How TIPP in DBT Helps with Intense Emotions

Dr. JeanAnne Johnson, PsyD, PhD, APRN-BC, FNP, PMHNP, PMHS

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Dr. JeanAnne Johnson is a Psychiatric/Mental Health Nurse Practitioner with over 30 years of medical experience. She holds advanced degrees from Georgetown University and Rush University, along with multiple certifications in psychiatric care, addiction treatment, and pediatric mental health. She is currently pursuing a fellowship in Precision Psychiatry and Functional Medicine.

JeanAnne provides psychiatric services across 14 clinics, specializing in mental illnesses, substance use disorders, and criminogenic programs. A national speaker and author of I Can Do Hard Things: Tools to Manage Anxiety When Medication Isn’t Enough (2019), she is passionate about holistic mental health care. Her approach addresses the root causes of mental illness through nutrition, lifestyle changes, and functional medicine.

Outside of work, JeanAnne enjoys outdoor activities with her two children, is a cancer survivor, and loves animals.

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Learn how the TIPP skill in DBT helps manage intense emotions fast using temperature, exercise, breathing, and relaxation techniques.
Dr. JeanAnne Johnson, PsyD, PhD, APRN-BC, FNP, PMHNP, PMHS
October 15, 2025
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Dialectical Behavior Therapy is an evidence-based therapy for treating mental health disorders and emotional challenges. It consists of four major skillsets to help people manage their emotions. 

TIPP is a tool in one of these skillsets and stands for Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation. TIPP can serve as a mental health first aid kit in times of crisis, helping you reduce physical and emotional distress. 

Read on to understand how TIPP can help manage intense emotions and when to use it. 

What is Dialectical Behavioral Therapy (DBT)?

DBT teaches skills to cope with emotional challenges and strengthen relationships. It focuses on reducing the impact of emotional distress and encouraging mindfulness. DBT is a highly effective treatment option for reducing self-harm behaviors, suicidal thoughts, mood swings, emotional blow-ups, and relationship problems [1]. 

There are typically four modules in DBT, each with its own set of skills. These include:

  1. Distress Tolerance gives you the skills to tolerate crises, cope with adversity, or emotional pain. TIPP falls under the distress tolerance skillset. Other skills include radical acceptance and distraction. 
  1. Mindfulness focuses attention on the present moment, allowing thoughts and feelings to pass without judgment. This can lower anxiety, improve self-esteem, and help manage impulse control problems. 
  1. Emotional Regulation helps you recognize, label, and manage emotions effectively. This increases mood stability and can reduce feelings of self-harm or suicidal ideation. 
  1. Interpersonal Effectiveness strengthens relationships, helps you set boundaries, learn to be assertive, and manage conflicts.  

Understanding TIPP Skills

The acronym TIPP stands for: temperature, intense exercise, paired muscle relaxation, and paced breathing [2]. 

(T)emperature: To quickly calm down, hold your breath and put your face in a bowl of cold water for 30 seconds. This can trigger your mammalian diving reflex, a natural reflex that is activated when your face is submerged in cold water. This reflex reduces heart rate and activates the parasympathetic nervous system (e.g., “rest and digestion”) [3]. 

(I)ntense Exercise: A quick exercise, even 20 jumping jacks, can get your heart rate up, provide a distraction, and release negative energy or trauma stored in the body. 

(P)aired Muscle Relaxation: When we’re in crisis or when our stress response is high, we tend to carry tension in our bodies. Muscle relaxation paired with breathing can help reduce emotional tension in the mind and body. Try breathing in deeply, and clenching your fists really tight, and as you breathe out, release that tension. 

(P)aced Breathing: This, paired with muscle relaxation, is another cue for your parasympathetic nervous system to slow down.  Breathe slowly and deeply, and aim for 5 to 6 breaths per minute.   

How Does TIPP Help With Emotional Regulation? 

The TIPP skill is a part of the distress tolerance skillset of DBT and can be used during a crisis when emotions are high and you are experiencing physical responses to stress. TIPP skills may not work immediately, but with practice, they can help you regulate emotions and feel better.

When and How to Use Your TIPP Skills

Use your TIPP skills during moments of intense emotional distress, crisis, panic attacks, urges to self-harm, anger and aggression, or if you’re struggling with cravings for substance abuse. If you’re unable to concentrate, feeling out of body, or trapped in a cycle of emotional overwhelm (e.g., work stress), TIPP skills can also be beneficial.   

Practice TIPP skills even when you’re calm, so they become automatic during times of distress, and consider making a TIPP card or crisis plan you can refer to in times of emergency.  

Some ways to integrate TIPP skills into your daily routine include: 

  • Try paired muscle relaxation and breathing exercises before bed to help you fall asleep. 
  • Cold water and intense exercise as soon as you wake up can help clear morning anxiety and get you motivated to start the day. 
  • Use TIPP cues, such as sticky notes, cards, or digital reminders. 
  • Have a TIPP crisis plan and create a personalized routine for each TIPP that best helps you regulate during emotional crises. Keep this accessible if you can (in your wallet or on your phone). 
  • Combine TIPP skills with other coping strategies such as radical acceptance, self-compassion, and self-soothing activities such as journaling, yoga, or listening to music. 
  • Track your progress. Consider keeping a journal or log where you keep track of what TIPP skills were used and reflect on what worked best in different situations. 

Evidence-Based DBT in Utah: Improve Your Emotional Health  

Whether through therapy, medication, or holistic practices, recovery is within reach. Seeking help is a sign of strength, and you don’t have to navigate the journey alone. Maple Mountain Mental Health & Wellness Center provides evidence-based DBT therapy to help you regulate emotions, reduce psychological distress, and work through trauma. 

We understand the complex nature of healing emotional health and offer individualized treatment options. Recovery starts with taking the first step.  Reach out to our Admissions team today.

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Sources 

[1] Wergeland, J. et al. (2024). Evaluation of dialectical behavior therapy for adolescents in routine clinical practice: a pre-post study. BMC psychiatry, 24(1), 447.
[2] Northern Arizona University. 2015. TIP Skills: Changing Your Body Chemistry. 
[3] Godek, D. et al. 2022. Physiology, Diving Reflex. StatsPearl Publishing.

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