Distress Tolerance TIPP Skills

A Guide for Enhancing Distress Tolerance


In the realm of mental health and wellness, Dialectical Behavior Therapy (DBT) stands out as a well-researched and effective approach, particularly for individuals grappling with intense emotions. One of the pivotal components of DBT is the TIPP technique – a distress tolerance skill designed to manage acute emotional distress. This article delves into the TIPP technique’s application, its scientific underpinnings, and its connection with DBT’s mindfulness skills, providing a comprehensive guide for individuals seeking to incorporate this technique into their health and wellness plans.

What is the TIPP Technique?

TIPP stands for Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation. It is a set of immediate coping strategies aimed at reducing extreme emotional arousal and helping individuals regain control over their emotional state.

When to Use TIPP

The TIPP technique is most effective when:

  • An individual is experiencing overwhelming emotional distress.
  • There is an urgent need to prevent impulsive or harmful behaviors triggered by intense emotions.
  • The individual seeks to calm the body’s fight or flight response.

Why Use TIPP?

The rationale behind using TIPP is rooted in its ability to:

  • Physically calm the body, reducing the intensity of emotional distress.
  • Provide immediate, short-term relief in crisis situations.
  • Serve as a bridge to more in-depth therapeutic interventions.

How to Use TIPP: Step-by-Step Instructions

1. Temperature

  • Purpose: To engage the body’s dive reflex, which helps to decrease anxiety and distress.
  • How to Use: Splash cold water on your face or hold a cold compress over your eyes and cheeks for 15-30 seconds.

2. Intense Exercise

  • Purpose: To rapidly reduce high levels of emotional arousal by expending energy.
  • How to Use: Engage in brief, intense physical activity like running, jumping jacks, or fast walking for a few minutes.

3. Paced Breathing

  • Purpose: To slow down the body’s arousal system and induce calmness.
  • How to Use: Breathe deeply and slowly, aiming for 5-6 breaths per minute. Inhale for a count of 5, hold for a count of 2, and exhale for a count of 5.

4. Progressive Muscle Relaxation

  • Purpose: To reduce physical tension associated with emotional stress.
  • How to Use: Tense each muscle group for 5-10 seconds and then release. Start from the toes and move upward to the top of the head.

Scientific Effectiveness

The TIPP technique, as part of DBT, is backed by extensive research. Studies have shown that DBT, including its distress tolerance skills like TIPP, is effective in reducing symptoms of Borderline Personality Disorder, depression, anxiety, and Post-Traumatic Stress Disorder. The immediate physical interventions in TIPP directly influence the central nervous system, helping to downregulate intense emotional responses.

Relation to DBT Mindfulness Skills

Mindfulness, a core component of DBT, involves being fully present in the moment and accepting thoughts and feelings without judgment. TIPP complements mindfulness by providing tools to manage overwhelming emotions, thus enabling individuals to engage more effectively in mindfulness practices. By reducing the intensity of emotional distress, TIPP allows individuals to approach their experiences with greater clarity and equanimity, which is central to mindfulness.


The TIPP technique is a vital component of DBT’s distress tolerance module, offering practical, immediate tools for managing intense emotional crises. Its integration with mindfulness practices enhances its effectiveness, making it a valuable skill in any health and wellness plan. By understanding and utilizing the TIPP technique, individuals can take an active role in managing their emotional well-being, paving the way for long-term mental health resilience and stability.


  1. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  2. Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont), 3(9), 62–68.
  3. Robins, C. J., Chapman, A. L. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18(1), 73-89.
  4. Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 164(6), 922-928.