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New Program Day 19: Extinction Bursts

Discussion in 'General Discussion Subforum' started by Alan Gordon LCSW, Aug 1, 2017.

  1. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    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.

    Last edited: Sep 9, 2017
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  2. Eugene

    Eugene Well known member

    I remember getting rid of my pain for a whole month once (oh, what bliss), but then I had just a small twinge. I was making a cup of tea at the time. In a minute I went from making the tea without a care in the world to blind panic, and before I knew it I was back with the full blown pain and I've been that way ever since ... argh!

    I'd love to think I can do like you did Alan, but I just don't think I could ever keep chasing the fear away for a year.
    kim marie, Ollin, Benjuwa and 2 others like this.
  3. nightcountry

    nightcountry New Member

    Hi Alan
    How does one know if the sudden pain flare is an extinction burst or just another bump in the pain cycle. Are you saying that these extinction bursts happen over and over again - how do we identify them and gain confidence that the process of
    changing ones relationship with fear is actually working and the pain flare is a manifestation of that change -0r - is it just the same old pattern repeating itself. It would be great to have a marker or a tool to actually gauge ones progress and
    be able to recognize an extinction burst accurately.
    Jossje, Ollin, Kat and 2 others like this.
  4. Eugene

    Eugene Well known member

    An excellent question @nightcountry

    I'd love to know that too.
    kim marie likes this.
  5. Walt Oleksy (RIP 2021)

    Walt Oleksy (RIP 2021) Beloved Grand Eagle

    Alan Gordon's explanation of extinction bursts is very interesting, but we need to know how to move on from there.
    If he reads my reply, I hope he can offer some suggestions. Or others will. What works for you?

    I find that stopping the anger that causes TMS pain to be very helpful. I accept the anger and instead I laugh at whatever is troubling me.

    If pain increases as we heal, so be it. Take it as a sign we soon will be pain-free.
    lindyr, Jossje, kim marie and 2 others like this.
  6. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    Great question. Honestly, it doesn't really matter because we respond the same either way. Knowing about extinction bursts can be a helpful tool to make it easier not to buy in to the fear, but it's always good not to buy into the fear.

    In fact, the thought of "wait, is this an extinction burst or is my mind just responding to some other perceived threat?" Is just another fear thought. And we can respond to it with, "Actually, it's going to be okay either way. I know it's temporary and it's going to pass."

    That's a way of treating ourselves that can make our brains feel safer instead of leading us deeper into a state of fight or flight.
  7. Celayne

    Celayne Well known member

    This post is perfect for me today, Alan. I am going through some pretty intense extinction bursts - some old symptoms that had not been bothering me lately have returned and the pain that led me to Dr. Sarno's work and this site have seemed to be worse than ever. I did get some good days, 80-90% pain free ones, so I know that can happen again. While I am 100% committed to the fact that it is TMS, it is discouraging to say the least.

    The story of the rat frantically pushing the lever to get his food pellet is a great analogy for what is going on with my TMS pain. It really doesn't want to go away. And I want it gone now. It feels like an epic battle of wills -- but I will prevail.
  8. Kerrj74

    Kerrj74 Well known member

    Another great post today Alan. Thank you!
    kim marie likes this.
  9. Delilah

    Delilah New Member

    Alan, I just wanted to thank you again - this post was spot on for me today. I already feel more positive, because what you've said and the analogies you've used give me fresh insight into how the pain recurs and sustains itself. I especially relate to the toddler candy story. I have no difficulty "being strong" and putting my foot down in these sorts of situations because I am well aware of the need to do so in order to foster long term changes in the behaviour of young kids - this will help me to stay strong internally when my fear comes back with persisting symptoms and I am sure this will help. Thanks so much again.
    toucansam, kim marie and Bodhigirl like this.
  10. Click#7

    Click#7 Well known member

    I hope you are right Walt....I have a couple good days and then a bad one.
    kim marie likes this.
  11. itmsw

    itmsw Peer Supporter

    Hi Alan - thank you again for explaining about the extinction process. It is scary when all of a sudden you have new pain somewhere else - -Mine started out in my lumbar area and left leg sciatica 32 years ago. I didnt know about TMS then and Doctors at Columbia Presbyterian Hospital in NYC diagnosed me with herniated disc at L4-S1 with sciatica down left leg and spinal stenosis. He said I had to have a fusion or id be paralyzed by the time I hit twenty so I had the surgery - which was extremely traumatizing. Before going into the surgery the anestiologist said If you dont hold still I will stick this needle in your F-----n eye- it was an aterial line he was attempting to put in, then when I woke up in the recovery room and couldnt breathe and told them I cant breathe. Then after they took the foley catheter out I couldnt urniate and the pain was unberable as I watched my abdomen enlargen . Then I was in a soft cast for six months and when he came off the doctor told me I need to join a gym and increase my muscle strength. Three days after that I had severe muscle spasms- I realize know that all of this was TMS- but those traumatic experiences I believe helped to increase my level of fear. Then I develped coccyx pain and had to go to a doctor to figure out what that was and was told I had a bone spur and had many injections, but none helped. Then I developed pain in my right butt and right leg sciatica so I had to have MRI to figure out if anything serious and was told I had a bulging disc at L3-L4. Then I developed glaucoma at the age of 36 and needed immediate laser surgies- all painful and traumatic. Then I developed Cancer and had to undergo 14 hour surgery and chemo and additional surgeries there after with lots of side effects. Then I develped a bladder infection and had to see the doctor after doctor after doctor and took over a month to cure which resulted in Interstial Cystitis and Pelvic Floor dysfunction and PN then Had more glaucoma surgeries. then I tore my labrum in my right hip and needed MRI and doctor said a labral tear never heals unless you have surgery and then I spoke with many people who had surgeries and some were successful but others were not and Im too traumatized to have any surgery another doctor said labral tears dont heal but it may get to the point that it doesnt hurt. Then I developed nerve pain in my writsts and feet, severe migraines and severe neck pain - where the doctor says I have herniation at c6-c7. So my question Alan is that when the pain is on the run- you have to go to the doctor to see if it is structrual or not- it is alot of tests and doctor visits that are traumatic and I feel that can cause fear and strengthen the fear. So how does one go about not not getting caught up in pain chasing and numerous doc visits to make sure it is not structural?
    My other question is in working on my emotions and fears, and feeling into my body, I feel like 24/7 I have to constantly be on top of whats happening with my self talk and analzye whats going on up there and try to reframe thoughts - it is an exhausting, never ending job that i feel I have been trying to do for over thirty years -
    kim marie likes this.
  12. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    It's a hard question to answer. I had 22 TMS symptoms, but then I tore a ligament in my wrist. Sometimes we do have physical injuries that need to be addressed.

    It's something that needs to be taken on a case by case basis, depending on the various pieces of evidence.

    To answer your second question, if we attend to ourselves from a place of pressure and hypervigilance, it can further communicate a messages of fear. Ultimately the goal is to come at ourselves with a sense of ease.

    In tomorrow's post, I'll be talking more about this.
    mm718, Laleah Shoo Shoo and itmsw like this.
  13. MicheleRenee

    MicheleRenee Peer Supporter

    theres 2 books called at last a life and at last a life finally (or something along those lines) of a man who suffered severe anxiety for 10 years. he talks about acceptance and thoughts...etc. honestly i pocked it up monday and i can say it made things soo much clearer for me in terms of pressure thoughts acceptance etc. obviously check out what allen says tmw but also look into these books if they interest u!
    Eugene likes this.
  14. itmsw

    itmsw Peer Supporter

    Thank you so much for your reply and sharing that you had 22 TMS symptoms - Im sorry for the lengthy email- I even forgot to write in some other TMS symptoms lol- but sometimes its hard for me to communicate my thoughts in a more concise manner, so thank you Alan for reading and responding to it anyway- Your response was extremely helpful!
    After reading my post again some of the numbers were wrong like when the doc said id be paralyzed if didnt get it - it says twenty but it is supposed be Thirty years old- But that prob. doesnt matter either.
    Anyway- Thank you soo very much for responding!!!
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  15. itmsw

    itmsw Peer Supporter

    I MicheleRenee- I really appreciate you replying to my post and sharing with me about these two books- I really appreciate it! Ill definitely look them Up!!
    MicheleRenee likes this.
  16. James59

    James59 Well known member

    For the first couple of days after I started putting the somatic tracking lesson into practice my physical symptoms didn't change beyond normal variations, but I noticed my overall disposition improved significantly. Specifically, I found I was less prone to being angry with my symptoms and with life in general. But then the anger came back as before. Now it sort of waxes and wanes. Is this a form of the extinction burst?
  17. Benjuwa

    Benjuwa New Member

    As I was going though this course my anxiety and pain started getting bad sometimes in different places, different pressures and new fears I keep doing the Somatic tracking which is great to not let the fear take hold. You know after reading this tonight my anxiety changed again and lessened. Thank you so much for this course I know we are on the right track.
    Celayne, James59 and Laleah Shoo Shoo like this.
  18. itmsw

    itmsw Peer Supporter

    Yes, this program really resonates with me in a way that nothing ever has before
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  19. BOP

    BOP Newcomer

    I break the cycle with tapping (EFT). When the pain or the thoughts come, I begin to tap. "Even though I am feeling pain, I fully and completely accept myself and my body. I know these symptoms are temporary and are going away". I just repeat and tap and repeat and tap, until it loses energy. Other times I am like, "Ok pain, bring it on. You don't mean anything. You're leaving soon". You have to take away its power to control. This for me is a muscle I have to constantly strengthen or I will forget and go back to old behaviors.
  20. itmsw

    itmsw Peer Supporter

    Thank you Bop for sharing such an effective way to talk back to the pain!!
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