As we continue our series on accessible skills for coping (DBT Skills), I want to introduce Distress Tolerance Skills.  Dialectical Behavior Therapy consists of four “chapters” or modules, each presenting dozens of strategies in each skill group.  One of the modules is the all-important Distress Tolerance module. Distress Tolerance skills help us survive and cope when experiencing a crisis or intense escalation of emotion.  The skills help us tolerate emotional [and physical] pain and can be used in situations when there are few, if any, alternatives to feel better.

When experiencing intense negative emotion, it’s not uncommon to feel like “this will never end” or “this is how it is.”  It’s not surprising that when in this activated – and desperate – state of mind, one might resort to the use of unhealthy coping mechanisms (like binge eating, purging, self-harm) in an effort to self-soothe. DBT founder Marsha Linehan developed distress tolerance skills that are easy to access and straightforward to help people use more adaptive, less destructive strategies when in crisis.

As a Distress Tolerance tool, TIP skills are primary and vital. TIP is an acronym that stands for Temperature, Intense Exercise, Paced Breathing, and Progressive Relaxation. TIP skills ask that we change our body chemistry to regain control of our emotions and behavioral responses.

T: Temperature. Have you heard of the mammalian dive reflex? Try leaning over a sink or surface and placing cold water, ice or a cold pack over the temples, eyes and upper nose region for ~30 seconds. This dive-like stance triggers a reflex that occurs in nature when mammals submerge in cold water. Think back to the last time you dove into a cold pool at the start of summer–you may recall the sensation of slowly cutting through the water with your arms, and a feeling of slowed time as you drifted up toward the surface. As we dive face first into cold water, our heart rate slows and our breathing regulates as the body prepares to conserve energy for survival. We have engaged our parasympathetic nervous system and experience a calming effect.  So next time you feel highly activated, distressed, upset, angry think “T for temperature” and try running cold water on your forearms, taking a hot or cold shower, chewing on ice or just holding an ice cube in your hand.  When we briefly change our temperature, we ground ourselves in the present moment and refocus.

I: Intense exercise or brief bursts of exercise can be helpful in the grounding process. Think of this process as ‘using up’ some of the energy that may be fueling high-energy emotions like anger or anxiety. When in a low-energy state (e.g. feeling, down, depressed, lethargic) getting the heart rate up will invigorate the individual.   It’s important to note that exercise can be a highly sensitive issue for those who struggle with eating disorders.  If you’re at a place in your treatment where you need to limit exercise, it would make more sense to try the T or P and P skills.

P: Paced breathing allows us to activate our parasympathetic nervous system as we regulate and slow our breath. With paced breathing we breathe deeply into our lungs and diaphragm. As we slow the pace of our in-breaths and out-breaths, we may achieve 5-6 thoughtful breaths per minute.  Some people refer to deep breathing as “having a pill in your pocket.” In other words, breathing is a highly accessible skill – available to you at all times no matter where you are – and one that can be very effective to calm and steady you when emotion is riding high.

P: Progressive Muscle Relaxation is paired with paced breathing.  With paced breathing we tense and relax muscle groups throughout the body to promote a relaxing effect. If you are feeling extreme emotion, you may try mindfully tensing all of your muscle groups at once… and then dropping your weight back into the ground or into your chair. As you travel from head to toe engaging all of your muscle groups simultaneously or one area at a time, pay close attention to the sensations in your body.

Contact us at Columbus Park today to learn more about DBT and distress tolerance skill building.