By Amanda Polster, LMSW
Do you ever experience deep and intense emotions that are so challenging that you find yourself at a loss for how to manage them? You might even have thought that “there is no way out” and you won’t be able to overcome these overwhelming and agonizing experiences.
We all have gone through stretches of time where we experience overwhelm and gloom, but when these emotions linger for long periods of time, they can have repercussions on our overall health and quality of life.
Distress tolerance skills, also known as crisis survival skills, support us when we are feeling intense emotional pain. Distress tolerance skills can help us cope in moments of extreme discomfort to bring us back to a more balanced state.
In times when we are experiencing intense escalation of emotions, it is normal to try to self soothe with strategies that might help us in the moment, but can have harmful consequences. Some common self soothing strategies that can help us relieve pain immediately but do not resolve, and might actually make these problems worse, include using substances, binge eating, gambling, excessive or unsafe sexual practices, and/or self harming behavior.
Distress tolerance techniques seek to provide us tools to help us relieve pain immediately AND keeping us safe and healthy in the long run.
Distress Tolerance Tool: TIPP
Mindfulness practices are at the core of distress tolerance tools due to their focus on using body sensation awareness as ways of coping in the present moment. A very helpful distress tolerance tool that is used universally to help calm us down when we are at an escalated emotional state is called TIPP. TIPP is a creative acronym for different body awareness techniques we can use to help us de-escalate and get back to a more balanced state. TIPP stands for Temperature, Intensive Exercise, Paced Breathing, and Paired Muscle Relaxation.
T for Temperature
Temperature in the TIPP distress tolerance technique is most often used with ice or cold temperatures. For this practice, try holding an ice pack or a cold towel over your face for 30 seconds. This technique will trigger your mammalian diving reflex, a natural reflex in mammals that is triggered by cold water sensations. When this reflex is stimulated, our body chemistry changes - “our heart rate drops down immediately and our parasympathetic nervous system is activated to prompt a relaxation response” (Sevlever, 2019).
*It is key to keep the water above 50 degrees Fahrenheit to ensure a safe temperature for the body during this activity.
I for Intensive Exercise
Emotion is created by motion. Whatever you’re feeling right now is related to how you are using your body” ~Tony Robbins
Intense Exercise can be intimidating. For this activity, any change in body movement can help shift our current state of emotions. Physical activity has been proven to reduce anxiety and depression, and improve self-esteem. Similar to the temperature technique, intensive exercise has proven to change brain chemistry - exercise naturally releases endorphins that act as organic painkillers and help minimize discomfort in the body (Domonell and Burn, 2016). Examples of intense exercise ranges from doing a full workout routine to doing 25 jumping jacks just to get our bodies moving and heart rates beating faster.
Paced breathing is a mindful method of relaxation that helps us be intentional and aware of our breath in the present moment. When we breath quickly, we send a signal to our brain that something is wrong, which can cause us to feel threatened and scared. When we begin to slow our breath down with paced breathing, we send a counter signal to our brain that everything is ok, allowing our bodies to relax and feel calm. A common paced breathing exercise is belly breathing for 4 seconds in and 6 seconds out. We can take a few moments here to practice paced breathing: Placing one hand on your belly and one hand on your heart, gently count as you slowly breathe in 1, 2, 3, 4 seconds and slowly breathe out 1, 2, 3, 4, 5, 6 seconds. During this exercise, notice the belly expand as you breathe in for 4 seconds and contact as you breathe out for 6 seconds.
Paired Muscle Relaxation
Paired muscle relaxation is a mindfulness technique to help us notice changes in our bodies when we tense up and relax our muscles. Tensed muscles are typically a physical sign that we are feeling emotional tension as well, like stress and overwhelm. Releasing tensed muscles and relaxing them can help our bodies and minds begin to relax together. This practice can be paired with paced breathing; while breathing in deeply for a count of 4, slowly begin to clench your fists. As you breathe out for a count of 6, slowly begin letting go of the tension in your hands. Notice any difference you feel after releasing the tension. This exercise can be practiced will all different paired muscle groups in the body - hands, feet, legs, arms, etc.
It is normal to prefer some of the TIPP techniques over others. It is also normal for these practices to take time to fully work in helping us calm down, which is why they are called practices. These techniques take practice to work, and the more we are dedicated to using them in times of distress, the more effective they will be in relaxing us in the present moment and helping us build safer and healthier lives.
Sevlever, Melina. 2019. Dialectical Behavioral Therapy (DBT) Distress Tolerance Skills: TIPP Skills. Manhattan Psychology Group, PC.
Domonell, Kristen and Daily Burn. 2016. Why Endorphins (and Exercise) Make You Happy. www.cnn.com.