DBT Self Help - TIPP

Distress Tolerance skills are a set of Dialectical Behavioral Therapy skills that are strategies to help you get though difficult feelings and situations, and tolerate (deal with, sit with, accept) the things that you can’t immediately change. Emotions can be extreme and lead to behaviors that are ineffective. You may not be able to change the stressful situation you’re in, but you can change the way you feel. Distress Tolerance skills are aimed to make your response to distress more effective.

TIPP changes your body’s chemistry in order to calm you down during times of distress. TIPP stands for:

  • Temperature
  • Intense exercise
  • Paced breathing
  • Paired muscle relaxation

IMPORTANT: Please be aware of your physical limitations before utilizing this skill. Consult your physician if you have a medical condition or are unsure. Using cold water decreases your heart rate rapidly and exercise increases it. This can be dangerous for those with cardiac conditions, those on beta blockers, those with temperature intolerance, or those struggling with disordered eating.

DBT Self Help - TIPP


Decreasing the temperature of your body can calm you down fast. The best way to do this is with cold water or ice. Try putting your face in a bowl or sink full of cold water or holding an ice pack to your face and neck. You can even take a quick cold shower. You can also hold ice in your hand and watch it melt. Apply the cold for about 30 seconds at a time. Make sure the water isn’t too cold. You don’t want to damage your skin. Even though you are distressed, try to reach Wise Mind in order to prevent yourself from causing further harm.

Intense Exercise

When your body is revved up by emotion, working it out physically can help move that emotion along. Engage in intense exercise for a short period of time. Intense emotions can create physical energy in your body, so expending this energy through exercise can help calm you down. Try doing 20 jumping jacks, sprinting a short distance, going for a jaunty walk or doing any other kind of sport. Again, access your Wise Mind to prevent yourself from pushing yourself beyond what is physically safe.

DBT Self Help - TIPP

Paced Breathing

Breathe deeply into your belly. Slow down the pace of your breathing gradually until you are breathing quite slowly. Breathe out more slowly than you breathe in. The exact counts are up to you but for example, breathe in for a count of 5 and breathe out for a count of 7. Focus on your counts. Imagine exhaling your distressing emotion out with your breath. Slowing your breathing slows your pulse and calms you down.

Paired with Muscle Relaxation

While breathing into your belly, tense your muscles. Squeeze enough to feel tension but not so much to cause a cramp. Notice that tension. While breathing out, let go of the tension. Say the word ‘relax’ in your mind if that helps facilitate relaxation. Notice how your body feels differently after releasing the tension in your muscles. Focusing on your body will not only take your mind off the distressing situation but also change your body chemistry as you tense and relax.


Try at least one of these self-soothing exercises this week. You may want to choose a whole group of things, say all the visual things, or you may want to choose a single thing to try. As you do what you have chosen, do it mindfully. Breathe gently, and try to be fully in the experience, whether it is walking in the woods or watching a flower or taking a bubble bath or smelling some fresh-baked bread.

As you begin to overcome your feelings that perhaps you do not deserve this, or guilt, and start to enjoy one or more of these activities, you will be learning very useful tools to help you deal with negative feelings and difficult situations.

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Additional Resources

Mental Health Resources
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DBT Encyclopedia

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Diary Cards

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