The TIP skills in DBT help you cope with a difficult situation or crisis without making things worse. They represent part of our crisis survival skills. You might use them when flooded with emotion, when in distress, or when you have the urge to engage in a destructive behavior. With the TIP skills, you can capitalize on the mind-body connection by using your body to help regulate your emotions. These skills activate the parasympathetic nervous system, the part of our nervous system responsible for decreasing our arousal (the parasympathetic nervous system opposes the sympathetic nervous system, which activates us, often into “fight or flight”). If you can decrease your physiological arousal, you might be able to decrease your emotional arousal too.
The T in TIP stands for temperature. Here, you use a change in temperature to help regulate your physiology. When you expose your full face (or at least the top portion of your face) to cold water, your brain receives the message that you are diving underwater. This results in what is called the “dive response,” something that occurs in mammals when diving into cold water. With the dive response, your heart rate slows and blood flow is redirected from nonessential organs to places like your brain and heart. What results is a slowing of your system, and these changes in your biology can help you regulate your emotions.
To practice the temperature skill, while holding your breath (if possible), submerge your face in a bowl of cold water (though not too cold – something greater than 50 degrees Fahrenheit), or hold an ice pack on your eyes and cheeks for about 30 seconds, if you can. You can sometimes intensify the response if you bend over while you’re doing this, creating the same posture as if you were diving. After you try the temperature skill, be sure to follow up with another skill, perhaps some distraction or self-soothing. If you go right back to the content that was distressing you, the positive effects won’t last for long. Even so, you might need to repeat the temperature skill. And be sure to check with your medical doctor before trying this activity. The temperature skill can be contraindicated for folks with heart issues and those struggling with eating disorder symptoms.
Intense exercise is the I in the TIP skills. When we’re in distress, our bodies hold tension and energy. Engaging in exercise allows us to release some of this pent up energy and also changes our body chemistry, both which help us regulate our nervous system. Intense exercise can reduce painful emotional states (e.g., sadness, anxiety) and increase positive emotions, like joy. It can also reduce our reactivity to stress. In fact, research has shown that on the days we engage in physical activity, we are less reactive to stress.
With intense exercise, the goal is to engage in physical activity that significantly increases your heart rate (the target being 70% of your maximum heart rate) for a sustained period of time, usually 20-30 minutes or so (though you can still benefit from shorter bouts of activity). For a rough heart rate formula, take the number 220 and subtract your age. Then use 70% of that number (though you can go lower and still experience a positive effect) to get your target heart rate. Here’s a heart rate calculator that takes into account your resting heart rate, allowing for greater specificity.
Just like with the temperature skill, you’ll want to get medical clearance to participate in intense exercise. And for those with eating disorders, it’s important to check with your team to see if intense exercise – or any exercise – is indicated in your case. Finally, it’s important to note that exercise is a privilege afforded to those who are able-bodied.
The first P in the TIP skills is paced breathing. With paced breathing, you’ll do two things. First, you’ll slow your breathing rate down, to about 5-6 breaths per minute. Second, you’ll spend more time on the exhale than you do on the exhale. So, for example, you might spend five seconds breathing in and seven seconds breathing out. The numbers don’t matter as much as the target, that your out-breath is longer than your in-breath. Inhaling increases our heart rate (activating the sympathetic nervous system) and exhaling decreases our heart rate (activating the parasympathetic nervous system), so spending more time in the exhale helps calm us down. There are a number of breathing apps and timers available that can help you pace your breathing. This site (scroll down to the DBT Paced Breathing Skill) allows you to choose the number of breaths you want to take per minute and then offers audio cues for paced breathing practice.
Paired Muscle Relaxation
Paired muscle relaxation is the second P in our TIP skills. To practice this strategy, you tense muscle groups while you breathe in and then relax the muscles as you breathe out. You’ll want to notice the sensations of tension and relaxation as you go through this activity. So for example, you might clench your fists as you breathe in, noticing the tension, and then relax your hands as you exhale, noticing the muscles letting go.
Some people wonder why we tense first when we’re already activated and the goal is release or relaxation. Research shows that tensing and then releasing actually leads to greater deactivation than relaxing alone.
Some folks practice paired muscle relaxation by saying the word “relax” in their minds while they exhale. So they’ll use this word as a mantra while they breathe out and release their muscle tension. If you do this consistently, your mind and body can begin to associate the word “relax” with an easing of tension, and it might be possible to say this word and elicit a relaxation response, even without engaging in the full exercise.
For some, just trying to relax can increase arousal. If this is true for you, keep in mind that tensing and releasing muscles may or may not result in relaxation. The task really is to increase your awareness of muscular tension throughout your body. And you can always stop the exercise if it doesn’t feel like it’s working for you.
Summary of TIP Skills
For all of the TIP skills, it might be useful to rate your level of distress (for example, on a scale of 0-100, where 0 is no distress and 100 is the most distress you’ve ever experienced) before and after using the skill. This will give you a sense of how effective the skill is for you. One of the benefits of the TIP skills is their variety. You might find that one or two of them work better for you than others. Some are accessible in most situations (e.g., paced breathing, paired muscle relaxation) while some require props, ability, space, or time (e.g., temperature, intense exercise). It’s a good idea to practice all of them so that your arsenal is stocked, while recognizing that you might not be able to access everything during a particular crisis or that you might have a preference for one over the others.
To learn more about the TIP skills – and many other coping skills – you might want to consider joining a DBT skills group, where you can learn a host of other skills that can help you tolerate distress, regulate your emotions, and interact with others more effectively.