Distress Tolerance Series # 2 TIP Skills

Distress Tolerance Series # 2 TIP Skills

If you haven’t already checked out the blog posts on 5 Ways to Handle a Crisis and What the Heck is Distress Tolerance, they are linked here in case you want more information.

The TIP skills are for managing extreme emotional arousal and will be described in more detail in the acronym below. These skills help to literally change your body chemistry in order to reduce high emotional arousal. TIP skills work to regulate our nervous system and bring our body back to a more neutral state. These skills are great for those times when your mind is racing, your heart is pounding, you are out of breath, your muscles are tense, and are thinking about doing something impulsive (like throw your phone, yell at your partner, etc.).

It is super important to regulate our bodies when distressed as our mind and body are constantly communicating with one another.

When you are breathing heavy and have tensed muscles, it sends the signal to your brain, “We are not ok!,” “Prepare for attack!” and puts you in a fight or flight stance. We are not great problem solvers when in a fight or flight stance.

If instead, we can help to relax the body with the following strategies and regulate our breathing and unclench our muscles, it sends a different signal to the brain. Now the body is saying to your mind, “It’s all cool here,” “We got this.” From that space you now have more options for solving the problem at hand rather than acting out of crisis.

As always, different skills may work better for different people. Make sure to try them all when you are in a neutral or relaxed state so that you know which ones work best for you and you do not have to learn a new skill when you are already distressed.


Tipping the temperature of your face with cold water triggers the “dive response,” which is the reaction the body has to being immersed in water without oxygen. This works by increasing the body’s activation of the parasympathetic nervous system (or the relaxation response).

There are several ways you can utilize this skill:

  • Using a bowl of cold water: hold your breath and dip your face into the bowl up to your temples while holding your breath for between 30-60 seconds. The colder the water and the longer you spend immersed, the better the skill works.
  • Using an ice pack: hold an ice pack or a bag filled with ice in a cloth over your eyes and upper cheeks. The effect is increased if you also bend over and hold your breath at the same time.
  • Splashing cold water on your face is a good option if you do not have access to an ice pack or need a quick solution.

*Using the dive reflex with cold water can reduce your heart rate rapidly, thus it is not recommended for any individuals with a heart disorder, low heart rate due to medications, or other medical complications.


Exercising intensely for at least 20 minutes can have a drastic effect on mood by decreasing negative thoughts and increasing positive feelings.

The reason that exercise works to regulate the body is that the purpose of emotions is to prepare people to act. For example, fear might prepare us to run away from a negative situation or anger might prepare us to fight.

When we are in an intense emotional state, we are ready to act, even if that action might not be the best one. By exercising and expending some of that energy you bring the body back to a more neutral state so that you can act in a more effective way afterwards.

This can be any exercise of your choice, but here are a few examples:

  • Walking at a quick pace
  • Running
  • Hiking
  • Biking
  • Kickboxing
  • Lifting weights
  • Yoga
  • Body weight exercises such as squats or pushups
  • Dancing
  • Walking or running up and down stairs


Paced breathing refers to focusing on your breathing and regulating your in and out breath to a certain pace. The goal is to breathe in and breathe out more slowly while counting. Ideally, the out breath should be longer than the in breath, as this helps to regulate the nervous system. Try focusing on your breath for one minute; breathing in for a count of 5 and out for a count of 7.

If you are a visual person the YouTube video linked here is great for helping to regulate your pace.

There are also great phone apps to have on hand whenever you need such as Breathe2Relax, which is linked here.



Paired Muscle relaxation involves tensing various muscle groups and then pairing relaxing your muscles with breathing out.

I always love teaching this skill because the opposition between your muscles tensing and then relaxing actually allows you to relax. If I just told you to relax your muscles, you would be like, “I am relaxed!,” but in fact your muscles are likely holding a lot of tension and stress, especially during emotionally charged times.

While you can’t just relax your muscles by telling them to, you can get them to relax in opposition to tensing them.

The task is to tense muscle groups while breathing in and then relax each group, letting go of the tension, while breathing out.

The following is a script you can use, and I will also link to a video that explains this concept as well. I find that listening to or watching a video of paired muscle relaxation allows me to better engage in the activity than when I am reading the script and trying to practice at the same time.

Tense the following muscle groups for 5-10 seconds each while breathing in and then release while breathing out for 5-10 seconds:

  • Hands and wrists: make fists with both hands and pull fists up to your wrists
  • Lower and upper arms: make fists and bend arms up to your shoulders
  • Shoulders: pull your shoulders up to your ears
  • Forehead, face, and lips: pull eyebrows close together and scrunch up your face
  • Eyes: shut eyes as tightly as you can
  • Neck: push head into a chair, the floor, or the bed, or push your chin into your chest
  • Chest: take in a deep breath and hold it
  • Back: arch your back and bring shoulder blades together
  • Stomach: tense your stomach as if you are about to be punched
  • Buttocks: squeeze buttocks together
  • Upper legs and thighs: point your legs out straight and tense your thighs
  • Calves: point your toes down
  • Feet: curl your toes under and squeeze


Here are two videos that I like to use for this exercise:




Tune in next week for the next skill in the Distress Tolerance Series, ACCEPTS skills.


Thank you so much for tuning in for the Distress Tolerance Series! I hope these skills are helpful to you right now and for a long time to come. Skills practice is not a replacement for professional help. If you are struggling with depression, anxiety, or other mental health concerns I encourage you to seek out professional help. ACTivation Psychology offers individual therapy for adolescents and adults struggling with anxiety, depression, transitions, Autism Spectrum Disorders, and other mental health concerns. Telehealth services are available during this time for individuals in the state of Colorado. Please remember that you do not have to struggle alone!


*The above is adapted from Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press. Please see the full text for more resources*



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