a common challenge that appears just when clients (and sometimes we therapists) start doubting our approach.
Extinction psychology isn't just theory – it's a practical tool we use daily. Whether we're treating anxiety disorders, OCD, substance use, or phobias, understanding extinction psychology can greatly improve our results and help clients through the often confusing recovery process.
This guide offers practical, research-backed strategies to use extinction principles effectively with different clients and problems.
What is Extinction Psychology?
Extinction refers to a neurological mechanism where behaviors gradually weaken and disappear when they're no longer reinforced. Extinction psychology is using this mechanism to disappear unwanted responses/ behaviors in a therapeutic context.
As therapists, we use extinction procedures regularly to help reduce unwanted behavior.
Understanding the Two Types of Extinction
Before using extinction strategies, we need to understand the two main types and how they differ. Both work differently, but achieve similar results – reducing problem behaviors.
Classical vs. Operant Extinction: Key Differences
Classical Extinction:
Involves primarily involuntary, automatic responses like fear reactions, salivation, or emotional reactions
Extinction happens when the trigger no longer predicts a specific outcome (like food or pain), so the automatic response weakens
Example: A client who feels anxious when hearing a certain sound gradually stops reacting when the sound happens repeatedly without anything bad following it
Operant Extinction:
Involves voluntary behaviors that a person chooses to perform, that were previously received reinforcement
Extinction happens when a behavior no longer produces the reward, so the person stops performing the behavior
Example: A child who throws tantrums to get attention stops this behavior when parents consistently don't give attention during tantrums
Involuntary responses like panic attacks might need classical extinction techniques (e.g., exposure therapy), while voluntary behaviors like attention-seeking might need operant extinction techniques (removing the reinforcement).
How Extinction Works in the Brain
Extinction isn't simply "forgetting" – it's new learning that blocks old responses. For example classical extinction changes brain pathways:
The amygdala (fear center) becomes less active
New brain chemicals help store this learning
Calming signals increase to reduce fear responses
This explains why extinction depends on context and can sometimes reverse – an important fact for preventing relapse. When a trigger is repeatedly presented without reinforcement, it gradually loses its power to cause fear responses.
How Extinction Differs From Other Approaches
Many therapists confuse extinction with other techniques:
Extinction:
What it is: Removing rewards that maintain a behavior
Example: No longer providing reassurance for OCD rituals
How it works: When reinforcing consequences stop, the behavior decreases
Punishment:
What it is: Adding something unpleasant after a behavior
Example: Imposing a consequence for unwanted behavior
Limitation: May only suppress behavior temporarily without fixing the root cause
Response Prevention:
What it is: Blocking the behavior from happening
Example: Physically preventing compulsive hand-washing
Connection: Often paired with extinction to stop reinforcement
Understanding these differences helps you choose the right approach. For instance, extinction alone might not work for behaviors with multiple rewards or safety concerns. Applied behavior analysis uses these distinctions when designing treatment plans.
Recent Research Findings
Recent research has improved our understanding of extinction:
Surprise is important – the mismatch between what's expected and what actually happens drives extinction learning
Brief exposure to triggers can destabilize fear memories, making them easier to change
Sleep helps strengthen extinction learning, suggesting scheduling exposure sessions before sleep can improve results
Classical conditioning studies show that extinction creates a new association that competes with the original fear connection. These findings have practical applications – like scheduling exposure sessions before sleep or using surprise elements to enhance extinction.
Why Some Behaviors Are Harder to Extinguish
The partial reinforcement extinction effect (PREE) is a phenomenon where behaviors that were reinforced intermittently (only sometimes rewarded) are more resistant to extinction than those that were continuously reinforced (rewarded every time).
This occurs because intermittent reinforcement creates a persistent expectation that "if I just keep trying, eventually I'll get the reward." For example, a child whose tantrums are occasionally rewarded with candy will continue tantruming longer during extinction than one whose tantrums were rewarded every time. Similarly, a gambler who occasionally wins at slot machines will persist playing longer when the machine stops paying out compared to someone who experienced consistent wins.
In therapy, this effect explains why behaviors maintained by unpredictable attention or inconsistent rule enforcement are particularly challenging to extinguish, often requiring more extended treatment periods and greater consistency. Understanding PREE helps therapists prepare clients for potentially stronger extinction bursts and longer extinction processes when the target behavior has a history of inconsistent reinforcement.
Behaviors maintained by unpredictable rewards will show stronger extinction bursts
The extinction curve showed slower improvement for behaviors that were inconsistently rewarded
Prepare clients for longer treatment when targeting behaviors that were reinforced irregularly
Common Challenges and How to Handle Them
When using extinction procedures, several predictable challenges can arise. Understanding these helps you prepare clients and stay on track.
Extinction Bursts
An extinction burst is a temporary increase in frequency, intensity, or variety of behavior – and it's actually a good sign that extinction is working. This common pattern often makes clients (and sometimes therapists) mistakenly think the treatment is failing when it's actually progressing normally.
What to expect during an extinction burst:
The behavior initially gets worse (often 20-30% more intense)
New variations of the problem behavior appear
Emotional reactions like frustration, hopelessness, or anger emerge
Usually lasts 2-7 days for most behaviors
Real-world example: When working with a parent whose child has tantrums for candy at the store, you might explain, "When you stop giving in to the tantrums, expect them to get worse before they get better. Your child might cry louder, throw themselves on the floor, or start screaming. This actually shows our approach is working—they're trying harder because the old behavior isn't getting results anymore."
Spontaneous Recovery
Even after successful extinction, behaviors can temporarily reappear without any new reinforcement. This spontaneous recovery can be discouraging but is a normal part of the extinction process.
Common triggers for spontaneous recovery:
Time passing since extinction
Changed settings or situations
Stress or strong emotions
Exposure to original triggers
Recovery typically follows a pattern of improvement, temporary setback, then permanent gains.
Clinical example: A client who overcame elevator fear through exposure therapy might suddenly feel anxious again when using an elevator during a stressful work week. This doesn't mean therapy failed—it's a temporary setback requiring a brief return to extinction procedures.
When New Problem Behaviors Emerge
When a behavior is being extinguished, clients may develop alternative behaviors to achieve the same goal. This extinction-induced variability can create unexpected new problems.
How it shows up:
A child who no longer gets attention for whining starts breaking things instead
A client with OCD whose handwashing compulsions are being extinguished begins excessively cleaning household items
An adult whose complaining no longer gets sympathy switches to passive-aggressive behaviors
Or more commonly these days, clients with eating disorders that get on GLP1 drugs then switch to other substances like alcohol to fulfill their emotional needs
Management strategy: Identify what purpose the original behavior served and watch for new behaviors serving the same function. Apply extinction to these new behaviors while reinforcing appropriate alternatives.
How to Prepare Clients for Extinction Psychology
Given the nature of the process, it's important to give clients visibility on what to expect, and the expected challenges. Frame these challenges positively as:
Expected recovery phases, not treatment failures
Biological responses with predictable patterns
Opportunities to build learning and resilience
Practical preparation strategies include:
Creating plans for handling extinction bursts
Practicing responses to difficult moments
Scheduling extra support during predicted difficult periods
Creating reminder cards with encouraging messages
Understanding that spontaneous recovery is normal prevents clients from becoming discouraged about minor setbacks.
Maintaining the Therapeutic Relationship
The extinction burst often coincides with strain in the therapeutic relationship. Preserve the connection by:
Validating the difficulty without reinforcing avoidance
Emphasizing partnership—"we're testing this together"
Increasing session frequency during critical periods when possible
Sharing anonymized success stories that normalize the process
Your confidence during this phase is therapeutic—maintain appropriate certainty even when clients doubt the approach. Reinforce positive behaviors throughout the extinction process.
Everyday Applications of Extinction Psychology
Extinction principles work beyond the therapy room. Understanding these concepts helps you provide practical guidance for common everyday challenges.
Breaking Unwanted Habits
Morning Coffee Example: Many clients develop habits triggered automatically by certain situations or times of day. Consider a client who stops for an expensive, unhealthy coffee drink every morning during their work commute. To extinguish this habit:
Identify the trigger: The commute route itself has become a conditioned stimulus
Disrupt the pattern: Taking a different route temporarily breaks the association
Create competing responses: Making coffee at home creates a new, healthier habit
Manage extinction bursts: The urge to stop for coffee will temporarily intensify before fading
Relationship Patterns
Extinction can improve problematic relationship patterns:
Attention-Seeking Behaviors:
When one partner uses dramatic complaints to get attention, the other partner can apply extinction by not providing the rewarding attention
Instead, they can give attention when the partner communicates appropriately
This may initially lead to an extinction burst where the complaining intensifies
Enabling Behaviors:
Family members may accidentally reinforce substance use by providing money or hiding consequences
Applying extinction principles by allowing natural consequences is difficult but essential for change
Support groups help family members maintain consistency during challenging extinction periods
Workplace Applications
Meeting Interruptions:
When colleagues consistently interrupt during meetings, attention rewards this behavior
Systematic extinction involves the group agreeing not to respond to interruptions
The group instead reinforces waiting for appropriate speaking opportunities
This structured approach can greatly improve meeting dynamics
Modified Approaches
When standard extinction isn't always possible, consider these alternatives:
Graduated extinction: Gradually increasing the delay before providing reinforcement. Extinction occurs more slowly here, but is also easier for many clients to practice.
Extinction plus differential reinforcement: Combining extinction with strong reinforcement of alternative behaviors. Extinction occurs faster here - use where possible. Typically this requires a bit of creativity on part of both the therapist and the client to work together on a solid plan.
Stimulus control procedures: Teaching when behaviors are appropriate rather than eliminating them entirely. This aims to moderates the response, and trains the client to exercise choice based on the situation. Extinction occurs more slowly here, and new neural pathways are developed around reasoning, moderation and choice. This is probably the hardest of the three.
Safety Considerations and Ethical Applications
While powerful, extinction approaches must be used ethically and safely, and there are situations where extinction may not be appropriate/ sufficient. Remember, extinction aims to fundamentally rewire neurological patterns, and these changes take time - so extinction psychology may not be appropriate in situations that need more immediate responses
Safety Concerns:
Behaviors that might cause harm should not rely solely on extinction
Severe self-harming behaviors need more comprehensive approaches
Ethical Considerations:
There are also several ethical considerations around extinction psychology - given how powerful it can be in establishing/ disappearing neurological patterns, as therapists we need to be thoughtful on where we apply it systematically
Extinction should never be used to eliminate appropriate self-advocacy
Communication attempts in non-verbal individuals should be redirected, not extinguished
Cultural factors must be considered when deciding which behaviors to target
Comparing Extinction With Other Approaches
Understanding how extinction compares with other therapy approaches helps you make informed treatment decisions and explain options to clients.
Extinction vs. Cognitive Therapy
Extinction-Based Approaches:
Target behaviors and physical responses directly
Create change through new learning from direct experience
Focus on in-session exposure and response prevention
Emphasize practice exercises for homework
Often show slower initial progress with faster improvement later
May experience relapse in new contexts (spontaneous recovery)
Cognitive Therapy:
Primarily targets thought patterns and beliefs
Changes occur by examining and changing thinking patterns
Sessions focus on challenging unhelpful thoughts
Homework typically involves thought records and cognitive exercises
May show earlier thought shifts before behavior changes
Relapse can occur when negative thought patterns return under stress
When to choose extinction: Consider extinction-based approaches when behaviors are clearly maintained by reinforcement, when physical responses are prominent, or when cognitive approaches haven't worked despite insight.
Extinction vs. Acceptance-Based Approaches
Extinction-Based Approaches:
Aim to reduce or eliminate problematic symptoms
Measure success through decreased symptom frequency and intensity
Client experience may involve temporary increases in discomfort
Focus more on direct experience than verbal processes
Frame exposure as a way to extinguish conditioned fear response
Acceptance-Based Approaches (ACT, DBT):
Focus on changing the relationship to symptoms rather than eliminating them
Success measured through increased flexibility and valued action
Emphasize mindful awareness of discomfort without struggle
Draw from contextual behavioral science and mindfulness
Place substantial focus on language and verbal relations
View exposure as an opportunity for new responses in the presence of difficult experiences
When to choose extinction: Extinction approaches may work better when symptom reduction is a primary goal, when clients prefer concrete behavioral approaches, or when acceptance alone hasn't produced real-life changes.
Using AI Tools for Extinction Psychology and Treatment Planning
As therapy practices evolve, new AI-powered tools are emerging to support therapists in implementing evidence-based approaches like extinction psychology more efficiently.
Tools like Supanote.ai and similar ambient AI documentation platforms can be particularly valuable for extinction-based work. They can:
Listen during sessions to identify extinction-relevant content and create structured notes
Extract functional relationships between behaviors and reinforcers to inform extinction strategies
Flag potential extinction bursts by analyzing reported increases in behavior frequency or intensity
Generate progress notes that track extinction curves over time
For example, a therapist working with a client on extinguishing anxiety responses might use an ambient AI tool to document exposure exercises, track SUDS (Subjective Units of Distress) ratings throughout the extinction process, and note instances of spontaneous recovery—all while remaining fully present with the client during the session. At the end of the session, Supanote would directly generate the relevant progress note in your preferred format (SOAP, DAP, GIRP etc.), do an MSE, and also directly create relevant treatment plans based on extinction psychology. We really shouldn't have to manually do the planning and documentation anymore.
They save a ton of time for therapists, especially in thinking through exercises, reinforcements and in documentation. While technology should always remain secondary to clinical judgment and the therapeutic relationship, thoughtfully implemented AI tools can enhance the delivery of extinction-based interventions by improving documentation quality and reducing administrative workload.
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FAQs
For Therapists
Q: How do I explain extinction bursts to clients without discouraging them?
A: Compare it to "muscle soreness after exercise"—a sign the therapy is working. Use metaphors like "the dawn is darkest before sunrise" and provide specific timeframes for when to expect improvement.
Q: When should I not use extinction?
A: Avoid relying primarily on extinction with actively suicidal clients, those with psychosis, or when behaviors serve essential communication functions without alternatives in place.
Q: How do I handle clients wanting to quit during extinction bursts?
A: Use pre-commitment strategies—have clients write future letters to themselves, increase session frequency during difficult periods, and develop specific plans for moments of wavering motivation.
Q: How do extinction principles apply to attachment issues?
A: Inconsistent responses in early relationships can create attachment patterns that resist extinction. Therapy may need to address these deeper patterns through consistent therapeutic responses and explicit work on relationship patterns.
Q: What's the connection between extinction and mindfulness?
A: Mindfulness complements extinction by helping clients observe urges and emotional responses without acting on them, essentially applying extinction to internal experiences.
For Clients (How to Answer Their Questions)
Q: How long will the extinction burst last?
A: While it varies by person, most extinction bursts last 2-7 days of consistent practice. The intensity typically peaks around day 3 before gradually declining.
Q: Will my symptoms completely disappear with extinction?
A: Rather than complete elimination, expect significant reduction and a changed relationship to remaining symptoms. Most clients report 70-90% reduction in distress and return to normal functioning.
Q: Why do I feel worse before I feel better during extinction?
A: This is the extinction burst—a normal pattern where the behavior or emotional response intensifies temporarily when reinforcement stops. It's actually a sign that extinction is working properly.
Q: If I give in during an extinction burst, what happens?
A: Reinforcing the behavior during an extinction burst can actually strengthen it more than before, making it harder to change in the future. This is why consistency is so important.
Conclusion: The Power of Extinction Psychology
Extinction principles form the foundation of many effective interventions. As therapists, we need to understand how extinction psychology applies to various situations, from formal therapy to everyday challenges.
The path through extinction isn't always straightforward. Clients will face extinction bursts, spontaneous recovery, and the challenge of staying consistent.
Your role as a guide—explaining the counterintuitive nature of extinction, providing support during difficulty, and celebrating progress—makes all the difference. Your skilled guidance through extinction can transform clients' relationships with fear and anxiety, creating lasting change where other approaches have failed.