TIP Skills for Coping with Distress

What are Distress Tolerance Skills?

Distress tolerance is a term used in the dialectical behavior therapy (DBT) world. It is important to have a toolkit of coping skills you can use when you are feeling particularly overwhelmed. There are many skills we can learn to help regulate our emotions more generally. However, not all skills are as easily accessible if we are experiencing a higher level of distress. 

We can think of our emotions on a scale from 0 to 10:  

0---1---2---3---least distress

4---5---6---7---moderate distress

8---9---10---highest distress

When we are experiencing a moderate level of distress, we can use a variety of skills to help regulate our emotions. Examples include trying to challenge our thinking, making sure we are eating well and getting enough sleep, and exposing ourselves to situations we tend to avoid.

However, when we are in a state of crisis (where we are experiencing a high degree of distress), we are usually in emotion mind, and are not as easily able to access skills that involve a higher level of thinking or a large shift in our behavior. Crises can be any situation that triggers intense, overwhelming emotions, and usually lead to impulsive behaviors that may result in negative consequences. 

Distress tolerance skills are not necessarily designed to help us "feel better"- rather, to help us hit the pause button, so we can ride out the high state of emotions and not make things worse. The goal is to notice our distress and any urge to act on the distress with a behavior that could make things worse, and instead to use these techniques to distract ourselves enough until the distress level goes down. Once we can get our emotions from about an 8-10 to a 5-7, we can then utilize additional skills that may be more helpful to bring our emotion state down. 

Three easily accessible skills we can use when we are in this state are known as TIP skills:

Tip the temperature of your face with cold water

Intense exercise

Paced breathing/Paired muscle relaxation 

These skills consist of the following:

Tip the temperature of your face with cold water:

This skill involves taking a bowl of cold water and dipping your face in it, holding your breath for ~30 seconds. We want to primarily dip our eyes/area around our eyes in the water, as this will activate something called the mammalian dive reflex, which basically tricks your brain into thinking you dove into a pool of cold water. (*If you have any heart issues, please consult with your doctor before trying this). This skill is very helpful physiologically, as it will pretty immediately slow down your breathing and heart rate. I recommend practicing this skill when you are not in a state of distress, so you can see how it feels. You can also use an ice pack if you prefer.

Intense exercise:

This is a little different than when we recommend routine exercise for mental health. With this skill, I'm not referring to spending an hour in the gym, or going for a 5 mile run. This skill involves short, intense bursts of exercise, to expend energy. This can include doing push ups, burpees, or running in place. By ramping up our heart rate, in turn we can actually slow things down.

Paced breathing/Paired muscle relaxation: 

Alternatively, instead of expending energy through exercise, we can directly slow things down through breath work.  Breathing exercises are a way to activate our parasympathetic nervous system (the relax/calming system), and slow down our sympathetic nervous system (fight or flight system). In a previous blog post, I discussed a breathing exercise called square breathing. This is an excellent tool to slow our breath down. When practicing square breathing, we want to inhale through the nose and exhale through the mouth, making sure our exhales are longer than our inhales. We can also practice something called paired muscle relation (PMR), which involves intentionally squeezing muscle groups, starting from the toes, up to the top of the head. By tensing and releasing muscles, our body will feel more relaxed. Many people report this exercise to be helpful before sleep as well.

If you are feeling like you are in a state of crisis and need skills to help you hit the pause button, and not act on an urge you may regret, try these TIP skills today.