In DBT, a TIPP skill is a quick acting distress tolerance technique used to manage intense emotions by changing body chemistry, helping to shift from a flight – or – fight response to a calmer state.  When I was first told about TIPP, I thought it sounded a bit silly to be honest. 

I was thinking, “so they are trying to tell me that if I’m really super anxious and struggling, rather than take a Valium I should stick my face in a bucket of water!” 

The thing is though, it actually does work – it’s a works a lot faster and more effectively than a Valium if you ask me, especially if you follow it up with a self sooth technique.

Tip can reduce intense emotions quickly and slow down your heart rate and breathing.  This is a good way of preventing destructive behaviours, such as taking illegal substances or self-harming. There are four different ways you can use this skill – one is temperature, one is intense exercise, then there is Paced Breathing and Progressive muscle relaxation. My two favourites are temperature and intense exercise.

Temperature

The first one TIPP skill, Temperature, is one I find to be super helpful when I’m anxious or wanting to do something I know I will later regret.  The best way I’ve found to do this is get a container (big enough to put your face in) and half fill it with water.  Then add some ice cubes. Wait until the ice cubes cool the water, take a deep breath and put your face into the ice water.  Try to hold your breath for 30 seconds.  Sometimes I do this twice.  It brings your heart rate down really quickly and calms you down. 

We did some sessions in group where one of us would place our face in a container of cold water, whilst attached to a heart rate monitor. It is remarkable to see how fast the persons heart rate goes down.  If you want to use this skill on the go, you can keep an instant ice pack in your bag; when you get anxious – activate the ice pack, take a deep breath and place your face onto the ice pack whilst holding your breath for 30 seconds.  That works too. 

Medical professionals and laypeople must move beyond their ignorance and understand that people with BPD behave as they do because they have an illness. They do not elicit these behaviours because they wish to be annoying or a ‘difficult patient’. They behave as they do because they have an illness.  If a patient with a cold constantly blows their nose, nurses wouldn’t label the behaviour as ‘difficult’, it would be understood that the action is caused by a cold. Yes, it may be annoying, but they are doing it because they are unwell. This thought process should be the same for patients with BPD. Alas, as more medical professionals label and push them into a corner, the likelihood reduces that they’ll receive the support needed for their behaviour to change.

Intense Excersise 

I tend to use Intense Exercise –when I’m feeling angry or upset about something. If you need it to work quickly you could do some jumping jacks or run up and down some steps.  Sometimes, when I have more time – I go for a really fast walk and get my heart rate up.  I often walk for a while, and it calms me down and also releases feel good endorphins.

Paced Breathing

Paced Breathing is another way to use the TIPP skill. This increases oxygen intake and lowers heart rate and blood pressure.

To do paced breathing follow these steps:

1. Repeat the above process several times, until you are feeling calmer.
2. Inhale through your nose for a count of 4
3. Hold your breath for a count of 7
4. Exhale through your mouth for a count of 8

Progressive Muscle Relaxation

Progressive muscle relaxation is a process whereby you tense and relax your muscles.  This helps the body to let go of stress, triggering the relaxation response.  The best way you can do this is to find an App or YouTube video that talks you through the process.  Lie down or sit in a comfortable position, close your eyes and relax as you listen to the voice on the video.

Follow your TIPP skill with a Self Sooth Activity

Once you’ve used a TIPP skill to calm down, do something to self sooth.  For me, when I’m really upset or angry about something – I go on a really fast walk (intense exercise) and get my heart rate up.  I come home, tired and sweaty – have a shower and then I do something to relaxing to sooth myself.

Self Sooth is another DBT skill that involves using the 5 senses (sight, hearing, taste, touch and smell) to generate pleasure and kindness towards oneself.  How you choose to do to self sooth is dependent on what you find relaxing in moment.  Often, I choose to sit in my massage chair, with a cold pack over my eyes whilst listening to an audiobook.  I find this really relaxing and pleasurable. Other times I might do some colouring in while listening to an audiobook.

So, there you have it.  You’ve learned the TIPP skill, and a little about the self sooth skill.  These are DBT skills – but like with all DBT skills, they can be used by anyone.  Next time you are angry or anxious, or wanting to do something you know you will come to regret STOP and use the TIPP skill. Trust me, it really does work better than a Valium!!!!

Thank you for reading.