DBT Distress Tolerance (TIPP): Calm an Intense Moment Fast Without Making It Worse

About this tool

This DBT distress tolerance skills PDF is a printable reference for coping with intense emotions without acting on harmful urges. It brings together TIPP, STOP, self-soothing, and distraction so you can choose a practical next step. 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.

TIPP focuses on physical arousal through Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. These skills come from Marsha Linehan's DBT skills training materials. Cold applied to the face can slow heart rate through the dive response, but that physiological effect is not a guarantee of emotional relief. Choose a medically appropriate skill that you can use comfortably. There is no requirement to use cold water, exercise intensely, or complete the sequence before seeking support. Linehan's handouts label the group TIP, with paced breathing and paired muscle relaxation grouped together; TIPP spells out those practices separately. For paired muscle relaxation, gently tense a comfortable muscle group during the in-breath, then release the tension during the out-breath. The release belongs with the exhale. Avoid tensing hard enough to cause pain or cramping.

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. Used briefly and with a plan to return to the problem, they can help you get through a hard moment without adding harm. Repeatedly postponing an important problem can still become avoidance.

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.

DBT overall has strong research support: randomized controlled trials have found it reduces self-harm and crisis behavior for people with borderline personality disorder, and distress tolerance is one of its four core skill modules alongside mindfulness, emotion regulation, and interpersonal effectiveness. That evidence is behind the whole skill set, not just the version summarized on this free TIPP skills PDF.

Read the medical cautions before using temperature changes or intense exercise. Linehan's handouts advise consulting a health care provider when a heart or other medical condition, medication-related low heart rate, beta-blocker use, or cold allergy may affect safety. A cold pack on the face can also change heart rate and is not automatically a safe substitute for immersion. If uncertain, skip cold exposure and vigorous exercise until a clinician advises you. Choose a comfortable skill without straining or forcing your breath.

Use the PDF as a reminder sheet rather than a scorecard. After an intense moment, note the situation, the urge you noticed, the skill you tried, and whether it helped you postpone a harmful action. Feeling upset afterward does not mean the attempt was worthless. The practical question is whether you have enough space to choose what happens next, such as contacting support or returning to a solvable problem.

The trial by Linehan and colleagues listed below evaluated a structured DBT treatment program for suicidal behavior and borderline personality disorder. It supports DBT as a treatment approach; it does not show that this PDF alone treats self-harm or that TIPP is the fastest option for everyone. The DBT Worksheets hub and Emotion Regulation Skills (DBT) offer related practice. A BPD Test is a screening aid and cannot explain every episode of distress.

If crises recur or coping takes up much of your day, use Psychology.com's therapist directory to look for professional support. A therapist can help you make a plan that fits your health, triggers, and circumstances. Sensory coping should remain comfortable: skip any suggestion that causes pain, marks, or injury, including prolonged ice contact or snapping a band. If you may act on an urge to hurt yourself, seek immediate support rather than waiting to see whether a worksheet helps.

Prepare your DBT crisis survival skills PDF for the situations you actually encounter. Mark a familiar skill that fits your health and surroundings, and write down who you can contact if you need support. For example, after an upsetting message, you might put down the phone, pause before replying, and try comfortable paced breathing. When you can consider your options, decide whether to ask for clarification, set a limit, or return to the conversation later. Keep the sheet accessible alongside any safety plan developed with your clinician.

Reviewed by David A. Brooks, PhD, ABPP, ABN
Reviewed the crisis survival skills, including TIPP, for accuracy and safe framing.

References

1. Linehan MM. DBT Skills Training Manual. 2nd ed. Guilford Press; 2015.
2. Linehan MM. DBT Skills Training Handouts and Worksheets. 2nd ed. Guilford Press; 2015.
3. Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63(7):757-766.
4. Linehan MM. TIP Skills: Changing Your Body Chemistry. Reproducible materials from DBT Skills Training Handouts and Worksheets. Guilford Press. https://www.guilford.com/add/linehan6_old/lin-c-4.pdf?t=1
5. National Library of Medicine. Abstract of Linehan et al., randomized controlled trial of dialectical behavior therapy. https://pubmed.ncbi.nlm.nih.gov/16818865/

DBT Distress Tolerance (TIPP) FAQ