Episode Behind the Scenes

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According to Ken Biller, the requirement of involving science fiction in this Star Trek story inspired B'Elanna's use of the holodeck to cause the aforementioned self-harm.
The concept of orbital skydiving was reused in this episode, having been featured – with James T. Kirk performing the skydiving – in a scene deleted from Star Trek Generations. Just as the orbital skydiving is in the teaser of this episode, the deleted scene would have been at the start of Generations.
According to Paris actor Robert Duncan McNeill, there was a slim chance that B'Elanna's confidante in this episode would be his character, rather than Chakotay. "I think there was a little bit of fear of getting melodramatic," McNeill reflected, "so rather than let Paris be the one to help B'Elanna deal with these issues, they let Chakotay."
Shortly after Roxann Dawson received the script for this episode, she described the teleplay as "a very nice script for me, with a lot of character development." Moments later, she commented, "It really addresses a lot of B'Elanna's inner demons. It was nice to get back to doing that again, and it should be a good episode." At about the end of the fifth season, Dawson remarked, "It was really great to see some of my ideas about B'Elanna's darker side explored by these writers. I was pleased with the writing. It's always hard to explore a subject like that [....] I think for the most part it really did accurately explore a very difficult quality to put on film, without being trite and without being predictable. I think that they explored this self-destructive nature of hers in a really original way, and I appreciated that. It's also an area that Star Trek doesn't deal with very much. I appreciated their risk, to quote the title, of going there, spending time in a show exploring just one aspect of an emotional nature that had nothing to do with science fiction." In a retrospective interview, Dawson cited the installment as "one of my favorite episodes" and went on to say that this was because she herself had been instrumental in its development. The actress also enthused, "I think they came up with a great episode. And I love the title, 'Extreme Risk', because – with B'Elanna's character being as bold as she was – people wouldn't question her wanting to take risks. It would only be B'Elanna that would know that she's taking these risks to the point of possibly injuring herself and that injuring herself comes from a self-loathing, a self-hatred that she would need to explore. So it became a wonderful physical drama, but also a psychological one, and I think that they explored it very well."