General Instructions for Therapists
As you guide clients through these TIPP skill activities, the goal is to help them learn how to manage emotional crises by targeting the body’s physiological responses. The TIPP skill uses four specific techniques—Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation—to quickly reduce emotional arousal. By practicing these methods, clients can regain control when they are overwhelmed, helping them make clearer decisions and avoid impulsive reactions.
Encourage clients to experiment with each technique and reflect on which ones work best for them in various situations.
General Instructions for Clients
Today’s activities focus on practicing the TIPP skill, which is designed to help you quickly calm down during moments of emotional distress. TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation. Each of these techniques helps your body recover from the physical effects of strong emotions, allowing you to regain control and feel more grounded.
These exercises will guide you through the different parts of the TIPP skill. After each exercise, we’ll reflect on how it felt and how you might use it in the future when dealing with stress or strong emotions.
Table of Contents
What is the TIPP Skill in DBT?
The TIPP skill in Dialectical Behavior Therapy (DBT) consists of four quick and effective techniques to reduce emotional distress by calming the body’s physiological responses. These techniques are:
- Temperature: Changing your body temperature, such as by holding ice or splashing cold water on your face, can help lower intense emotions.
- Intense Exercise: Engaging in short bursts of intense physical activity, such as running or jumping jacks, can help release built-up tension.
- Paced Breathing: Slowing your breathing to a steady, controlled rhythm can reduce anxiety and help you regain focus.
- Progressive Muscle Relaxation: Tensing and relaxing different muscle groups helps release physical tension and calm the body.
By practicing these methods, you can quickly regain control when faced with overwhelming emotions.
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15 TIPP Skill Activities
Activity 1: Using Cold Water to Reduce Intense Emotions
Intro to activity:
This activity helps clients practice the Temperature part of the TIPP skill by using cold water to rapidly lower emotional arousal and help the body calm down.
How to practice this activity:
Prompt:
“We’re going to focus on using cold water to reduce intense emotions. The goal is to use a quick temperature change to help your body relax and reduce emotional overwhelm.”
Preparation:
The therapist asks clients to have access to cold water, whether in the form of a sink with cold water, an ice pack, or a cold compress. Clients are encouraged to think about a moment when they felt overwhelmed by emotions and could have used this skill.
Guidance:
Therapist says: “As you think about that moment of emotional intensity, practice using cold water. Splash cold water on your face for 30 seconds or hold an ice pack on your forehead. Focus on the sensation of coldness and notice how it helps your body and mind calm down.”
Experience:
Clients spend 5-10 minutes practicing the cold water technique, paying attention to the shift in their emotional and physical state. The therapist encourages them to reflect on how the sudden temperature change affects their emotions.
Observation:
Clients reflect on how they felt after using the cold water technique. Did they notice a reduction in emotional intensity and feel more in control?
Discussion:
After the activity, the therapist asks: “What did it feel like to use cold water to calm down? Did the temperature change help reduce your emotional distress?”
Reflection:
Reflect on how using cold water can help you quickly calm intense emotions. In a group, the therapist might ask: “How could using the Temperature technique during emotional crises help you manage your emotions more effectively?”
Activity 2: Using Intense Exercise to Release Emotional Tension
Intro to activity:
This activity helps clients practice the Intense Exercise part of the TIPP skill, allowing them to use physical movement to quickly reduce emotional arousal and release tension.
How to practice this activity:
Prompt:
“We’re going to focus on using intense exercise to release emotional tension. The goal is to engage in short bursts of physical activity to reduce emotional overwhelm and help your body release built-up tension.”
Preparation:
The therapist asks clients to choose a form of physical exercise they feel comfortable with, such as running in place, jumping jacks, or dancing. Clients are encouraged to think about a time when they felt emotionally stuck or overwhelmed.
Guidance:
Therapist says: “As you think about that overwhelming moment, practice using intense exercise. Engage in your chosen activity for 1-2 minutes, focusing on moving your body and releasing tension. Notice how your emotions shift as you move.”
Experience:
Clients spend 5-10 minutes engaging in short bursts of exercise, paying attention to the physical and emotional release that follows. The therapist encourages them to observe how the intense exercise impacts their emotional state.
Observation:
Clients reflect on how they felt after using intense exercise. Did they notice a reduction in emotional intensity or feel more energized and in control?
Discussion:
After the activity, the therapist asks: “What did it feel like to use intense exercise to release emotional tension? Did it help you feel more in control of your emotions?”
Reflection:
Reflect on how using intense exercise can help you manage emotional overwhelm. In a group, the therapist might ask: “How could incorporating physical activity during emotional crises help you regain focus and clarity?”
Activity 3: Paced Breathing for Calming Anxiety
Intro to activity:
This activity helps clients practice Paced Breathing, a technique that slows down their breathing to reduce anxiety and calm their emotions.
How to practice this activity:
Prompt:
“We’re going to focus on using paced breathing to calm anxiety. The goal is to slow your breathing to a steady rhythm to help reduce emotional distress and bring your body back to a relaxed state.”
Preparation:
The therapist asks clients to sit or lie down in a comfortable position. Clients are encouraged to reflect on a time when they felt anxious or their heart rate increased due to stress.
Guidance:
Therapist says: “As you think about that moment of anxiety, practice paced breathing. Inhale slowly through your nose for four counts, hold for four counts, and exhale slowly through your mouth for six counts. Focus on each breath, letting it ground you in the present moment.”
Experience:
Clients spend 5-10 minutes practicing paced breathing, focusing on the rhythm of their breath and the sensation of calming down. The therapist encourages them to notice how their body feels as their breathing slows.
Observation:
Clients reflect on how they felt after practicing paced breathing. Did they notice a decrease in anxiety and feel more relaxed and centered?
Discussion:
After the activity, the therapist asks: “What did it feel like to use paced breathing to calm down? Did it help reduce your anxiety and bring you back to a place of calm?”
Reflection:
Reflect on how paced breathing can help you manage anxiety. In a group, the therapist might ask: “How could using paced breathing during stressful situations help you feel more in control of your emotional responses?”
Activity 4: Progressive Muscle Relaxation for Releasing Tension
Intro to activity:
This activity helps clients practice Progressive Muscle Relaxation, a technique where they tense and relax different muscle groups to release physical tension and calm the body.
How to practice this activity:
Prompt:
“We’re going to focus on using progressive muscle relaxation to release tension. The goal is to tense and relax different muscle groups to reduce physical tension and calm emotional distress.”
Preparation:
The therapist asks clients to sit or lie down in a comfortable position. Clients are encouraged to think about a time when they felt physically tense due to stress or anxiety.
Guidance:
Therapist says: “As you think about that moment of tension, practice progressive muscle relaxation. Start by tensing the muscles in your feet and hold for five seconds, then release. Move up to your legs, stomach, arms, and finally your face, tensing and relaxing each group. Focus on the sensation of releasing tension.”
Experience:
Clients spend 5-10 minutes tensing and relaxing their muscles, paying attention to the feeling of physical and emotional release as they go. The therapist encourages them to reflect on how their body feels after the exercise.
Observation:
Clients reflect on how they felt after using progressive muscle relaxation. Did they notice a reduction in physical tension and feel calmer overall?
Discussion:
After the activity, the therapist asks: “What did it feel like to use progressive muscle relaxation? Did it help you release physical tension and feel more relaxed?”
Reflection:
Reflect on how progressive muscle relaxation can help you manage stress. In a group, the therapist might ask: “How could using this technique during moments of stress help you stay grounded and calm?”
Activity 5: Combining Temperature and Paced Breathing
Intro to activity:
This activity helps clients practice a combination of the Temperature and Paced Breathing techniques to calm emotional distress.
How to practice this activity:
Prompt:
“We’re going to focus on combining temperature and paced breathing to reduce emotional distress. The goal is to use cold water or an ice pack with slow, steady breathing to bring your body back to a state of calm.”
Preparation:
The therapist asks clients to have access to cold water or an ice pack and find a comfortable position. Clients are encouraged to think about a recent moment when they felt overwhelmed.
Guidance:
Therapist says: “As you think about that overwhelming moment, start by placing cold water on your face or holding an ice pack. At the same time, practice paced breathing—inhale for four counts, hold for four counts, and exhale for six counts. Focus on both the cool sensation and your breath.”
Experience:
Clients spend 5-10 minutes practicing this combined technique, focusing on the cooling effect of the water and the calming rhythm of their breathing. The therapist encourages them to reflect on how these two techniques work together to reduce emotional arousal.
Observation:
Clients reflect on how they felt after combining temperature and paced breathing. Did the combination help them feel more grounded and in control of their emotions?
Discussion:
After the activity, the therapist asks: “What did it feel like to combine these two techniques? Did it help you calm down faster and feel more in control?”
Reflection:
Reflect on how combining temperature and paced breathing can help you manage overwhelming emotions. In a group, the therapist might ask: “How could using these two techniques together help you regain calm during emotional crises?”
Activity 6: Using Ice or Cold Packs to Manage Emotional Intensity
Intro to activity:
This activity helps clients practice the Temperature part of the TIPP skill by using ice or a cold pack to reduce emotional intensity and help the body quickly reset.
How to practice this activity:
Prompt:
“We’re going to focus on using ice or a cold pack to manage emotional intensity. The goal is to use the shock of cold against your skin to help your body calm down and reduce emotional overwhelm.”
Preparation:
The therapist provides clients with ice cubes wrapped in a cloth or a cold pack. Clients are encouraged to think about a time when emotions felt out of control and they could have used this technique to regulate.
Guidance:
Therapist says: “When you feel emotionally overwhelmed, place the ice or cold pack against your forehead, temples, or the back of your neck. Hold it there for about 30 seconds, focusing on the cold sensation. Notice how your emotions start to shift as your body reacts to the cold.”
Experience:
Clients practice holding the ice or cold pack for 30-60 seconds, paying attention to how the cold temperature helps their body and emotions calm down. The therapist encourages them to focus on the physical sensation and how it influences their mood.
Observation:
Clients reflect on how they felt after using ice or a cold pack. Did the cold sensation help reduce emotional intensity and bring more clarity?
Discussion:
After the activity, the therapist asks: “What did it feel like to use ice or a cold pack to manage emotional intensity? Did it help you reset and regain control?”
Reflection:
Reflect on how using ice or cold packs can help you quickly calm intense emotions. In a group, the therapist might ask: “How could using this simple technique help you manage emotional crises and feel more grounded?”
Activity 7: Using Jumping Jacks for Quick Emotional Reset
Intro to activity:
This activity helps clients use jumping jacks, a quick and intense physical exercise, to rapidly release emotional energy and regain a sense of control.
How to practice this activity:
Prompt:
“We’re going to focus on using jumping jacks for quick emotional reset. The goal is to use short bursts of intense movement to help your body release built-up tension and bring your emotions back into balance.”
Preparation:
The therapist asks clients to find a space where they can comfortably perform jumping jacks. Clients are encouraged to think about a recent time when they felt emotionally stuck or tense.
Guidance:
Therapist says: “When you feel emotionally tense or stuck, try doing jumping jacks for 1-2 minutes. Focus on releasing the energy as you move and notice how your emotional state shifts as you exercise.”
Experience:
Clients perform jumping jacks for 1-2 minutes, focusing on the intensity of the movement and how it helps them release emotional tension. The therapist encourages them to reflect on how their mood and physical sensations change.
Observation:
Clients reflect on how they felt after using jumping jacks. Did the intense movement help them release emotional energy and feel more balanced?
Discussion:
After the activity, the therapist asks: “What did it feel like to use jumping jacks for an emotional reset? Did it help you release tension and regain control of your emotions?”
Reflection:
Reflect on how using quick, intense exercise like jumping jacks can help you manage emotional overwhelm. In a group, the therapist might ask: “How could using this technique during emotional crises help you stay grounded?”
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Activity 8: Focused Breathing with Visualisation
Intro to activity:
This activity combines paced breathing with visualisation to enhance emotional calming by using mental imagery alongside deep, steady breathing.
How to practice this activity:
Prompt:
“We’re going to focus on using focused breathing with visualisation to reduce emotional distress. The goal is to pair your breathing with calming mental images to bring yourself back to a state of relaxation.”
Preparation:
The therapist asks clients to sit in a comfortable position and think about a peaceful place or positive image. Clients are encouraged to recall a moment when they felt stressed or anxious.
Guidance:
Therapist says: “As you breathe in slowly through your nose, picture a calming image—like a beach, a forest, or something that brings you peace. Hold your breath for four counts and then exhale through your mouth, keeping the image in your mind. Let the image guide you toward relaxation.”
Experience:
Clients spend 5-10 minutes practicing paced breathing while focusing on their chosen visualisation. The therapist encourages them to observe how both the breathing and imagery together help reduce their emotional distress.
Observation:
Clients reflect on how they felt after using focused breathing with visualisation. Did the combination of breathing and imagery help calm them down and ease their emotions?
Discussion:
After the activity, the therapist asks: “What did it feel like to use visualisation alongside your breathing? Did it help you calm down more effectively than breathing alone?”
Reflection:
Reflect on how combining breathing with visualisation can deepen your relaxation during stressful moments. In a group, the therapist might ask: “How could using this technique during emotional challenges help you regain calm more quickly?”
Activity 9: Progressive Muscle Relaxation for Sleep
Intro to activity:
This activity helps clients practice Progressive Muscle Relaxation specifically to prepare for sleep, calming the body and mind for restful relaxation.
How to practice this activity:
Prompt:
“We’re going to focus on using progressive muscle relaxation to help you prepare for sleep. The goal is to reduce physical and emotional tension, helping your body relax for better rest.”
Preparation:
The therapist asks clients to lie down in a comfortable position, ideally in a quiet space where they can sleep. Clients are encouraged to think about any physical tension they’ve felt during the day.
Guidance:
Therapist says: “Start by tensing the muscles in your feet, holding for five seconds, and then release. Move up through your legs, stomach, arms, and finally your face, tensing and relaxing each muscle group. Focus on the feeling of release as you let go of the tension, preparing your body for sleep.”
Experience:
Clients spend 5-10 minutes practicing progressive muscle relaxation while focusing on letting go of the day’s tension. The therapist encourages them to notice how their body feels more relaxed and ready for rest.
Observation:
Clients reflect on how they felt after using progressive muscle relaxation for sleep. Did they feel more prepared for restful sleep and notice a reduction in physical tension?
Discussion:
After the activity, the therapist asks: “What did it feel like to use progressive muscle relaxation to prepare for sleep? Did it help you feel calmer and ready to rest?”
Reflection:
Reflect on how using progressive muscle relaxation can help you sleep more peacefully. In a group, the therapist might ask: “How could incorporating this technique into your nighttime routine help you improve your sleep?”
Activity 10: Cooling Down with a Cold Compress After Exercise
Intro to activity:
This activity helps clients practice using the Temperature part of the TIPP skill by cooling down with a cold compress after exercise to help regulate both body and emotions.
How to practice this activity:
Prompt:
“We’re going to focus on using a cold compress after exercise to help cool down both physically and emotionally. The goal is to use the cooling effect to calm your body and reduce emotional distress after intense physical activity.”
Preparation:
The therapist asks clients to have access to a cold compress or ice pack. After performing intense exercise (such as jumping jacks or running), clients can use the cold compress to help cool down.
Guidance:
Therapist says: “After intense exercise, place the cold compress on your forehead or neck. Focus on how the cold temperature helps bring your body and emotions back to a calm, balanced state.”
Experience:
Clients spend 5-10 minutes using the cold compress, paying attention to the physical sensation and how it helps their body and mind cool down after exercise. The therapist encourages them to reflect on how the cold temperature affects their emotional state.
Observation:
Clients reflect on how they felt after using the cold compress post-exercise. Did the cooling effect help bring their emotions and physical energy back to a calm state?
Discussion:
After the activity, the therapist asks: “What did it feel like to use a cold compress after intense exercise? Did it help you calm down and feel more balanced?”
Reflection:
Reflect on how combining intense exercise with a cooling down period can help manage emotional arousal. In a group, the therapist might ask: “How could using this cooling technique help you regulate both your body and emotions after stressful situations?”
Activity 11: Quick Intense Exercise Break
Intro to activity:
This activity encourages clients to take a quick exercise break by doing intense, short-burst exercises like sprinting in place or shadow boxing, to rapidly reduce emotional tension and stress.
How to practice this activity:
Prompt:
“We’re going to focus on using a quick, intense exercise break to reduce emotional tension. The goal is to release pent-up energy and stress through physical movement to help bring your emotions back into balance.”
Preparation:
The therapist asks clients to find a space where they can comfortably engage in exercises like sprinting in place or shadow boxing. Clients are encouraged to think about a time when they felt emotionally tense or frustrated.
Guidance:
Therapist says: “When you feel emotionally tense, take a 1-2 minute break and engage in quick, intense exercises like sprinting in place or throwing air punches (shadow boxing). Focus on releasing the tension as you move, and notice how your emotional state begins to shift.”
Experience:
Clients perform a quick, intense exercise for 1-2 minutes, paying attention to how the physical movement helps release their emotional tension. The therapist encourages them to observe the effects on their mood and energy levels.
Observation:
Clients reflect on how they felt after taking an intense exercise break. Did the short burst of movement help release emotional tension and allow them to feel more balanced?
Discussion:
After the activity, the therapist asks: “What did it feel like to use intense exercise to release emotional tension? Did it help you regain control and feel less stressed?”
Reflection:
Reflect on how quick bursts of exercise can help you manage intense emotions. In a group, the therapist might ask: “How could taking quick exercise breaks during stressful situations help you reset emotionally?”
Activity 12: Paced Breathing with Counting Focus
Intro to activity:
This activity helps clients practice Paced Breathing with a focus on counting their breaths, which encourages mindfulness and helps calm both mind and body.
How to practice this activity:
Prompt:
“We’re going to focus on using paced breathing with a counting focus to calm down. The goal is to slow your breathing and focus on counting each breath to bring your emotions back to a balanced state.”
Preparation:
The therapist asks clients to sit in a comfortable position. Clients are encouraged to think about a recent time when they felt stressed or overwhelmed.
Guidance:
Therapist says: “As you sit comfortably, inhale slowly through your nose for four counts, hold for four counts, and exhale through your mouth for six counts. As you breathe, count each breath in your mind. Let the counting help focus your mind and calm your emotions.”
Experience:
Clients spend 5-10 minutes practicing paced breathing while focusing on counting their breaths. The therapist encourages them to notice how counting helps bring a sense of calm and control.
Observation:
Clients reflect on how they felt after practicing paced breathing with a counting focus. Did the combination of breathing and counting help them calm down more effectively?
Discussion:
After the activity, the therapist asks: “What did it feel like to focus on counting your breaths while practicing paced breathing? Did it help you feel more centered and calm?”
Reflection:
Reflect on how focusing on counting can enhance the calming effects of paced breathing. In a group, the therapist might ask: “How could this technique help you focus and regain calm during stressful situations?”
Activity 13: Using Cold Water and Progressive Muscle Relaxation Together
Intro to activity:
This activity combines the Temperature and Progressive Muscle Relaxation techniques to help clients quickly reduce emotional distress by cooling their body and releasing tension in their muscles.
How to practice this activity:
Prompt:
“We’re going to focus on using cold water and progressive muscle relaxation together to reduce emotional distress. The goal is to combine the cooling effect of cold water with muscle relaxation to help your body calm down.”
Preparation:
The therapist asks clients to have access to cold water or an ice pack and find a comfortable space where they can sit or lie down. Clients are encouraged to reflect on a recent stressful moment.
Guidance:
Therapist says: “Place cold water or an ice pack on your forehead or neck while practicing progressive muscle relaxation. Start by tensing and relaxing your feet, then move up through your legs, arms, and face. Focus on the cold sensation and the release of tension in your muscles.”
Experience:
Clients spend 5-10 minutes combining cold water with progressive muscle relaxation, focusing on the cooling effect and the gradual release of tension in their body. The therapist encourages them to observe how the two techniques work together to reduce emotional arousal.
Observation:
Clients reflect on how they felt after using cold water and progressive muscle relaxation. Did the combination help reduce their emotional and physical tension more effectively?
Discussion:
After the activity, the therapist asks: “What did it feel like to combine cold water with progressive muscle relaxation? Did it help you calm down more quickly and feel more in control?”
Reflection:
Reflect on how combining these techniques can enhance emotional regulation. In a group, the therapist might ask: “How could using these two techniques together help you manage emotional crises more effectively?”
Activity 14: Paced Breathing with Music
Intro to activity:
This activity combines Paced Breathing with calming music to enhance emotional relaxation and help clients return to a balanced emotional state.
How to practice this activity:
Prompt:
“We’re going to focus on using paced breathing with music to enhance relaxation. The goal is to breathe slowly and steadily while listening to calming music to help you reduce emotional distress.”
Preparation:
The therapist asks clients to choose a piece of calming music they enjoy and find a quiet space. Clients are encouraged to reflect on a time when they felt emotionally overwhelmed and needed calm.
Guidance:
Therapist says: “As you listen to the music, practice paced breathing—inhale for four counts, hold for four counts, and exhale for six counts. Let the music guide your breathing and focus on the calming effect of both the music and the breath.”
Experience:
Clients spend 5-10 minutes listening to calming music while practicing paced breathing. The therapist encourages them to observe how the combination of music and breathing helps reduce emotional tension.
Observation:
Clients reflect on how they felt after using paced breathing with music. Did the music enhance the calming effect of the breathing and help them feel more centered?
Discussion:
After the activity, the therapist asks: “What did it feel like to combine music with paced breathing? Did the music help you focus and relax more deeply?”
Reflection:
Reflect on how music can enhance the effects of paced breathing during emotional distress. In a group, the therapist might ask: “How could using music with breathing help you manage your emotions more effectively?”
Activity 15: Cooling Down with Ice After Intense Exercise
Intro to activity:
This activity combines the Intense Exercise and Temperature parts of the TIPP skill by using ice or a cold compress after exercise to help clients cool down both physically and emotionally.
How to practice this activity:
Prompt:
“We’re going to focus on cooling down with ice after intense exercise. The goal is to use a cold compress after physical activity to help your body and emotions return to a calm state.”
Preparation:
The therapist asks clients to have access to ice cubes wrapped in a cloth or a cold compress. After engaging in short bursts of intense exercise, clients can use the cold compress to help cool down.
Guidance:
Therapist says: “After your intense exercise, place the ice or cold compress on your forehead, neck, or wrists. Focus on the cold sensation and notice how it helps your body and emotions settle back into a calmer state.”
Experience:
Clients spend 5-10 minutes using the ice or cold compress after engaging in intense exercise, paying attention to the cooling effect and how it helps regulate both their body and emotional state. The therapist encourages them to reflect on the combination’s impact.
Observation:
Clients reflect on how they felt after cooling down with ice following intense exercise. Did the combination of exercise and cold help reduce emotional intensity and bring them back to a balanced state?
Discussion:
After the activity, the therapist asks: “What did it feel like to cool down with ice after intense exercise? Did it help you calm down physically and emotionally?”
Reflection:
Reflect on how combining intense exercise with a cooling down period can help regulate emotional arousal. In a group, the therapist might ask: “How could using this combination help you manage emotional crises more effectively?”
