DBT Distress Tolerance (TIPP)
DBT crisis survival skills, including TIPP, for getting through an intense emotional moment without doing anything that makes it worse.
About this tool
Distress tolerance skills come from dialectical behavior therapy (DBT). They are for moments when emotional pain is so high that you cannot solve the problem yet and you are at risk of making it worse: lashing out, self-harming, using substances, or saying something you cannot take back. The goal is not to feel better or fix anything. It is to get through the crisis safely until the wave passes and you can think clearly again.
The fastest of these skills is TIPP, because it works on your physiology rather than your thoughts. When you are flooded, your nervous system is in overdrive, and TIPP brings it down quickly through four levers: Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. Cold water on the face in particular can trigger the body's dive response, slowing your heart rate within seconds. These are tools to use in the heat of the moment, when talking yourself down is not possible.
Alongside TIPP, DBT teaches other crisis survival skills: STOP for hitting the brakes before you act on an urge, distraction and self-soothing to ride out the intensity, and radical acceptance for pain that cannot be changed right now. None of these are avoidance. They are deliberate ways to survive a hard moment without adding new damage to it.
These skills are most reliable when practiced ahead of time, while calm, so the steps are automatic when distress hits. They are a bridge to the longer work of understanding and changing what drives the crises, ideally with a therapist.
- Linehan MM. DBT Skills Training Manual. 2nd ed. Guilford Press; 2015.
- Linehan MM. DBT Skills Training Handouts and Worksheets. 2nd ed. Guilford Press; 2015.
DBT Distress Tolerance (TIPP) FAQ
What does TIPP stand for?
Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. It is a DBT distress tolerance skill that lowers extreme emotional arousal quickly by changing your body chemistry.
Why does cold water help during a crisis?
Cold on the face can trigger the body's dive response, which slows your heart rate and calms your nervous system within seconds. That brief physiological shift can take the edge off intense distress so you can think again.
Are distress tolerance skills the same as avoidance?
No. Avoidance is escaping a feeling indefinitely. Distress tolerance is deliberately getting through a crisis moment safely so you do not make things worse, then returning to solve the problem once you are calmer.
When should I not rely on these skills alone?
If you are having thoughts of harming yourself or feel unsafe, please reach out for support right away rather than coping alone. In the US, call or text 988 to reach the Suicide and Crisis Lifeline.