TIPP Skills with DBT

By Danielle Goldberg

With many people in addiction , a major issue is the inability to regulate their emotions effectively. When we do not know how to manage what we are feeling, we tend to search for an escape or a ” quick fix”. Those ” quick fixes” usually lead us down a round of rebellious behaviors with negative consequences.
At, Relevance we utilize a dialectical approach to treatment using Dialectical Behavior Therapy. DBT helps balance the synthesis of acceptance and change and helps individuals to learn how to regulate their emotions more effectively, and reduce the urges to use . Many times people in active addiction find themselves in distress often . DBT therapy teaches clients to learn to identify distress and use skills to decrease that level of distress to a more manageable level.
A popular distress tolerance skill from DBT is TIPP skills. TIPP skills helps provided the client a intense sensation to shift the focus of their brain to something else, which allows the level of distress to come down. The TIPP skills are ; change of temperature, intense exercise, progressive muscle relaxation , and paced breathing . These skills can be used alone, one skill for 5 minutes, or as a group of skills working your way down the list over a 20 minute period , based on your level of distress.

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The change in temperature skill is anything that provides a shocking change of temperature, some examples are taking a very cold or very hot quick shower, splashing cold water on your face, dipping your head in a bowl of water, blasting the air conditioning with the vents on you, or holding ice in your hands.

The intense exercise skill is a short interval of an exercise, not a workout at the gym, some examples are a quick sprint around the block, setting of 20 jumping jacks, push ups, or a short rep of an exercise at your max weight . This helps us focus on the pain or discomfort from the exercise rather what is causing you distress, and allows the emotions or urges to come down .

The progressive muscle relaxation skill is where you tense each muscle up in the body, working from your head down to your toes tensing each muscle and then letting go of the tension as a way to let go of the distress and the physical sensations of distress . You can also use visualization and imagery to use this skill, by putting whatever is causing you distress on a conveyor belt and letting it fall off , as way to let go. You can also do yoga poses or a stretching to do this skill.

The paced breathing skill is to have some method to your breathing in order to keep you focused. You may use square breathing where you breath in for four seconds , hold for four seconds, and breath out for four seconds. This way you are focusing on your breathing rather then your distress.

These skills are intense and work rather quickly , which is why they are helpful to manage your distress. They put the clients in control of their emotions which tends to empower them. DBT has proven effects to help clients with substance abuse and mood disorders. I have been intensively trained as a DBT therapist , and implement the DBT curriculum as a basis for treatment to provide clients with coping skills that will help to manage urges to use and negative emotions . I have seen this treatment work first hand and I have seen the impact it has on the therapeutic process.