The TIPP Skill: Managing Distress in DBT for Addiction


Private Practice

Key Points

  1. The TIPP skill is a distress tolerance technique used in crisis situations, involving Temperature, Intensity, Paced breathing, and Progressive relaxation.
  2. Temperature regulation, such as dipping one’s head in ice water or using cold packs, can quickly reduce intense emotions and distress.
  3. Intensity exercises can help decrease feelings of rage or urgency, while paced breathing and progressive relaxation techniques promote physiological and mental relaxation.
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The TIPP skill is a distress tolerance technique used in crisis situations. It has four components: Temperature, Intensity or Intense exercise, Paced breathing, and Progressive (muscle) relaxation. Dr. Marsha Linehan refers to these as crisis intervention techniques.

Temperature regulation, as briefly mentioned before, can involve immersing one’s head in a bowl of ice water. This sensory experience reduces the intensity of prevailing emotions and feelings. For younger clients, such as the children Dr. Petracek works with, she often provides them with handy cold packs that can be instantly chilled by snapping them. She recommends that the children place them in their backpacks, ready to aid in the reduction of emotional temperature.

Intensity is vigorous physical exercise. Engaging in activities like running, swimming, or taking a brisk walk can alleviate sensations of anger or urgency that a client may be experiencing.

Paced breathing can mean any number of techniques, including the structured breathing pattern known as box breathing. It entails inhaling for three seconds, holding the breath for three seconds, exhaling for three seconds, and once again holding for three seconds, then repeating the cycle. It is equally effective if the number of seconds is changed to four. Paced breathing mitigates physiological distress.

Progressive relaxation entails guiding the client through a body scan exercise, beginning with the head. The client is instructed to scrunch up their face and then relax it, tense and then relax various muscles, and form fists with their hands before relaxing them. This can induce a profound sense of calmness by the end of the exercise.

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The TIPP Skill: Managing Distress in DBT for Addiction

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