The TIPP Skill: Managing Distress in DBT for Addiction


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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.

Looking for practical everyday tools? This print-friendly handout is just what you need. Click on the following link to download the PDF:

The TIPP Skill: Addressing Distress in DBT for Addiction Recovery

The TIPP skill, used in dialectical behavior therapy (DBT), offers invaluable strategies for managing acute distress in addiction recovery. Using such techniques as temperature regulation and intensity through exercise, TIPP provides immediate sensory and physical interventions to disrupt overwhelming urges or cravings. Additionally, paced breathing is a grounding mechanism used during heightened anxiety or when memories linked to substance use arise. Progressive relaxation further aids people in attuning to their bodily sensations, fostering a sense of control that is especially vital during the emotional challenges of withdrawal. Together these methods empower those on the recovery journey, offering tools to navigate the complexities of addiction.


When using the TIPP skill within your therapeutic approach for addiction recovery, it’s essential to introduce these techniques during moments of relative calmness for clients to ensure comprehension and engagement. Start by illustrating the immediate benefits of temperature regulation, demonstrating with cold packs or other cooling implements. For intensity, collaborate with clients to identify physical activities compatible with their preferences and capabilities. Familiarize them with paced breathing, adjusting breath counts according to their comfort. Introduce progressive relaxation by guiding clients through a full-body exercise, emphasizing the sensations of tension release. Draw attention to the timely application of these skills, especially during acute distress or cravings, reinforcing their role as short-term interventions complementing a broader recovery strategy.

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The TIPP Skill: Managing Distress in DBT for Addiction

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