When emotions are out of control, you can use TIPP skills to bring down the intensity. There are four TIPP skills described in dialectical behavior therapy (DBT). Using them in a crisis can calm things to the point that we can then use other coping skills. They are presented first in summary form, and then with more detail below.
Temperature — by changing our body temperature, we can quickly decrease the intensity of an emotion. Dip your face in cold water (not less than 50 degrees) and hold your breath. Try to hold it there for 30 to 60 seconds. (Do not attempt this TIPP skill if you have cardiac problems.) If that’s not feasible for you, try an ice pack on your face around your eyes and cheeks.
Intense exercise – by engaging in intense cardio/aerobic exercise, we engage our physical body in a way that de-escalates intense emotions. Ideally, try to exercise for 20 minutes or more, but if that’s not possible, do what you can. Exercise so that your heart rate is 70% of its capacity. You can use this calculator to compute your target heart rate.
Paced breathing – try to slow your breathing down to 5 or 6 breaths per minute. This means that your inbreath and outbreath put together should take 10 to 12 seconds. To help you do this, a timer or app can be very helpful. Try using the “Paced Breathing” app for android (configure this ahead of time for your desired pace of breathing) or the Breathing App for iPhone.
Paired muscle relaxation – practice tensing your muscles as you breathe in for 5-6 seconds. Notice that feeling. Then relax them as you breathe out, paying attention to how that feels as you do it. Notice the difference between the feeling of tension and the feeling of relaxation. Go through each muscle group in the body (list can be found below) and tense then relax each one. As you relax a muscle group, say to yourself, “relax.”
Further helpful information on the TIPP skills
DBT TIPP skills can be lifesavers. Sometimes emotion is so intense it takes away our ability to use our other coping skills. TIPP (or TIP) skills won’t take the emotions away altogether. However, they help take the intensity down to a level where we can make use of the other things we typically do to cope with difficult situations and feelings. Below is more detailed information about each skill.
Putting your face in cold water helps ease intense emotion by triggering what’s called the mammalian dive reflex. (See video below.) This reflex slows our heart rate and activates our parasympathetic nervous system. Emotion is something we often experience with our bodies. With this TIPP skill, we use use our bodies to change our emotions.
If you use an ice pack on your face instead of cold water, try holding your breath at the same time to more fully stimulate the dive reflex.
To get the most out of this DBT TIPP skill, write down your level of emotional intensity (rate it from 0 to 100) before you exercise and then afterward. See what the difference is. Pick a type of exercise that’s available immediately — remember, the TIPP skills are meant for help with managing emotions now, not later.
One of the essential functions of emotions is to prepare us for action. When emotions are intense, the body is primed for intense activity; intense exercise can release that part of the emotional experience.
Just as with the temperature TIPP skill, paced breathing works by activating our parasympathetic nervous system. This, in turn, will slow our heart rate and decrease emotional intensity.
Breathe into your belly to allow for a deeper and slower breath cycle. Plan to do this exercise for at least five minutes; don’t give yourself the option to stop early. Before you start, just like you did with exercise, write down your level of emotional arousal by rating it from 0 to 100. After five minutes, take stock of how different you feel from when you started.
Paced breathing in DBT can be thought of as a mindfulness skill. However, unlike most mindfulness exercises, this one does not require you to do anything specific with your mind. It’s a physical exercise, not a mental one.
Paired muscle relaxation:
Paired muscle relaxation is a DBT TIPP skill that improves with practice. It’s helpful to practice it when you’re not in an intense emotional state. That way, when you really need the skill, it will already be well rehearsed.
It’s important to say “relax” to yourself as you exhale and relax your muscles. This is where the “paired” in “paired muscle relaxation” comes in. By saying “relax” to yourself, you’re pairing that word with the feeling of relaxing. This will help your ability to relax at times when you need to.
This skill is practiced by going through muscle groups in sequence, tensing then relaxing one at a time. Go through each of the following muscle groups:
- hands (make fists)
- arms (make fists and tense your forearms, biceps and triceps)
- shoulders (raise shoulders up as high as possible)
- forehead (wrinkle your forehead, lowering eyebrows)
- eyelids (shut them tightly)
- face (scrunch up nose and raise lips and cheeks)
- tongue and mouth (distort muscles around mouth, push tongue against roof of mouth)
- neck (push chin down toward chest)
- chest (take deep breath and hold it)
- back (arch your back)
- stomach (tense abdominal muscles)
- buttocks/glutes (squeeze together)
- thighs (tense quads and hamstrings)
- calves (point toes downward)
- ankles and feet (curl toes, heels out)
TIPP skills are what DBT recommends to survive a crisis. Use them when you need them, and once you do you’ll be able to cope more effectively.
Linehan, M. M. (2015). DBT Skills Training Manual, 2nd edition. Guilford Press. New York.