Day 19: Extinction Bursts When I first began working with pain patients, I noticed an interesting pattern. Just as their symptoms started abating, their fear was decreasing, and they began making some real progress – POW! They’d get blindsided by horrendous pain. This, of course, terrified them, and they were right back in the pain-fear cycle. To understand this phenomenon, we need to go back about 80 years to a laboratory in Boston. Learning and Unlearning B.F. Skinner was a Harvard psychologist who was interested in how behavior was shaped. He did all kinds of fascinating experiments – once even teaching a couple pigeons to play ping-pong. His most notable experiment though, involved placing a rat inside an enclosed chamber. When the rat pressed a lever, a food pellet was released. The rat learned that lever = food, and began pressing the lever whenever he was hungry. This led to a new psychological discovery: when you positively reinforce a behavior, that behavior will continue. But then one day there was an unexpected twist – the contraption broke. A rat was pressing the lever, when the pellet dispenser got jammed. Eventually, the rat stopped pressing the lever…no behavior continues if it’s not getting reinforced. This is called extinction. But before the rat gave up, an interesting thing happened: he pressed the lever like crazy. Over and over and over he pressed, hoping that if he were persistent enough, things would go back to normal. This is called an extinction burst. This process happens with people as well. Imagine you have a toddler who throws tantrums – he cries, he yells, he stomps his feet…it’s awful. And whenever he throws a fit, you give him a piece of candy, which calms him down. After realizing that you’re actually reinforcing the behavior, you decide to stop giving him candy when he acts out. So what happens? The tantrums get even worse! At this point, you have two choices: you can give in, or you can stay strong. If you give in, you go back to reinforcing the behavior, and the tantrums persist. If you stay strong, eventually the extinction burst runs its course, and the tantrums subside. Riding Out the Burst Fear reinforces psychogenic pain. Like candy for a tantrum-throwing toddler, like food for a lever-pressing rat, fear is the force the drives the pain…and a behavior will continue as long as it’s getting reinforced. When we begin to authentically change our relationship with fear, we break that cycle of reinforcement, and the symptoms often start to fade. But this is just the beginning. Fear has been part of your life for a long time – your brain has become accustomed to it, and it won’t go quietly. As you do begin to progress, know that your brain may use pain to try and pull you back to that familiar state of fear. This isn’t a setback, but an expected part of recovery. In these situations, you have two ways of responding. You can get sucked back in to the fear, or you can laugh and say, “I know what you’re doing and I know why you’re doing it. Bring on the extinction burst!” On Day 4 of the program, we saw a live demonstration with Felicia, as she confronted and overcame her fear of the pain. About a week after the conference, Felicia filled me in on what happened after the demonstration. She gave me permission to share her response: “Since the conference I have been doing well! About 2 days after the demonstration I developed such severe pain in my neck that I could hardly turn my head. It was unbearable. I remembered what you said about the pain coming back, and I practiced the tools that we went over. By the end of the day the pain was gone.” Fear is a beast. When you start to free yourself from it, it will pull you back in with a vengeance. Felicia overcame her fear in two days. For Christie, it took about three months. For me, it took a year. All three of us eventually learned the same lesson though: the only power the fear had over us was the power we gave it.