DBT distress tolerance: TIPP
Temperature, intense exercise, paced breathing, progressive relaxation — crisis survival.
When to use: Acute dysregulation when emotion mind blocks skillful action.
Clinician tip: Screen physical contraindications for intense exercise / cold.
Temperature, intense exercise, paced breathing, progressive relaxation — crisis survival. Use the worksheet in session or as homework. Preview the layout on the right — tap it or choose View full preview below for the complete on-screen version.
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Use TIPP when emotion mind is high and problem-solving can wait. Not for daily stress — crisis survival.
T — Temperature
Cold water on face or hold ice pack (safe duration). Activates dive reflex to slow heart rate.
I — Intense exercise
P — Paced breathing
Exhale longer than inhale (e.g. 4 in, 6 out) for 2–3 minutes.
P — Progressive relaxation
Related resources
- DBT skillsDBT DEAR MAN (assertiveness)Script framework for asking for what you need — especially in family and workplace duty conflicts.
- DBT skillsDBT diary card (blank week)Track urges, skills used, and mood — weekly template for DBT-informed therapy.
- DBT skillsDBT GIVE & FAST (relationship effectiveness)GIVE for keeping relationships; FAST for self-respect — pair with DEAR MAN for difficult family or workplace talks.
- DBT skillsDBT STOP skillStop, Take a step back, Observe, Proceed mindfully — impulsivity and conflict moments.