TIPP Skill Worksheet

This worksheet covers the TIPP skill from DBT distress tolerance—four body-based techniques that lower emotional intensity fast. TIPP works because it changes your physiology directly, bypassing the need to think your way out of a crisis.

When emotions are above a 7 out of 10, cognitive skills like check the facts or pros and cons are hard to use. TIPP gets your body chemistry to a place where those thinking skills become accessible again.

How to Use This Worksheet

Practice each technique when you're calm so you know how to do them during a crisis. Then use the tracking section to log which TIPP skills you used and how effective they were.

T — Temperature

Cold temperature triggers your body's dive reflex, which slows your heart rate and redirects blood flow. This is the fastest way to lower emotional arousal.

How to do it:

• Fill a bowl with cold water and ice. Hold your breath and submerge your face for 15-30 seconds.
• Alternative: Hold an ice pack or cold compress against your cheeks and forehead.
• Alternative: Take a cold shower or splash very cold water on your face.

Target: Heart rate drops noticeably within 30 seconds.

I — Intense Exercise

Intense physical activity burns off the stress hormones (adrenaline, cortisol) that fuel emotional intensity.

How to do it:

• Sprint, do jumping jacks, run stairs, or do burpees for 10-20 minutes.
• The exercise needs to be intense enough that you can't easily carry a conversation.
• Match the intensity to the emotion—a 9/10 emotion calls for more vigorous movement.

Target: Emotional intensity drops 2-3 points within 20 minutes.

P — Paced Breathing

Slow, controlled breathing activates your parasympathetic nervous system (the "rest and digest" system), counteracting the fight-or-flight response.

How to do it:

• Breathe in for 4 counts.
• Breathe out for 6-8 counts (exhale must be longer than inhale).
• Continue for 1-3 minutes.
• Focus your attention on the sensation of breathing.

Target: Heart rate slows, body tension decreases within 1-3 minutes.

P — Progressive Muscle Relaxation

Systematically tensing and releasing muscle groups releases the physical tension that accompanies emotional distress.

How to do it:

• Start with your feet. Tense the muscles for 5 seconds, then release for 10 seconds.
• Move up: calves, thighs, abdomen, hands, arms, shoulders, face.
• Notice the difference between tension and relaxation in each group.

Target: Full-body tension reduction in 10-15 minutes.

Filled-Out Example

Here's a tracking log from someone using TIPP during the week:

Notice how TIPP skills are sometimes stacked—using temperature to bring intensity down from a 9, then paced breathing to bring it down further.

Common Mistakes

Using lukewarm water for the Temperature step. The water needs to be genuinely cold—ideally below 50 degrees F. Room-temperature water doesn't trigger the dive reflex.

Exercising at moderate intensity. A casual walk doesn't burn off crisis-level adrenaline. The exercise needs to be vigorous enough that thinking about the problem becomes difficult.

Breathing too fast during paced breathing. The key is the extended exhale. If your exhale isn't longer than your inhale, the calming effect is significantly reduced.

Skipping practice during calm moments. If the first time you try TIPP is during a crisis, the unfamiliarity of the technique adds stress. Practice each method at least twice when calm.

Digital Alternative

Tracking which TIPP skills work best for you is hard on paper—you're not going to fill out a worksheet during a panic attack. DBT Pal gives you quick access to TIPP instructions during crises and logs your practice so you can see which techniques work best for your specific patterns.

Related Worksheets

• STOP Skill Worksheet — Pause before acting on crisis urges
• Distress Tolerance Worksheet — Complete set of crisis survival skills
• Self-Soothe Kit Worksheet — Gentler techniques for lower-intensity distress

For a deeper look at TIPP, see TIPP DBT Skill. For printable worksheets, visit DBT Worksheets PDF Free.

FAQ

What does TIPP stand for? Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation. These four techniques change your body's physiology to reduce emotional intensity quickly.

How fast does TIPP work? Seconds to minutes. Cold temperature triggers the dive reflex within 15-30 seconds. Paced breathing calms the nervous system in 1-3 minutes. Intense exercise works in 10-20 minutes.

Can I use just one part of TIPP? Yes. Pick whichever technique is most accessible in your situation. You don't need all four every time.

Is TIPP safe for everyone? Most people can use it safely. Check with your doctor if you have heart conditions, respiratory issues, or are pregnant, as cold temperature and intense exercise affect heart rate.