For many of us who struggled with self-harm, our urges and behaviors are often accompanied by intense emotions seeming to incapacitate all of our abilities to cope with what we are experiencing.
During this kind of emotional turmoil, it can be difficult to distract ourselves or use any other coping mechanism. Sometimes, these initial coping mechanisms can be ineffective in the moment while other times we may be too overwhelmed to think of what to do.
At other moments, it may not be possible for us to use some of our go-to coping mechanisms.
This is where TIP skills come in.
TIP skills were originally developed by Marsha Linehan as part of Dialectical Behavioral Therapy (DBT) and are a way to rapidly decrease significant emotional distress within seconds to minutes. They reduce emotional arousal by altering your body chemistry, and are as effective as damaging behaviors (i.e. self-harm, using drugs and alcohol, etc.) at reducing painful emotions, but without the negative effects.
TIP skills work by decreasing the activity of our sympathetic nervous system (our fight-or-flight response), and activating our parasympathetic nervous system. Activation of the parasympathetic nervous system increases our ability to regulate our emotions.
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Essentially, TIP skills alter our physical state which then changes our emotional state.
So, what exactly are these TIP skills?
T = Temperature
The first TIP skill involves changing our body temperature with cold water. This can be done by submerging your face in a bowl or sink of cold water, holding an icepack or cold compress over your eyes and cheeks, or by splashing cold water on your face.
Personally, I find taking a cold shower, while not pleasant, is the most effective in helping me regulate my emotions and decrease self-harm urges.
Tipping your body temperature helps you to calm down quickly, by simulating the dive reflex, which slows down the heart rate. It can also be helpful when experiencing difficulty sleeping due to anxiety, or when dealing with any sort of dissociation. Because using this cold water method slows down your heart rate, make sure to consult your medical provider if you have a heart or medical condition, are taking certain medications, or have an eating disorder.
I = Intense exercise
The second TIP skill is to engage in an intense aerobic exercise of any kind for at least 20 minutes. This works especially well when you are feeling agitated or angry when you cannot stop ruminating, or when you need to bring up your mood.
Because emotions organize the body for action (e.g. anger prepares you to attack or defend, fear to run, etc.), exercise helps to re-regulate your body into a less emotional state. Again, if you have a heart or medical condition, are taking certain medication, or have an eating disorder, you should consult your medical provider first.
P = Paced breathing and Paired or Progressive muscle relaxation
Let’s start with paced breathing.
This third TIP skill involves slowing down your breathing and breathing deeply from your stomach. There are two ways you can do this. You can watch a clock and focus on slowing to five or six breaths per minute, or you can use a breathing pacer online or in app form (you can find some here: http://www.dbtsandiego.com/current_clients.html). Also, make sure you breathe out more slowly than you breathe in (e.g. 5 seconds in, 7 seconds out).
The final TIP skill is paired or progressive muscle relaxation. The latter involves progressively tensing muscles and relaxing them, and the former involves letting go of tension while breathing out and mentally saying the word “relax.” There are great guided paired and progressive muscle relaxation videos available on YouTube for you to try this with!
This type of muscle relaxation can be difficult for some who panic because of not meeting the expectations of relaxing. Remember, it’s okay if relaxing muscles do not result in relaxation. The goal of any sort of muscle relaxation is to become aware of body tension. This also becomes easier with more practice, so it could be helpful to practice muscle relaxation at a time when you don’t feel emotionally overwhelmed.
Because physiological arousal is an important component of emotions, changing our physiological state will alter our emotional state.
After using one or more of the TIP skills you may feel more emotionally in control and capable of using other coping mechanisms to deal with self-harm urges.
Personally, I find it is helpful to re-regulate my emotions through a change in temperature. Afterward, I am able to reach out to a friend, journal, or distract myself, until my urges to engage in self-harm behaviors have passed.
TIP skills (and other DBT skills) have been a lifesaver for me in the recovery process, and I encourage you to give them a try!
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Source + Disclaimer:
Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). New York, NY: The Guilford Press.
Always consult your recovery team / a medical professional before taking on any new recovery tips such as are laid out in this article.
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