How to Manage Difficult Emotions: TIP Skills
When our emotions hit an extreme, it is difficult for our brains to process, think, and navigate through difficult situations. Take the situation where your anxiety has been building throughout a difficult week of managing tasks and juggling many responsibilities. Suddenly, you realize you forgot to complete a time-sensitive task at work. You freeze instantly. You start breathing fast, your heart is racing, and your mind is running right along with it. You are thinking through every terrible thing that might happen. Will your boss yell at you? Will you get fired? What if you partner dumps you afterwards for being such a failure? Surely your friends at work will stop talking to you because they will be so disappointed and embarrassed by your failure. I could go on and on.
When your anxiety is lower, you can likely take each of these concerns and dismiss or debunk them easily. “Actually the task was not that big of a deal,” “I’ve never made a mistake before so I likely will not get fired,” “It’s just a job and not my whole life,” and so on. But in the heat of the moment, when your emotions are at their highest, your brain cannot logically think through these different things. You are likely also struggling to think through the things that usually help to calm you down. Or you know that things like playing video games or watching a tv show will not be enough of a distraction at your current level of anxiety.
This is where distress tolerance skills come in.
Distress tolerance skills, as defined in Dialectical Behavioral Therapy (Linehan, 2014) are skills to use when you are navigating a crisis to not make it worse. Finding ways to navigate the crisis without further increasing your anxiety or acting on your anxiety in a way that is harmful to you or others.
The goal of Distress Tolerance skills is not to completely get rid of your anxiety. The skills I will share with you are more about bringing down your anxiety to a level that you can then cope with (or tolerate) the feelings in different helpful ways. If your anxiety is at a 9 or a 10 out of 10, Distress Tolerance skills may help bring that anxiety down to a 6 or 7. This might still be very uncomfortable, but will be at an intensity that you can start coping with your feelings in different ways, such as distraction, talking to others, etc. Although I’ve used anxiety as an example, you can use distress tolerance skills for any intense emotion: sadness, fear, anger, etc.
One of the most effective skills for navigating these emotional crises is called TIP skills, again from Dialectical Behavioral Therapy (DBT). These skills focus on changing your body chemistry in some way to help bring those emotions down. Since your brain cannot fully logic it’s way out of these high emotions, using the physical body to make changes to your body chemistry is a more direct way of navigating these challenging emotions.
TIP is an acronym that highlights 4 ways of changing your body chemistry:
T: Temperature
As mammals, when we swim in cold water our body automatically engages in a few things: our muscles de-tense, our breathing slows, and our heart rate decreases. Our body does all of this in cold water to help protect us. Therefore, we can use this same “mammalian dive reflex” to help change our body chemistry in moments of intense emotions. Many of us do not have a pool full of cold water that we can jump into readily at any given moment, so here is what you can do:
Fill a bowl with cold water. You will want the water to be cold, but not painful to the touch. Lean over the bowl, put your face in the bowl and hold your breath for about 30 seconds.
If you do not have a bowl, you can use something like an ice pack, a ziploc of cold water that you keep in the fridge, or something else cold and place it over your eyes while still leaning over forward and holding your breath.
I: Intense Exercise
Engaging in intense movement can be another way to change our body chemistry. Moving in ways that are very intense, even if for a short period of time, can help to regulate our bodies through increasing our heart rate and matching our physical responses to our actual physical movement. Jumping up and down quickly, lifting heavy things, running as fast as you can in place, even punching the air quickly for a few minutes can all be ways to break us out of our strong intense emotions. You don’t need to go to the gym for hours for this to be an effective way to bring your emotions down. Even engaging in intense movement for a few minutes, enough to raise your heart rate, can be effective.
P: Paced Breathing and Paired Muscle Relaxation
When our emotions are high, our breathing is often shallow and quick. Therefore, we can also intentionally slow and deepen our breathing. Breathe in through your nose into your belly deeply and slowly. Then exhale your breath slower than you breathed in. For example, if you breathe in for 5 seconds, breathe out for 7 seconds. Do this for a few minutes and you will notice your body begin to slow down as well.
You can also pair the paced breathing with muscle relaxation. As you take each breath in, focus on a muscle group. Tighten those muscles and notice the tension in them. As you breathe out, release the tension in your muscles and notice your muscles loosen. You can start in your feet and work up to your calves, then your thighs, and all the way up to your head.
** An important safety note: If you have a heart or medical condition, or take medications, such as beta blockers, consult with a healthcare professional before doing the Temperature and Intense Exercise Skills.
A few final tips for using the TIP skills:
Practice these skills at first at times that your emotions are not at a 9 or a 10 out of 10. Practice them at times that you are not in emotional crisis so you can figure out how to do the skills and make using them more of a habit. Remember, when our brains are running fast, it can be hard to remember different strategies, especially new habits and skills.
If you find yourself forgetting to practice the skills, set some reminders in your phone for random times to remind you to practice them.
Along with practicing, also prepare any materials you will need in advance. If you need any equipment for your intense exercise, make sure it is easily accessible. Make sure you know where the bowl or ice pack you will use for the temperature skill are kept. The easier these things are to grab, the easier the skills will be to use in a moment of high emotion.
You can try different strategies at different times. You may find that Paced Breathing and Paired Muscle Relaxation is very effective when you are anxious, while Intense Exercise is very effective when you are sad.
The TIP skills are often the first things you do when navigating an emotional crisis. Follow up the use of a TIP skill with another form of coping (i.e., distraction, talking to a loved one).
It can be helpful to share these skills with a friend or loved one so they can help remind you to use these skills when you are in a moment of emotional crisis. For example, you can ask your loved one “Can you please remind me to use Paced Breathing when I am very anxious?” This can be especially helpful when you are first using the skills.
If you are interested in learning more about TIP skills or other Distress Tolerance skills to help with anxiety or other difficult emotions, email me at carolyn@carolynmeillerphd.com or you can click here to request an appointment.
About the Author:
Dr. Carolyn Meiller is a trauma and anxiety therapist in Lexington, Kentucky. She received two years of weekly Dialectical Behavioral Therapy (DBT) training and consultation, and has provided both skills training and individual DBT therapy in the past. While working with clients now in her private practice, she will often utilize DBT-informed interventions to help clients navigate crisis, regulate emotions, and increase distress tolerance.
