Using the T.I.P.P.
Technique to Manage Distress
Objective
To reduce distress using the T.I.P.P. technique.
What to Know
When you’re experiencing intense emotions, you can use the Dialectical Behavior Therapy
(DBT) Distress Tolerance T.I.P.P. technique to reduce your distress about difficult situations.
Using this technique in a crisis can calm you down enough to tap into other coping skills and
respond to stress more effectively. This tool, which changes your body chemistry, helps you
manage difficult feelings and situations, and tolerate (deal with or accept) things you can’t
immediately change. The four T.I.P.P. tools are:
Temperature. When you change your body temperature, you can quickly decrease the intensity
of an emotion and how it feels in your body. Try:
• dipping your face in a bowl of cold water (50° or higher) and hold your breath for 30 to
60 seconds. (*do not attempt this skill if you have heart problems)
• putting an ice pack on your face around your eyes and cheeks
• taking a brief cold shower
• holding an ice cube in your hand and watching it melt
Doing these activities helps ease intense emotions by triggering the “mammalian dive reflex,”
which slows your heart rate and activates your parasympathetic nervous system.
Intense exercise. By engaging in intense exercise, you engage your physical body in a way that
de-escalates intense emotions. Exercise for 20 minutes or more so your heart rate is 70% of its
capacity. Calculate your target heart rate here ([Link]
Expending the energy from intense emotions through exercise can calm you down. Try:
• doing 20 jumping jacks
• sprinting a short distance
• going for a brisk walk
• doing any intense sport
Avoid pushing yourself beyond what’s physically safe for you.
Paced breathing. Take 5 or 6 breaths per minute to slow your pulse and activate your
parasympathetic nervous system. To help you do this, use a timer or app like the Paced
Breathing app or the Breathing app. Breathe deeply into your belly and slow down the pace of
your breathing gradually until you are breathing very slowly. Breathe out more slowly than you
breathe in. For example, breathe in for a count of 6 and breathe out for a count of 8. Imagine
exhaling your distress out with your breath. Do this exercise for at least five minutes.
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Paired muscle relaxation. Practice tensing your muscles as you breathe into your belly for 5-6
seconds, then relax them. Say “relax” as you breathe out and release the tension. By saying
“relax” to yourself, you’re pairing that word with releasing tension. Notice the difference
between tension and relaxation as you move through each muscle group in the body. Focusing
on your body will distract you and change your body chemistry as you tense and relax. Practice
this skill when you’re not feeling intense emotions. Go through each muscle group, tensing then
relaxing one at a time:
1. Hands (make fists)
2. Arms (make fists and tense your forearms, biceps, and triceps)
3. Shoulders (raise shoulders up as high as possible)
4. Forehead (wrinkle your forehead and lower your eyebrows)
5. Eyelids (shut them tightly)
6. Face (scrunch up nose and raise lips and cheeks)
7. Tongue and mouth (pretend you tasted something sour and push tongue against
roof of mouth)
8. Neck (push chin down toward chest)
9. Chest (take a deep breath and hold it)
10. Back (arch your back)
11. Stomach (tense abdominal muscles)
12. Buttocks/glutes (squeeze together)
13. Thighs (tense quads and hamstrings)
14. Calves (point toes downward)
15. Ankles and feet (curl toes and press heels out)
Note: Please be aware of your physical limitations before doing any of the above skills! If you’re
unsure, ask your doctor. Using cold water rapidly decreases your heart rate and intense
exercise increases it. This can be dangerous if you have a heart condition, use beta blocker
medication, or have temperature intolerance.
What to Do
First, describe a situation that causes you distress. Be as detailed as possible.
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Next, choose one of the T.I.P.P. tools to practice each day for one week. Each time you practice,
imagine the above situation, and deeply connect with the emotions you feel.
Check off which tool you’re going to use each day. If you wish, try more than one.
____ Temperature
____ Intense exercise
____ Paced breathing
____ Progressive muscle relaxation
Use the following chart for one week to write about your experience with the T.I.P.P.
technique. Note the date and the level of emotional distress before and after the exercise. Rate
your distress on a scale from 0 to 10, where 0 = no distress, to 10 = the worst distress I’ve ever
experienced. Describe which tool you practiced.
Date Emotional Tool used Emotional
distress before distress after
1-10 1-10
Did this technique help you manage distress? Why or why not?
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What was your favorite tool? Why?
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Reflections on This Exercise
What did you learn from this exercise that you didn’t know before?
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How helpful was this exercise? _____
(1 = not very helpful, 5 = moderately helpful, 10 = extremely helpful)
What can you do differently to make progress in this area?
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