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Using TIPP Skills to Cope with Self-Harm Urges

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TIPP skills were developed by Marsha Linehan as part of Dialectical Behavioral Therapy (DBT) and help rapidly decrease emotional distress.

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Originally published May 18, 2016

⚠️Trigger Warning: self-harm, intense emotions, anxiety

For many of us who struggled with self-harm, our urges and behaviours 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.

Related: Is Skin Picking a Form of Self-Harm?

This is where “TIPP” skills come in.

TIPP 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 behaviours (i.e. self-harm, using drugs and alcohol, etc.) at reducing painful emotions, but without the negative effects.

TIPP 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.

Essentially, TIPP skills alter our physical state which then changes our emotional state.

Related: Responding to Questions about Self-Harm Scars

What exactly are TIPP Skills?

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T = Temperature

The first TIPP 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 TIPP 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

This third TIPP 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.

Also, make sure you breathe out more slowly than you breathe in (e.g. 5 seconds in, 7 seconds out).

P = Progressive (or paired) muscle relaxation

The final TIPP skill is progressive muscle relaxation.

This involves progressively tensing muscles and relaxing them. There are great guided progressive and paired 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.

Closing Thoughts

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 TIPP 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 behaviours have passed.

TIPP skills (and other DBT skills) have been a lifesaver for me in the recovery process, and I encourage you to give them a try! (Always in consultation with your own medical team, of course.)

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Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). New York, NY: The Guilford Press.

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