Skills Review: Distress Tolerance and TIP/TIPP
Have you ever felt instances of panic or distress coming on and wish you could “snap” yourself out of it? Although there is no switch we can simply turn off in these instances, there are some tools we can utilize to try and help ease these reactions as quickly as possible.
TIP or as some refer to as TIPP is an acronym used to explain a combination of skills used for distress tolerance, which is an important concept of Dialectical Behavior Therapy (DBT). This acronym stands for Temperature change, Intense exercise, Paced breathing/progressive relaxation. This approach can help aid in "tipping" or changing body chemistry quickly when needed. It can also be helpful to practice these tools when you are in a regulated state, so you are more familiar with the process when needed. A disclaimer, however, is that these skills are something to review with your clinician to determine if they would be appropriate for you. You would also want to make sure and avoid harmful extremes of any of these tools that would lead to possible injury.
Below are very basic descriptions of how these tools can be implemented, or you can view this visual-learner friendly video, for more detail: https://www.google.com/search?q=tipp+skills+video&oq=tipp+skills+video&aqs=chrome.0.69i59j0i22i30.1672j0j4&sourceid=chrome&ie=UTF-8#fpstate=ive&vld=cid:a4263140,vid:UV59dv9i_sQ,st:0
Temperature: The use of ice, which could include drinking, holding, or splashing face/body with cold or ice water. You can also use an ice pack on your forehead/ neck. During the winter season (in an applicable climates and weather), you can even utilize snow.
Intense Exercise: Getting your body moving in an intense/vigorous way. This could be taking a few minutes shaking it out, squeezing an arm or leg, jumping in place, marching in place, doing high knees, sprinting, dancing etc.
Paced Breathing: Some basic breathing techniques that can be helpful are deep belly breathing (engaging your diaphragm), five finger (or star) breathing, and four corner (or square) breathing. There are many breathing technique examples online if you wanted to see demonstrations, wanted guidance, or wanted to explore other options that better resonate with you.
Progressive Relaxation: Progression can be from head down or toes up or start with body parts that specifically need attention. Begin by noticing the tension in your muscle followed by tensing up that muscle as much as you are able while you inhale and exhale. You can say the word ‘relax’ in your mind or out loud and then release the tension. Stay attuned to how much more relaxed the muscle feels now. There are also many examples along with guided progressive muscle relaxation online or in phone apps.
Please contact info@acbmt.com if you are interested in learning more about TIP/TIPP skills, distress tolerance, DBT, or exploring other coping skills with one of our qualified professionals.
Christine Perkins, MSW, SWLC
References
Linehan, M. (2015) DBT Skills Training Manual. (Second Edition). Guilford Press.
Pederson, L. (2017) The Expanded Dialectical Behavior Therapy Skills Training Manual. (Second Edition). PESI Publishing and Media.