DBT Distress Tolerance • Part 1

TIPP Skills

Changing your body chemistry to reduce extreme emotion.

Syracuse Integrative Psychiatry

The Emergency Brake

When your emotional arousal is at a 9 or 10 out of 10, you cannot think. Your brain is offline. TIPP skills are designed to physically hack your nervous system—activating the "dive reflex" or burning off cortisol—to bring you down to a 5 or 6 so you can use other skills.

T - Temperature

Tip the temperature of your face with COLD water.

  • Fill a bowl with icy water. Bend over, hold your breath, and put your face in it for 30 seconds.
  • Or, hold an ice pack (wrapped in a thin towel) to your eyes and cheekbones while holding your breath.

Why it works: Triggers the Mammalian Dive Reflex, instantly slowing your heart rate.

I - Intense Exercise

Engage in intense aerobic exercise for a short time (20 mins).

  • Run fast. Do jumping jacks. Burpees. Sprint up stairs.
  • The goal is to get your heart rate UP to match your emotional intensity, then let it come down naturally.

P - Paced Breathing

Slow your pace of breathing. Exhale longer than you inhale.

  • Breathe in for 4 seconds.
  • Breathe out for 6 or 8 seconds.
  • Do this for 1-2 minutes.

P - Paired Muscle Relaxation

Tense muscle groups, then let go.

  • Inhale and tense your fists/shoulders hard. Notice the tension.
  • Exhale and say "Relax" as you let go completely. Notice the difference.
Note: Consult your doctor before using cold water or intense exercise if you have a heart condition or medical issues.