At the peak of emotional intensity, you can be blinded by your distress and unable to think through logical options. This often leads people to act in impulsive and harmful ways to reduce the distress in the moment (e.g. self-harming) but creates a vicious cycle in which self-harm becomes the only option to reduce distress. DBT helps teach different skills to understand, manage and tolerate emotions. One such skill is the TIP skill. This skill is one to be used when you are in the eye of the emotional storm and when others skills simply would not work. There is a great deal of evidence and science behind each skill, some of which I will explore in this blog.
Before I explain the TIP skills, it is important to explain why the skills work. The TIP skills work on the parasympathetic nervous system. Put simply, the nervous system is made up of two systems which work in opposite directions from one another. The sympathetic nervous system is activating; it triggers the fight or flight response which sets off a whole host of physical, emotional and cognitive processes. The parasympathetic nervous system does the opposite: it slows you down and increases thoughtful, considered and emotionally attuned responses. The TIP skills act on the parasympathetic nervous system to help alleviate the intensity of the emotions and distress. What is important to remember here is that impacting on our physiology can have a huge impact on our emotions and thoughts. An interesting example of this is described by Amy Cuddy in her TED talk about how we hold our body changes our emotional, cognitive and even biochemical state (https://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are another important thing she talks about here is faking it to make it, something we will try to explore in future blogs).
The T stands for Temperature and involves tipping your face into cold water or putting a cold flannels onto your face whilst briefly holding your breath. This induces something called the dive reflex which is a naturally occurring process of slowing the heart rate when immersed in cold water without oxygen. Linehan (2015) suggests that this skill is helpful in states of high emotional arousal as well as times when you cannot sleep due to ruminative thoughts or during dissociative episodes. Linehan (2015) warns that this skill should not be used if you have a heart condition and that the effects are short lived therefore it is important to follow up immediately with an activity that continues to reduce arousal, is distracting or problem solving.
Intense exercise is the next skill. This means doing any intense aerobic exercise for 20 minutes; running, cycling, dancing, jumping, anything that gets your heart rate up! This can lead to a decrease in negative mood and ruminative thoughts. Linehan (2015) asserts that emotions activate the body and call for action. This often leads to destructive behaviour in people with a personality disorder however; intensive exercise re-regulates the body leading to reduced emotional arousal. This skill can be used when you are agitated or angry to help bring the emotion down so that you can engage in wise mind activities.
The P stands for paced breathing (Linehan, 2015). This means slowing your breathing rate to 5-6 breaths per minute. Linehan (2015) refers again to the sympathetic (activating) and parasympathetic (slowing) system to explain why this works. She explains that the sympathetic system becomes active when we breathe in and the parasympathetic system activates when we breathe out (Linehan, 2015). Thus, it is important to breathe out for longer than we breathe in (e.g. breathe in for 4 counts and out for 6 counts).
The final P (not included in the acronym) is for paired muscle relaxation. For the reasons described above, this involves pairing relaxing the muscles as you breathe out. There are numerous resources online to illustrate how to do this e.g. progressive muscle relaxation. However, it is important to note that the use of the breath can augment the calming effects of this exercise.
Linehan (2015) argues that together, these skills are just as effective at reducing the intensity of emotions as destructive behaviours such as self-harm. As part of our DBT service, we work to develop these skills with the individuals we work with. Changing habitual patterns such as self-harm is very challenging, particularly when alternatives don’t seem as effective or helpful in reducing the overwhelming intensity of emotions in the moment. Practicing these skills, even when not in the eye of the emotional storm is very important to ensure the skills are readily available when most needed.
If you are interested in accessing DBT treatment, please contact us (firstname.lastname@example.org) to explore options with our service.
LInehan, M.M. (2015). DBT skills training manual. Guilford Press.