Extinction Burst: Ending the Self-Harm Addiction
When it comes to a mental health condition like Borderline Personality Disorder, the proverbial line ‘It will get worse before it gets better’ is sometimes true.
When a person makes the first tentative steps towards recovery, it may appear that they are in the grip of a relapse. An upsurge in problematic behaviours — substance abuse, promiscuity, impulsivity, as well as self-harm and suicide attempts — can take hold. It naturally leads many family members, friends and therapists fearing the worse. However, in some cases it actually heralds improvement.
The extinction burst is a term from behaviourism to describe what happens, when you seek to eliminate a behaviour by refusing to reinforce it. Don’t add fuel to the fire, stop fanning the flames. It’s possible to heal yourself from maladaptive patterns of behaviour, by paying close attention to the environment in which they take place. With mindfulness and opposite action we can learn to cool down.
Ivan Pavlov the Russian psychologist was the first to identify classical conditioning. Every stimulus elicits a response. Using dogs as his subjects, Pavlov observed, not only did they salivate when they tasted food (an instinctual response) they salivated more, whenever they observed the technician who fed them (a learned response). They had been conditioned to pair food with the worker, and drooled accordingly. We are formed and shaped by habits.
B.F. Skinner took this a stage further when he defined operant conditioning. He was concerned with humans and animals changing behaviour in alignment to positive or negative conditions. The ‘Skinner Box’, housed rats, that learnt by flipping a lever in the vicinity, food would be dispensed. This led to the repeat behaviour of flicking the switch. The switch was an operant condition and reinforcer for the rats, because it led to a reward. Skinner believed the rats could also learn by punihsment. If the rats were to receive an electric shock everytime they pressed the lever, they would learn to stop pressing it. It could in fact lead to the extinction of a behavior all together. Behaviours are shaped by positive and negative reinforcers, or by punishers, and this had important implications for psychotherapy.
A behavioural approach to Borderline Personality Disorder, starts with the recognition that emotional distress is real, and maladaptive behaviours are attempts to cope with overwhelming pain.
If a person frequently self-harms, it’s likely they’ve been conditioned to act this way and have learnt this behaviour from environmental triggers. In turn it is an act which is bound to generate a response. If an individual self-harms and seeks out Emergency Room treatment because they believe they can be rescued, a positive reinforcer is the care and attention received from compassionate staff. It means the behaviour is more likely to be repeated, because it generates a favourable result.
From my experience doctors and nurses are rarely compassionate to self-harm injuries. So if that same person ends up in A&E and is treated with contempt they are less likely going to want to come back. The behaviour has elicited a response which is felt as a punishment. Repetition is now less likely because of an unfavourable outcome.
However what happens if we have a person who has experienced a trigger, feels intense emotional pain, but refuses to act on it? The answer is extinction. In the short term, not acting on a self-harm urge, leads to the temporary intensification of the pain; this feels like a punishment. However, not acting on a self-harm can also lead the extinction of the urge, or if not at least the behaviour that usually comes with it. If we self-harm but people refuse to respond it can also lead to the extinction of behaviour as well. This is a powerful tool for recovery.
However, sometimes extinction is something that we don’t choose, but others force upon us as a new condition. Families cut us off, and whether this is out of kindness or negligence, the affect is that we are made to suffer. Nevertheless even if we are pushed into exile we can make it to our own benefit.
Borderline Personality Disorder emerges in the family environment. In fact in many ways it is a diagnosis uniquely bound and dependent on family links. Habits become character. Combine habit with the effects of trauma, which leads to the ‘repetition compulsion’ (the need to relive old stories a means to master them) then we have a powder keg situation. Borderline Personality Disorder is created and sustained by the environment. They say the first way to recover from trauma, is by the establishment of safety. Voluntary or forced withdrawal from the conditions which create it, leads to stability and long term health. However it safety is another word for extinction. Before this comes the burst.
Perceptual control theory states, human beings naturally input the right amount of action to generate the right amount of reward. When a discrepancy emerges in the operant conditions, then human beings naturally put in more effort because they believe it must eventually produce the same result. When it doesn’t the intensification of behaviour occurs, because the brain on a behavioural level, believes that whatever are doing must eventually work. As a result behaviours increase, before they decrease. You have to get worst before you can get better.
Of course, there is a strong objection to all this, namely human beings are much more complex than theories. The fact is people with Borderline Personality Disorder, can and do commit suicide, and its very likely the worst harm will occur in the extinction burst. Its very easy to escalate self-destructive behaviours if the reinforcers are taken away. However, if both the family member and the individual engaged in the behaviour have the strength to hold on, then the brain will catch up with the mind’s desire to get better, and behaviours will stop. The extinction burst will cause a flurry of activity then die out. The fire extinguishes itself, the flames turn to cinders the cinders turn to ash.
The extinction burst is scary and therapy can help with this. While we all know about behavioural conditioning, when you put real people in the mix, with all their subjective feelings of pain, distress and bewilderment, not to mention motives, memories and ambitions, you have a volatile mix, which could explode. Tough love is not the way to end BPD, and from my experience it can generate such a powerful counter reaction that all positive work is undone. Nevertheless, if we reframe extinction as establishing safety, we’ll be able to see whether forced or voluntary being out of a situation, and away from triggers we are doing a kindness for ourselves which will make us better. The operant conditioning will unravel, habits will be broken, life can begin anew.