DBT #skilloftheweek: TIPP

Hi all, and welcome to the first blog post of my new series: ✨ DBT #skilloftheweek ✨

Each post in this series will provide you with the WHAT the function of each skill is, HOW it works on our bodies & emotions, and WHEN might be a good time to use it!

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10/15/2023

DBT #skilloftheweek: TIPP

(#distresstolerance)

WHAT: The TIPP skills are a way to quickly tip your body chemistry - they work very fast, within seconds to minutes, to help decrease high emotional arousal. The TIPP skills are easy to use and don't require a lot of thinking - this is why they're especially great on the go skills. Several of the TIPP skills can easily be used in various public locations - school, work, in the car, or in the grocery store!

HOW: When we're stressed, our bodies sympathetic nervous system (SNS) activates - you might know this as your fight-flight-or-freeze system. When this happens, our heart rate, blood pressure, and saliva production increases, our pupils dilate, digestion slows, and many of our other bodily functions are altered in some way. Important to note: When our SNS is activated, the part of our brain that controls thought - the prefrontal cortex - shuts down. This is because in that moment our body is preparing for action - action is what's necessary for survival!

Additionally, we also have the parasympathetic nervous system (PNS). The PNS is what helps us to slow down and take a rest - it's the complete opposite of the SNS. Think of it as the yin to the SNS's yang. If you're thinking to yourself: does this mean that it does the opposite of what the SNS does, then? Like, it decreases our heart rate and our blood pressure? If that's what you were thinking, then you'd be right! The PNS functions completely opposite to the SNS - it counteracts everything the SNS does!

The TIPP skills directly target our bodies PNS to allow for quicker emotion regulation. Using skills that target the PNS when our SNS has been activated can reduce the intensity of our emotions which, in turn, can decrease our brain being in a state of overwhelm. This gives us pause long enough to allow for our prefrontal cortex to come back online, for our thoughts to become a little clearer, and for us to make mindful, effective choices in the moment versus engaging in impulsive, ineffective behaviors!

WHEN: When do you want to use the TIPP skills?

- When you are completely caught in your emotion mind! (Don't know what emotion mind is? Ask your therapist, and/or stick around for the next skill: States of Mind & Mindfulness: Part 1)

- When you're having strong urges to engage in impulsive, self-destructive, ineffective behaviors

- When there's an important demand that needs to be met, responsibility that needs to be fulfilled, or task that needs to be completed and you are feeling overwhelmed by it

- When your brain is not processing information you are receiving and this is beginning to overwhelm you

- When whatever emotion you are experiencing is overwhelming you

- When you are not able to engage in other preferred skills

- When you have reached your skills breakdown point

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Practice Makes Progress

T (temperature)

Tip the temperature of your body, tip the temperature of your emotion from the high end of the thermometer down to at least the middle, if not lower!

How To:

- Grab a bowl of ice water (with both hands, preferably)

- Bend at the waist (slowly, so you don’t give your feet a bath) - Hold your breath - Dunk your face into the water - Hold in place for 20-30 seconds (or as long as you can stand - go at your own pace) - Repeat as needed until intense emotions and/or urges subside in intensity

Why?

Tipping your body temperature with the use of cold water activates the mammalian dive reflex. Whenever a human (or mammal!) is submerged in cold water with limited oxygen, our PNS is sent into overdrive. As a result, breathing slows, heart rate slows, and blood flow to non-vital organs is reduced in order to ready the body for the survival. With direct activation of the PNS, the intensity of any fight/flight and/or impulsive urges triggered by SNS activation are targeted for reduction!

CAUTION! Using cold water can reduce your heart rate very rapidly. If you have a heart disorder or a heart rate below normal due to medications or certain medical conditions, only do this with approval from a medical provider. Avoid ice water if you are allergic to the cold or allergic to water.

I (intense exercise)

One of the (many) primary functions of emotions is preparing our bodies to act. When we feel emotions intensely, we build up & store a lot of kinetic energy in our bodies. Engaging in brief, intense exercise can help redirect that energy to an effective coping mechanism which, in turn, can help reduce the intensity of those emotions and act as a barrier to engagement in impulsive, self-destructive urges!

When we engage in exercise, our brain releases endorphins. Endorphins are the hormones responsible for increasing feelings of euphoria/pleasure and reducing the experience of pain. The goal with intense exercise isn't to overdo it - the goal is simply to increase your heart rate and increase production & release of endorphins, which triggers activation of the PNS (the slow down system) which, in turn, can quickly reduce the intensity of our emotions!

How?

Fun fact: special equipment or a fancy gym membership not required! Some ideas of activities you can do at home/close to home:

- Go for a run around the block

- Jump rope

- Sit-ups and/or push-ups

- Swimming

- Bike Riding

- Have a solo dance party in your room (my personal favorite!)

CAUTION! Heat and exercise can increase heart rate rapidly. If you have a heart or medical condition, lowered base heart rate due to medications, take a beta blocker, or have an eating disorder, only do this with approval from a medical provider.

P (paced breathing)

Intentionally regulating and slowing down the rhythm of our breathing is one of the most effective ways to help tolerate and manage overwhelming, intense emotions.

How?

1) Breathe in deeply and slowly through your nose and into your belly to a count of 4

HINT: To make sure you're breathing into your belly, place one hand on your chest & one hand on your abdomen. As you breathe in, the hand located on your belly will rise and fall with each breath. If it isn't - that's okay! When you first start practicing paced breathing, it's okay to stick around at the first step until you get the hang of it. After all, it's not every day that we purposely have to remind ourselves to do something that typically is an involuntary act!

2) Breathe out slowly through your mouth to a count of 7

3) Repeat, continuing to focus on breathing out longer that you're breathing in until urges/intense emotions decrease

P (progressive muscle relaxation)

When we’re experiencing intense, overwhelming emotions, we often subconsciously tense our muscles. The kinetic energy generated from our emotional experience settles into our muscles, and paired muscle relaxation helps us to intentionally tense and relax those muscles, which depletes some of that stored energy!

How?

1) Tense each muscle (or muscle group) all the way; hold for 10 seconds

2) Relax each muscle (or muscle group) all the way; relax for 10 seconds

3) As you are intentionally relaxing each muscle, say out loud (or in your head!) a relaxation mantra (e.g., relax, calm, breathe easy, steady - do what works for you!)

4) Repeat 1-3 until you've moved through all of your muscles/muscle groups from head-to-toe/toes-to-head

5) Tense your entire body all the way; hold for 10 seconds

6) Relax your entire body all the way (don't forget to repeat your relaxation mantra!)

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Until next time, take care of yourselves ❤️

Sincerely,

Danielle Smith, LMHC, CCTS-I

DISCLAIMER: This post is not a substitute for therapy. The information contained in this post is general information for educational purposes only. The information in this post is not, nor is it intended to be, therapy or psychological advice. Nothing in this post should be considered professional advice. If you are a current or former patient please remember that your comments or likes may jeopardize your confidentiality. The information provided in this post does not constitute development of a therapist-patient relationship. Please consult your primary care physician or mental health provider regarding advice or support for your health & well-being. If you are in a crisis, please call the suicide crisis hotline at 988 or contact your local emergency room.