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

Exposure Therapy in a Public Bathroom

In this episode of Breaking the Rules, we record from an unusual location — the bathroom floor of a public restroom — as we explore an increasingly popular social media trend: “clean girl culture.” Across platforms like TikTok and Instagram, the clean girl aesthetic promotes a polished, minimalist lifestyle — natural makeup, tidy wardrobes, “clean” eating, and curated routines that appear effortless and healthy. But when does a healthy routine become rigidity, anxiety, or compulsive behavior? In this conversation we unpack how trends like clean girl culture can blur the line between wellbeing and preoccupation, and how certain aspects of the aesthetic can overlap with OCD patterns, particularly around contamination, checking, perfectionism, and the need for control. We also explore the broader question clinicians and individuals often face: how do we know when something has gone too far? In this episode we discuss: * What “clean girl culture” is and why it’s trending on social media * The appeal of curated lifestyles and polished aesthetics * When healthy habits start becoming rigid or anxiety-driven * Parallels with orthorexia and other wellness trends * How social media trends can reinforce perfectionism and control * When checking, reassurance seeking, and contamination fears creep in * How compulsive behaviours can sometimes hide behind socially rewarded habits * The importance of flexibility, connection, and values when evaluating lifestyle choices * Questions clinicians can ask when assessing whether a habit has become unhealthy * Ultimately, this episode isn’t about criticising trends — it’s about helping people reflect on the “why” behind their behaviours and recognizing when something that started as self-care begins to shrink a person’s life instead of expanding it. 🔖 Chapters 00:00 Recording From a Public Bathroom 01:30 Using Location as an Exposure Exercise 03:00 Introducing Clean Girl Culture 05:00 The Appeal of Polished Aesthetics 07:00 When Wellness Trends Go Too Far 09:00 Orthorexia and the Pursuit of Health 11:00 Perfectionism, Checking & Social Media 13:00 How OCD Can Hide Behind Trends 14:30 When Habits Start Shrinking Your Life 16:00 Values, Flexibility & Mental Health 17:30 Questions to Ask Yourself or Clients ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

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 ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

What Exposure Therapy Actually Feels Like (The Mentos/Jelly Bean Exercise)

In this episode of Breaking the Rules, we do something a little different — we guide you through a live experiential exercise used in therapy to demonstrate how Exposure and Response Prevention (ERP) actually feels in the moment. Using a simple jelly bean (or Mentos), we walk through an exercise that highlights one of the most important lessons in OCD treatment: the urge to escape discomfort can be powerful, but it can also be tolerated. Through this exercise, we explore how quickly the mind and body react to discomfort, how intrusive thoughts and urges show up, and how reconnecting with meaning and values can shift our relationship with those experiences. Experiential exercises like this are commonly used in ACT, DBT, and ERP therapy because they allow people to learn through doing, rather than just talking about the skills intellectually. In this episode we discuss: * What experiential exercises are and why they are powerful in therapy * Why learning skills during calm moments is different from using them during triggers * The Mentos (or jelly bean) exercise used to simulate urge surfing and response prevention * What happens in the mind and body when discomfort rises * Intrusive thoughts, urges, and the instinct to escape discomfort * The role of meaning and values in increasing distress tolerance * Why acceptance changes our relationship to discomfort, not the discomfort itself * How clinicians can use this exercise with clients, families, and teen group. 🔖 Chapters 00:00 Introduction – Doing Something Different Today 02:00 What Is an Experiential Exercise? 04:00 Why Experiential Learning Matters in ERP 06:00 The Mentos (Jelly Bean) Exercise Begins 08:00 Surfing the Urge to Swallow 10:00 Intrusive Thoughts and Rising Discomfort 11:30 Debrief: What Happened During the Exercise 14:00 Acceptance and Changing Your Relationship to Discomfort 16:00 Intrusive Thoughts, Images, and Urges 18:00 Using This Exercise With Clients and Families 20:00 Teaching ERP Through Experience ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

OCD and Productivity: The Struggle Behind the Scenes

In this episode of Breaking the Rules, we explore one of the most frustrating and often misunderstood impacts of OCD - how it interferes with studying, productivity, and performance at work. For many people, OCD hides behind traits that are often praised: diligence, responsibility, perfectionism, and attention to detail. But beneath the surface, what may look like hard work or conscientiousness can actually be hours of painful compulsions, paralysis, and mental exhaustion. We unpack how OCD shows up in school, university, and the workplace — from endlessly rewriting emails and rereading textbooks, to missed deadlines, avoidance, and overwhelming fatigue. We also discuss how these patterns can sometimes be mistaken for ADHD, learning difficulties, or lack of motivation, making accurate assessment and treatment even more important. Most importantly, we share practical strategies clinicians and individuals can use to support functioning while treating the underlying OCD. In this episode we discuss: * Why OCD often becomes most visible in study and work environments * How compulsions like checking, rereading, researching, and reassurance seeking sabotage productivity * The difference between perfectionism and OCD paralysis * Why OCD is often misinterpreted as ADHD or executive dysfunction * The emotional toll of feeling “ineffective” despite working incredibly hard * Strategies for managing compulsions while studying or working * Setting limits around checking, researching, and rewriting * Learning the practice of “good enough” * Rebuilding trust in your own judgement after OCD * Using values to guide action when motivation disappears 🔖 Chapters 00:00 Welcome Back – Recording Post Baby 03:08 How OCD Shows Up in Study and Work 05:30 The Hidden Nature of OCD Productivity Struggles 08:20 Email Checking, Reassurance & Workplace Compulsions 10:00 OCD Paralysis vs Normal Perfectionism 12:00 How OCD Impacts Teens and Students 13:45 When OCD Is Mistaken for ADHD 17:00 Assessing Functional Impact in OCD 18:30 Strategies for Studying With OCD 21:00 Attention Redirecting & Mindfulness 22:30 Practicing “Good Enough” 24:00 Limiting Checks, Research & Reassurance 25:30 Rebuilding Trust in Yourself 27:00 Using Values to Guide Action 29:20 Final Thoughts ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Perfectionism, Process-Based Therapy & The Anxious Perfectionist

In this episode of Breaking the Rules, we’re joined by researcher and clinician Dr. Clarissa Ong to unpack the complex relationship between perfectionism, anxiety, and OCD — and to explore how process-based therapy, particularly ACT, offers a powerful lens for understanding and treating these patterns. Drawing on her research and her book The Anxious Perfectionist, Clarissa helps us move beyond surface-level symptoms and into the underlying processes that drive rigidity, rule-following, self-criticism, and all-or-nothing thinking. We explore perfectionism not as a simple personality trait, but as a pattern of inflexible rule-governed behaviour — one that can show up across OCD, generalized anxiety, depression, eating disorders, and beyond. The conversation dives into how values can become fused with perfectionistic rules, how therapy itself can become “a thing to perfect,” and why flexibility — not flawless performance — is the real treatment target. 💬 Key themes: • Perfectionism as rigidity around internal rules and standards • The overlap between perfectionism, OCD, and generalized anxiety • Why perfectionism is often more process than diagnosis • ACT vs CBT in the treatment of perfectionism • Experiential work vs intellectualizing in therapy • How values can become hijacked by perfectionism • The “all-or-nothing” trap and treatment drop-off • The role of context in determining helpful vs unhelpful striving • Therapist perfectionism and projected expectations • Letting go of the need to be liked This conversation is especially valuable for clinicians wanting to deepen their formulations beyond symptom reduction and into process-based change. https://www.melbournewellbeinggroup.com.au #perfectionism #ocd #anxiety #acttherapy #processbasedtherapy #theanxiousperfectionist #clinicalpsychology #mentalhealthprofessionals #psychologicalflexibility #therapistlife #cbt #acceptanceandcommitmenttherapy #ocdrecovery #valuesbasedliving #mentalhealthpodcast ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.