TIPP Skill

Definition

TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation. It is a Distress Tolerance skill used to rapidly reduce extreme emotional arousal by directly regulating the body’s physiological state.

Purpose

Used to:

• Bring the nervous system out of “fight, flight, or freeze.”
• Reduce overwhelming emotions quickly.
• Regain control during crises.
• Stabilize the body before using other coping skills.

When to Use

Use TIPP when:

• You are feeling intense distress or panic.
• You are experiencing overwhelming anger, anxiety, or urges.
• You need to calm down quickly to prevent acting impulsively.

When Not to Use

Avoid using this skill if:

• You have medical conditions that contraindicate cold exposure or intense exercise.
• You are already calm or only mildly upset.
• You need a long-term solution rather than immediate relief.

How-To

T - Temperature

1. Hold your breath and submerge your face in a bowl of cold water for 30 seconds, or apply ice packs to the eyes and cheeks.
2. This activates the “mammalian dive reflex,” slowing your heart rate.

I - Intense Exercise

1. Engage in vigorous exercise (e.g., running in place, jumping jacks) for 10–20 minutes.
2. This burns off adrenaline and calms the body.

P - Paced Breathing

1. Slow your breathing to about 5–6 breaths per minute.
2. Inhale for 4 counts, exhale for 6–8 counts.

P - Progressive Muscle Relaxation

1. Tense and relax muscle groups in sequence.
2. Focus on the contrast between tension and release.

Tips & Variations

• Keep a bowl of ice water ready if you struggle with panic attacks.
• Combine steps (e.g., cold water followed by paced breathing).
• Adjust duration of exercises based on your fitness level.
• Use TIPP discreetly—carrying an ice pack in your bag or doing breathing exercises anywhere.

Example

Jordan feels the urge to self-harm after an argument.

1. Runs in place for 5 minutes.
2. Submerges face in cold water.
3. Practices slow breathing for 5 minutes.
4. Feels calmer and more able to call a friend.

Inventor / Origin

TIPP is part of DBT Distress Tolerance Skills, created by Marsha Linehan, PhD. The skill integrates principles from behavioral therapy, biology, and mindfulness practice.

Related Skills

• STOP Skill
• Self-Soothing
• Radical Acceptance
• Pros and Cons

Limitations

May not be effective if:

• Practiced inconsistently or without preparation.
• You have severe medical restrictions.
• You expect it to solve underlying problems permanently.

Evidence Base

Research shows:

• TIPP effectively decreases heart rate and emotional arousal.
• Immediate physiological calming improves ability to use other DBT skills.
• Cold water immersion reduces panic symptoms.

Further Reading

• DBT Skills Training Handouts and Worksheets by Marsha Linehan
• Mayo Clinic: Relaxation Techniques
• The Dialectical Behavior Therapy Skills Workbook by McKay, Wood, and Brantley
• DBT Self-Help: TIPP

References

• Linehan, M.M. (2015). DBT Skills Training Manual, Second Edition. New York: Guilford Press.
• Gratz, K.L., & Gunderson, J.G. (2006). "Preliminary Data on an Acceptance-Based Emotion Regulation Group Intervention for Deliberate Self-Harm Among Women with Borderline Personality Disorder." Behavior Therapy, 37(1), 25–35.