TIPP: A Beginner’s Guide to Distress Tolerance

If you have ever struggled with intense anxiety, you know what it feels like to experience a panic attack. As the panic sets in, you begin to feel it tangibly in your body. You may feel like your mind is escaping your body. You start to experience heart palpitations, shaking hands, or your face getting hot. The feeling of choking or complete loss of breath can be overpowering. Any number of these symptoms may take place when experiencing intense anxiety. This is because, “during a panic attack, the body’s autonomous fight-or-flight response takes over. Physical symptoms are often more intense than symptoms of anxiety.”

During such periods of intense stress, it is common to detach oneself from physical surroundings, then become hyper-focused on your mental state. If you struggle with a mental health disorder, this lack of mental clarity during times of intense crises can cause you to resort to behaviors like self-harming or substance use. Don’t let a time of emotional intensity trip you up along your path to health and wholeness. Within a form of treatment called dialectical behavior therapy (DBT), there is a learned skill called distress tolerance. Distress tolerance is defined as “a person’s ability to manage actual or perceived emotional distress. It also involves being able to make it through an emotional incident without making it worse.” The higher your distress tolerance is, the more you can tolerate intense situations and crises. 

Within dialectical behavior therapy, there is a well-known practice for distress tolerance called TIPP. The acronym stands for:

  • Temperature

  • Intense Exercise

  • Paced Breathing

  • Paired Muscle Relaxation


When you’re experiencing a panic attack, your body often gets hot. You most likely feel this change in temperature in your face. To bring your body temp back to baseline, you can use anything very cold. Some people use ice cubes, while others use ice packs or a bucket of ice water. You can put the ice cube on the back of your neck, or your forehead. If you’re in a place of intense distress, dunking your head in a bowl of ice water tends to do the trick. The cold temperature slows your heart rate and engages the parasympathetic nervous system to bring you to a place of calm. 

Intense Exercise

If you’re feeling exceptionally intense emotions, a burst of intense exercise can help you release that pent-up energy and relieve you of your stress. The intense exercise doesn’t need to be for an extended time, just a few minutes will tire you out enough for your body to calm down. A few options for intense exercise include: going for a long run, doing push-ups, jumping jacks, or going for a bike ride.

Paced Breathing

By controlling your breathing, you can get your body to a state of calm. Try breathing in through your nose for seven seconds, then breathing out for ten seconds. You can also try box breathing, where you breathe for four seconds, in intervals of four. Between each interval of breathing, you pause and hold your breath for four seconds. Another option is to try the 4-4-8 breathing technique, which is where you inhale through your nose for four counts, hold your breath for four counts, and exhale for eight counts. Make sure that when you exhale, you purse your lips and you can hear your breath being released. Manipulating your breathing in this way forces your heart rate to slow down. If you get stuck, refer to this helpful sheet

Paired Muscle Relaxation 

Paired muscle relaxation entails targeting one muscle or muscle group, tightening it very intensely, holding it for ten seconds, and then relaxing the muscle. This is helpful in distress tolerance because when you tighten a voluntary muscle, relax it, and allow it to rest, the muscle will become more relaxed than it was before it was tightened. Relaxed muscles require less oxygen, so your breathing and heart rate will slow down. Ensuring you verbally say “Relax,” as you exhale and release your tightened muscles. 

You can target any of the following muscle groups:

  • hands (make fists)

  • arms (make fists and tense your forearms, biceps, and triceps)

  • shoulders (raise shoulders as high as possible)

  • forehead (wrinkle your forehead, lowering eyebrows)

  • eyelids (shut them tightly)

  • face (scrunch up nose and raise lips and cheeks)

  • neck (push chin down toward chest)

  • chest (take a deep breath and hold it)

  • back (arch your back)

  • stomach (tense abdominal muscles)

  • buttocks/glutes (squeeze together)

  • thighs (tense quads and hamstrings)

  • calves (point toes downward)

  • ankles and feet (curl toes, heels out)

If your distress level is high, implementing this strategy can help mitigate symptoms. The purpose of TIPP is to bring your body back to a place of control and emotional regulation. Your symptoms will not be entirely alleviated, but after using TIPP it is possible to manage and tolerate the unpleasant feelings that accompany moments of intense stress.

Having a panic attack can be a frightening, overwhelming, and intense experience. Battling mental health can be a massive undertaking by itself, so it is imperative that you learn skills that help you tolerate such emotional distress. You can build your distress tolerance by practicing the acronym TIPP: Temperature, Intense Exercise, Paced Breathing, Paired Muscle Relaxation. TIPP can be helpful if you are in a crisis, experiencing anxiety, or are under immense life pressures. If you are in the California, Oregon, and Alaska regions, SokyaHealth may be right for you. Our goal is to help you realize your true potential and succeed in today’s challenging and evolving global environment. SokyaHealth is a unique, multidisciplinary, private psychiatric and mental health practice. We provide comprehensive, compassionate mental health and wellness services to children, adolescents, and adults. If you are interested in a consultation, don’t hesitate to call us at 866-932-1767.

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