This morning, I was looking through my therapy notes and handouts for two reasons:
- I need a reminder on some tools that will help me as I fight against my depression and PTSD demons. It’s amazing how quickly you forget things, and
- I wanted to find something useful to share.
And I did. I’m going to talk about TIPP skills, which help reduce extreme emotions quickly (so that you can go about your day, survive the next moment, escape a dangerous situation, etc.)
T = Tip the Temperature of your face with COLD WATER (to calm down fast)
- Holding your breath, put your face in a bowl of cold water, or hold a cold pack (or zip-lock bag of cold water) or ice cubes on your eyes, cheeks and/or neck. When you do this, it tells your brain you are diving underwater. This causes the “dive response” to occur (it may take at least 15 seconds to start).
- Hold your breath for at least 30 seconds. Your heart will slow down, blood flow to nonessential organs will be reduced, and blood flow will be redirected to the brain and heart. This dive response can help regulate your emotions. This will be useful as a distress tolerance strategy when you’re having a very strong, distressing emotion, or when you are having very strong urges to engage in dangerous behaviors.
- This strategy works best when you are sitting quietly - activity and distraction may make it less effective.
I = Intense Exercise (to calm down your body when it is revved up by emotion)
- Engage in intense exercise, if only for a short while. Expend your body’s stored up physical energy! This can be running up and down stairs, jumping, running in place, dancing the jitterbug, etc.
P = Paced Breathing (pace your breathing by slowing it down)
- Breathe deeply into your belly.
- Slow your pace of inhaling and exhaling way down (on average, 5 to 6 breaths per minute).
- Breathe out more slowly than you breathe in (for example, 5 seconds in and 7 seconds out).
P = Paired Muscle Relaxation (to calm down by pairing muscle relaxation with breathing out)
- While breathing into your belly deeply, tense your muscles (NOT so much as to cause a cramp).
- Notice the tension in your body.
- While breathing out, say the word “relax” in your mind.
- Let go of the tension.
- Notice the difference in your body.
Now, I can’t really do T or I right now, but I sure wish I had remembered the Ps yesterday! Coming out of a grocery store, I walked to my car, put the groceries away, and tied up Petunia in the back. A man waited until my dog was latched and closed in before he rode up behind me on his bike, asking for money. I ignored him and walked around to the driver’s side, but he followed me and was very pushy, inching his bike closer to me. He said he was from the mental health hospital, and I told him I was too and was not comfortable talking to men. Could he please go ask a man? And then I shakily got in my car, terrified he was going to come after me. My service dog didn’t even bark once! I managed to lock the door, but then I was frozen for a while and just cried, and the man stared at me the whole time. Like always, the real upset happened later that evening instead of at that moment. Talk about needing some TIPP. I’m going to go practice my Paced Breathing and Paired Muscle Relaxation right now.
If you would like a PDF of this exercise, you can find it here.
Keep on keeping on, friends.
CAUTION: Very cold water decreases your heart rate rapidly, and intense exercise will increase heart rate. Consult your health care provider before using these skills if you have a heart or medical condition, a lowered base heart rate due to medications, take a beta-blocker, are allergic to cold, or have an eating disorder.
From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills Training Manual, Second Edition, for personal use and use with individual clients only.