Module 2. Distress Tolerance: (Discussion #3) TIPP
DBTuesday is a series of posts where we explore skills and concepts from dialectical behavior therapy (DBT).
This is one of several posts focusing on distress tolerance, which is the second module of DBT skills training. See this post for general info about DBT and this post for more info about distress tolerance.
What is TIPP
TIPP is a set of four different skills for quickly reducing extreme emotions by changing your body chemistry.
- Temperature
- Intense exercise
- Paced breathing
- Paired muscle relaxation
If you’re in an emotional crisis, these are the skills to use.
- These skills work very quickly, usually within a few minutes.
- They help to calm down the limbic system, which controls emotional arousal.
1) Temperature
For panic, anxiety, or overwhelming emotions: cooling your body can decrease your heart rate and blood pressure.
- Hold your breath and put your face in a bowl of cold water (this is especially effective since it also triggers the mammalian diving response)
- Hold an ice pack to your eyes and cheeks
- Hold an ice cube in your hand
- Go outside on a chilly day
- Take a cold shower
For depression or sadness: warming your body can increase your heart rate and blood pressure.
- Take a hot bath
- Wrap yourself in a blanket
- Go outside on a hot day
- Drink a warm beverage
[Note: If you have any medical conditions that would make sudden changes to heart rate or blood pressure problematic, skip this step.]
2) Intense exercise
Intense exercise helps alleviate negative feelings in several ways:
- It releases built-up energy
- It increases oxygen flow throughout the body, which can reduce feelings of stress
- It triggers chemical reactions in the brain that can produce a feeling of euphoria
Exercise also happens to be very beneficial just for general well-being:
- Increases energy
- Increases muscle strength
- Increases body’s efficiency at physical tasks
- Reduces fatigue
- Reduces risk of injuries
- Reduces risk of diabetes
- Reduces effects of aging
- Can help with weight management
- Can help with depression
- Can help with addictions
- Can help with sleep disorders
Here are some examples of exercise activities you can do:
- Running
- Walking fast
- Lifting weights
- Playing a sport
- Jumping rope
- Swimming
- Dancing
3) Paced breathing
Breathing slowly and calmly can reduce blood pressure, decrease stress, and create feelings of relaxation.
If you already have a breathing exercise you like, you can do that. If not, you can try "box breathing”:
- Breathe in for 4 seconds
- Hold for 4 seconds
- Breathe out for 4 seconds
- Hold for 4 seconds
- Repeat until you feel calmer
4) Paired muscle relaxation
Paired muscle relaxation (also called progressive muscle relaxation) involves tensing groups of muscles and then relaxing them.
- Tensing muscles actually relaxes them more than only trying to relax.
- Relaxed muscles use less oxygen, which slows down your breathing and heart rate.
Here is one example sequence (guided practice video HERE if you prefer):
- Hands and wrists: Make fists with both hands and pull fists up on the wrists.
- Lower and upper arms: Make fists and bend both arms up to touch your shoulders.
- Shoulders: Pull both shoulders up to your ears.
- Forehead: Pull eyebrows close together, wrinkling forehead.
- Eyes: Shut eyes tightly.
- Nose and upper cheeks: Scrunch up nose; bring upper lips and cheeks up toward eyes.
- Lips and lower face: Press lips together; bring edges of lips back toward ears.
- Tongue and mouth: Teeth together; tongue pushing on upper mouth.
- Neck: Push head back into chair, floor, or bed, or push chin down to chest.
- Chest: Take deep breath and hold it.
- Back: Arch back, bringing shoulder blades together.
- Stomach: Hold stomach in tightly.
- Buttocks: Squeeze buttocks together.
- Upper legs and thighs: Legs out; tense thighs.
- Calves: Legs out; point toes down.
- Ankles: Legs out; point toes together, heels out, toes curled under.
Reflection
Which of these skills would you feel comfortable using if you’re in an emotional crisis?
Sources:
https://positivepsychology.com/distress-tolerance-skills/
https://dbt.tools/distress_tolerance/tip.php
https://dialecticalbehaviortherapy.com/distress-tolerance/tipp/
https://sunrisertc.com/distress-tolerance-skills/
https://www.youtube.com/watch?v=xiP6HZY0tmQ
@QuietMagic
Thanks for sharing! I usually find it hard to let go of emotions. TIPP among other stuff helps me do that – like I don't have to focus on the mental/cognitive part of emotions and knowing I can just do so through physiological means instead seems better!
I have been repeatedly told I can act distress intolerant (being practical is not fun XD /hj) so exploring these posts is really helpful!
@theriverissinging
Glad it felt helpful! I also love the idea of these simple actions that are like body/brain hacks along the lines of, "Just push this button and you'll feel better within a few minutes. No heavy mental/emotional lifting required at this time." 😊
I went on my first DBT journey quite recently. TIPP more than anything has stuck with me throughout everything. It's quick, it's effective, it can be paired with lots of other DBT skills like Problem Solving, and Pros/Cons. I love that this community is sharing these wonderful DBT skills openly.
@HeartOfTheLion
I'm glad the DBT skills have felt helpful, and yup increasing the spread of them so that people can benefit from them is what I'm hoping might happen from this post series.
TIPP really stuck out to me too just while I was writing this post! Like, how cool is it that there are certain things where if you do them, it changes your body's autonomic responses within minutes... just based on pure physiology regardless of what you're thinking/feeling. 😊
@QuietMagic
Thanks for this. I sometimes struggle with overwhelming feelings and often feel I'm fighting a need to "do something". And so I can't relax or calm down, because it's opposite to the need to "do". So I'm so happy to discover things that I can "do" that might help calm my system. I think some of these might work better for me than other suggestions.
@Clio9876
Hello there Clio9876!
How are you feeling lately?
It's good to choose what works better for you, exploring different methods could help you to personalize things at best!
You are welcome to share how you feel and post for updates in the Forum Area, sending you good vibes!
@MeaningfulSilence
Im so so. How about you?
I had just discovered distress tolerance and the fact I might not have much, when I discovered your post. I found it really helpful. Not just the ideas of things to do when overwhelmed. but also the concept that distress tolerance was something that I could develop and grow. It has often given me hope when I was struggling.
Right now my physical health isn't great. Nothing serious, just lots of annoying things that make life difficult - a pulled muscle, a swollen foot from a bee sting. At the moment it feels like I spend every weekend on the sofa recovering from something. Tedious and frustrating. And I'm just holding on to the fact that it will get better.
Have a good weekend.
@Clio9876
Hi there Clio! So glad to read you 💜
Yeah I imagine how it can be annoying to finally get into weekend time and it's spent to recover from something.
I see your strength tho, you really are doing your best to improve your well-being.
I plan to do forum discussions, to talk about topics that might interest you guys, it's an occasion to reflect on things and to learn from others but also....to feel less alone facing the same struggles.
Feel free to drop me a message if there's something specific you would like to be discussed!
Have a good weekend and fingers crossed the actual health issues will fade soon!
Take care 🌺
@QuietMagic has anyone ever wondered why one's tolerating distress
@communicativePond1728
I'm not sure if I understand the question. Are you asking why someone would want to focus on tolerating distress rather than taking a more proactive approach to resolve underlying causes?
@QuietMagic it's not a question. There's no question mark if you'll notice. It's an aloud musing to encourage discussion and thought as is the purpose of forums. If you'll recall. 😊😊😊
@communicativePond1728
For sure, one of the main functions of the forums is discussion and sharing thoughts back and forth. I responded to your post for that very reason.
However, I actually just didn't understand what you said. The purpose of my post was to get clarification on what you meant so that I could engage in discussion without misunderstandings or making false assumptions.
Would you be willing to clarify or expand upon your musing?
@QuietMagic now that you've articulated a bit more what you meant, no, I'm not willing to expand on it because it could go in any direction and you're not clearly communicating which one you mean. It's meant to engage discussion not prompt someone to make me explain myself so no. I'm not willing to "expand on it."
@communicativePond172
Sorry, I'm understanding something that I didn't before.
Currently, this post is being linked under the Personality Disorder forum resources as a "distress guide". The context this implies is, "if you're experiencing distress, here's a magic bullet that will help you and this is the one/only thing you should do that will help". Whereas the initial context of this post was as part of a broader series of several dozen posts discussing skills and theory from DBT (dialectical behavior therapy), with this just being one part of a broader system that has a lot of diversity.
So, I'm seeing how that might create confusion. I want to try to explain the bigger picture in the hopes of balancing things out, and I'll interact with some of the meanings I personally got from your post in the process.
What is distress tolerance
In the context of DBT, distress tolerance is a set of skills or strategies that are basically things to do in the moment if you're feeling bad to help with getting through that moment. The meaning of "tolerance" in this context is not "I'm going to let this distress dominate my life" but rather "the next time I feel absolutely awful, here's what I'm going to try to do to survive that experience without hurting myself or doing something destructive that causes more problems in the long-term".
What makes DBT dialectical
One of the things that makes DBT "dialectical" is there's a dialectic or dichotomy with change on the one end and acceptance on other end. They're different but complimentary approaches to dealing with suffering. Which pole is applicable depends on the personal situation/context and I'd also say just one's personality and personal preferences.
1) Change
One meaning I read from your post was encouraging the "change" side of this dialectic, which makes sense for a lot of situations. "I'm sick of feeling distressed and I want to do something about it. Why am I simply 'tolerating' my unhappiness instead of trying to do something to change it? I'm not okay with this and it should be possible to feel better. Is there something I can do to fix it and improve my life?"
That's a valid motivation and strategy a lot of the time, and I can see how connecting with that kind of attitude and energy could lead to good things happening. Maybe that could lead to brainstorming, exploring, planning, thinking about one's life in general and it might turn out that there's something that can be done action-wise to change one's life that reduces the underlying causes of distress (i.e. problem-solving).
2) Acceptance
To play devil's advocate and express the other side of the picture, sometimes people (especially those with personality disorders and/or trauma) will have the experience of just being randomly, repeatedly bombarded with intense, incapacitating emotions that really are not within their immediate control.
There isn't any realistic, obvious path of, "Well, I just have to be resourceful and work hard and I'm sure I can figure out how to get rid of this suffering." The suffering is just something that happens and it's a given fact of lived experience and not something that can "solved" in the same way as a normal problem.
An analogy would be like having a physical illness and being resigned to the fact of, "even if I do everything right, my body is sick and I've resigned myself to the fact that I'm not going to feel healthy or physically well for a few days".
Some of the ways that one might approach things outside of one's control are:
a) Radical acceptance - basically just trying not to struggle with or fight against something. For example, if I'm feeling sad, giving myself some space where it's safe/okay for me to feel sad instead of fighting with my sadness and trying to eliminate it. (Which is not to say that that fighting is bad. Deciding not to fight is just another possibility. And to apply this strategy self-reflexively, if fighting/struggling is something that just happens and isn't within my control, the application of acceptance might be to allow myself to struggle and be okay with that rather than adding another layer of struggling against my struggling and judging myself for it.)
b) Mindfulness - basically just sitting down and trying to notice what's there as it is. Sometimes emotions are mingled with lots of secondary things that aren't innate/inherent to those experiences. Just stopping and just watching what's there and trying to see it as it is can transform the way that it feels. Sometimes because the direct experience is different than one's conceptualization of it. Sometimes because engaging with direct experience prevents one from going down other mental pathways that lead to suffering.
***
Will note that my overarching ethic is that people should feel free to do what works for them. If something doesn't work and it doesn't make sense experientially, then people should feel empowered to ruthlessly eliminate what doesn't work in favor of what does work.
@QuietMagic
perplexed , try telling me that when in distress..
as per dbt, practice regularly when not in distress to make such utilisation more successful.
How can you pull logical thought back into play when emotions run the show? Screw wise mind but just a fraction of logical thought? Any suggestions would be much appreciated.
@LabeledBPD
Hi, you've made some great points:
1) Good luck trying to read or apply something complicated or confusing while you're in the middle of a really intense emotional experience
2) Maybe a good approach is to have certain go-to skills or practices figured out ahead of time so that you already know what to do when things get difficult
3) It seems really difficult if not impossible to try to get logical thought to happen if you're right in the middle of a very strong emotional experience.
***
A few thoughts I have about the emotion vs. logic thing:
1) A radical acceptance/self-compassion strategy might be, "You know what, I'm really emotional right now, but that's okay and just what's happening. I'll let these emotions happen and be what they are rather than trying to force myself to be logical or have fewer emotions. Will just let things exist and try to be gentle/understanding toward myself. It's understandable that I'm having emotions." So letting go of the idea of "I need to be more logical" if that really does feel impossible/unnatural and like trying to put a square peg in a round hole. I can't control what I am right now.
2) If the problem is that emotions are immediately exploding into impulsive actions, then it seems like it would help if you're able to notice an emotion when it occurs and create a pause/space between the feeling and the action. Just to have a chance to do something else (whatever that might be) instead of the impulsive action.
3) I'm not sure if this is how "wise mind" is supposed to be understood, but I'm currently drawn to the idea that there's some kind of third thing (awareness/mindfulness) that's different from both reason and emotion that can co-exist with either one. Like, regardless of how I'm feeling/thinking or not feeling/thinking, I'm able to pause and just pay close/sensitive/gentle attention to what's happening in my current experience.
I'm imagining this could balance things out, maybe not in the sense of "you'll be 50% reason and 50% emotion" but in the sense of smoothing out the imperfections of both reason and emotion, whichever one happens to be present ("you'll be able to know what's happening at a deep level and create space for digesting it in a way that's helpful"). If reason's dominant, then pausing to notice what's there brings one back into contact with body/instincts. If emotion's dominant, then pausing to notice what's there might help slow the flow of things and help create quiet/equanimity akin to what one gets from the detachment of reason, or the sensitive/gentle noticing might give rise to compassion that transforms the feeling you're noticing.
I don't think I've really answered your question. 🙏 Feel free to share more here about the emotions/situation, or can PM if you want to discuss.
I was not aware much of temperature, so want to take it into practice. However, remind of health is very reasonable, I have to look at my heart rates/blood pressures more carefully.
I always knew effectiveness of exercise, even by my own experience, but didn't get yet to do it regularly.
I do breathing of various kind, whenever I recall it. I think it is my preference, if to say so.
I learned about muscle relaxation recently before and tried out pretty much. I think I like that and will practice more.
@windSpirit
Sounds like breathing is one that feels easy to do and like you're able to use it consistently. 👍 And then maybe muscle relaxation is something to try again if you feel like it.
The temperature one was interesting to me when I first read about it. I hadn't heard of it before, but it sort of made sense:
1) Warmth => sympathetic nervous system activation => energy
2) Coldness => parasympathetic nervous system activation => calm
