Distress Tolerance Skill - TIP

When experiencing intense negative emotions, it’s not uncommon to feel like “this will never end” or “this will last forever.”  It’s not surprising that when in this distressed state of being, one might resort to the use of unhealthy coping mechanisms (like binge eating, use of illicit drugs, self-harm) in an effort to self-soothe.  Dialectical Behavioral Therapy (DBT) founder Marsha Linehan developed distress tolerance skills that are easy to access and straightforward to help people use more adaptive, less destructive strategies when in crisis.

 As a Distress Tolerance tool, TIP skills are primary and vital. TIP is an acronym that stands for Temperature, Intense Exercise, Paced Breathing, and Progressive Relaxation.  This skill asks that we change our body chemistry to regulate our emotions and our behavioral responses.

 T: Temperature. Think back to the last time you dove into a cold pool or body of water.  You may recall the sensation of slowly cutting through the water with your arms, and a feeling of slowed time as you drifted up toward the surface. As we dive face first into cold water, our heart rate slows and our breathing regulates as the body prepares to conserve energy for survival. We have engaged our parasympathetic nervous system and experience a calming effect.  Next time you feel highly activated, distressed, upset, and/or angry, try running cold water on your forearms or face, taking a cold shower, chewing on ice or putting an ice pack on the back of your neck. When we briefly change our temperature, we ground ourselves in the present moment and refocus.

 I: Intense exercise or brief bursts of exercise is helpful in “using up” some of the energy that may be fueling high-energy emotions like anger or anxiety. When in a low-energy state  (feeling down, depressed, lethargic) getting the heart rate up will invigorate us.   

P: Paced breathing allows us to activate our parasympathetic nervous system as we regulate and slow our breath. With paced breathing, we breathe deeply into our lungs and diaphragm. As we slow the pace of our in-breaths and out-breaths, we may achieve 5-6 thoughtful breaths per minute.  The use of breathing techniques cannot be stressed enough as breathing is a highly accessible skill – available to you at all times no matter where you are – and one that can be very effective to calm and steady you when an emotion is riding high.

 P: Progressive Muscle Relaxation is paired with paced breathing.  With paced breathing we tense and relax muscle groups throughout the body to promote a relaxing effect. If you are feeling extreme emotion, you may try mindfully tensing all of your muscle groups at once… and then dropping your weight back into the ground or into your chair. As you travel from head to toe engaging all of your muscle groups simultaneously or one area at a time, pay close attention to the sensations in your body. 

Overall TIP is a highly effective strategy to emotionally regulate and lower intense, unpleasant emotions.  If you would like to learn more about how DBT skills can help you, feel free to connect with me at 262-607-0070.