The DBT TIPP Skills

In dialectical behavior therapy (DBT), the distress tolerance skills are those used during periods of intense emotions, difficult experiences or crisis situations, when your primary goal is to “make it through” without making the situation worse.

These DBT crisis survival skills are effective when you are experiencing an intense emotion that feels like it will last forever, when you feel too overwhelmed by an emotion to complete a current task, or when you are worried you might resort to some really ineffective or risky coping behavior.

The first crisis survival skill you learn in DBT will probably be the TIPP skill.

Some DBT skills focus on changing thoughts, others on changing behavior. The TIPP skill is a physiological intervention. This means it is a skill that works through the body. The purpose of the TIPP skill is to change your body chemistry to quickly reduce the intensity of an extreme emotion. As with many of the DBT skills, TIPP is an acronym, and each letter represents a different method for lowering the intensity of an emotion. The TIPP skills can be used to prepare you for an event that may potentially cause you distress or anxiety. The TIPP skill can also be used to lower your emotional intensity after a distressing event.

If we are experiencing an emotion at an intensity of 10 out of 10, we do not have the capacity to use interpersonal effectiveness or emotion regulation skills, we first need to lower the emotional intensity by using distress tolerance skills, like the TIPP skill. The goal is to use the TIPP skill to decrease emotional intensity in a situation, so we can then effectively use other emotional regulation or interpersonal effectiveness skills, and generally proceed effectively, without making a situation worse.

The TIPP skill is actually four interventions. Each letter in TIPP provides a different method of reducing emotion quickly.

T: Tip the Temperature

Also called ice diving, this skill exploits the human “dive response.” There are nerve endings on parts of the face that, when suddenly exposed to cold water, send a powerful signal to the brain and ramp up the parasympathetic nervous system. It is thought this response helps to keep us alive longer, should we fall into cold water. But, we can create this response ourselves by applying cold to the right places.

The result? Your heart rate and breathing slows down as blood flow is directed away from your limbs and towards your heart and brain, calming the body, and then (hopefully) the mind.

To perform this skill, try putting your face in a bowl of cold water while holding your breath, making sure to submerge the area near your temples. You can also try holding an ice pack up to this part of your face, though this doesn't work quite as well. Whichever method you choose, hold for 30 seconds.

In our experience, this skill works really well for about ⅓ of people, ok for about ⅓, and ⅓ of people don’t like it. Try it a few times, and try to figure out which group you fall into.

I: Intense Exercise

Do some type of intense exercise to calm your body when experiencing intense emotion. The duration of the exercise can be short or long, but it must be intense! This helps to burn off excess energy, and can wear you out so much that you don’t have the energy to be emotional. More importantly, it provides an alternative reason for the physiological arousal that comes with emotion. When emotions are high, your body goes into overdrive. Then, engage in some intense exercise. Now, your heart rate is high because you're running, not because you’re upset! When your heart rate returns to baseline after the exercise is over, you may find your emotions subside, at least partially, with it.

One of our favorite forms of intense exercise is a spring tabata. Find an open field, smooth road, and a treadmill. Run as fast as you can for 20 seconds, and rest for 10 seconds. (There are lots of apps and videos to help with the timing). Repeat 8 times. In just four minutes, your emotional outlook might be very different.

P: Paced Breathing

Breathe deeply to slow your breathing pace from your natural pace to about 5-6 breaths per minute. Exhale for longer than you inhale. You may find it helpful to count 5 seconds per inhale and 7 seconds per exhale. Breathe like this for about two minutes. Using paced breathing can help reduce the emotion’s physiological effects, like increased heart rate and sweating.

The best thing about paced breathing is it helps almost everyone, and you can do it anywhere. Driving? In a meeting? Giving a speech? You can use paced breathing, and no one will know. The downside? Paced breathing is hard, and you have to practice for a while before you get good at it. Try just 5 minutes a day for 2 weeks, and you’ll probably be skilled enough to use it anytime, anywhere.

There are many paced breathing apps available. One of our favorites is Virtual Hope Box (on iPhone and Android).

P: Paired Muscle Relaxation

Pairing paced breathing with muscle relaxation calms your body by releasing built-up tension you may not even realize is there. You may find it helpful to start at the top of your head and move down your body, tensing one part of your body at a time. First, breathe in deeply through your nose while tensing your facial muscles for 5 seconds and say in your mind, “I breathe in to be calm”. Then, noticing the tension in this part of your body, breathe out through your mouth while saying, “I breathe in to stay calm” in your mind. Release the tension, and notice how this feels in your body. Repeat these steps for your neck and shoulders, arms and hands, abdominals, thighs, calves, then feet. Like intense exercise, paired muscle relaxation is a way to release built-up energy and tension in your body.

It can be hard to get this skill down at first, so it is important to practice with prompts. Check out our muscle relaxation video here.