#10: The TIPP Skill: Using Your Body to Calm Down
Marielle and Ed continue their conversation about Distress Tolerance focusing on the TIPP skill. That extra P in TIPP isn’t a typo! TIPP is an acronym that actually stands for 4 different skills. The skills in TIPP intervene on a biological level to bring down overwhelming emotions to help you think more clearly.
Learn how to assess your distress level using the Subjective Units of Distress scale, or SUDS, in order to figure out which skills you need in an emotional crisis. If you are someone who leans toward impulsive behaviors when under emotional distress then tune in to learn more effective ways of responding to strong negative affect.
“Our ‘distress tolerance’ skills in DBT are a more effective way to bring down that emotional overwhelm, so that we can think more clearly.”
Ed Fowler
Show Highlights:
- Measuring your distress level with the SUDs scale (Subjective Units of Distress)
- SUD scale 0-10, from peaceful to an unbearably overwhelmed state of mind
- TIPP skills and reasonable expectations
- T – Tip the temperature of your face with cold water
- I – Intense Exercise
- P – Paced Breathing
- P – Paired Muscle Relaxation
- Ed describes the body’s response to cold temperature
- Exercise can bring down the fight or flight response (2 minutes of jumping jacks, running up and down stairs, etc.)
- Differentiating between regular exercise vs. intense exercise in the moment
- Parasympathetic nervous system vs. sympathetic nervous system
- Sit or lie down as Marielle leads you in practicing a Paced Breathing exercise
- Paced Breathing is the most accessible TIPP skill because you can do it anywhere
- Ed leads you to practice a Paired Muscle Relaxation exercise
Links & Resources:
Subjective Units of Distress : https://en.wikipedia.org/wiki/Subjective_units_of_distress_scale
Would you like to ask a question and have the chance for it to be answered on the podcast? If so, please use this form. Please note that asking a question and this podcast in general is for educational purposes only and is not a substitute for individual mental health treatment.
#10: The TIPP Skill: Using Your Body to Calm Down Transcript
Marielle Berg
Hello and welcome to The Skillful Podcast, where we explore DBT and RO-DBT skills to help you reduce emotional suffering, improve your relationships, and become more present in your life. I’m your host, Marielle Berg, a psychotherapist at the Bay Area DBT and Couples Counseling Center.
Marielle Berg
So welcome back, Ed.
Ed Fowler
Thank you.
Marielle Berg
I’m looking forward to us diving more deeply into the Distress Tolerance skills
Ed Fowler
Me too.
Marielle Berg
And before we jump into some of the skills, we’ll talk about the TIP skills today. And if we have time, we’ll go into some Distracting and potentially Self-Soothing skills. But just to lay the groundwork for listeners, let’s revisit briefly, our Subjective Units of Distress or SUDs scales to help kind of orient folks.
Ed Fowler
I think that the as we had mentioned before, having a way to measure what is our distress level is a good way to number one, be mindful of what’s going on. And number two, give us concrete factual information about where we’re at now, in order to figure out what to do. So having this Subjective Units of Distress scale, is a really valuable starting point, if we want to reduce emotional distress.
Marielle Berg
Yes, I’ll link to this in the show notes so listeners can see it. But essentially, it’s a scale from zero to 10, with zero being peaceful, total serenity, no emotional distress whatsoever, all the way up until 10, which is your most kind of out of control, unbearably overwhelmed state of mind. And the reason why this matters when we’re talking about skills is that we have skills that can help you when you start to get closer to that 10. So they’re skills that are great when you’re kind of six and below. And so that means that your emotional distress is not too out of control.
Marielle Berg
And the reason why this is important is that if you are at a moderate level of upset, you will be able to still likely access your Wise Mind, you’ll be able to think more clearly. But once we get really upset and those numbers start to go higher, we’re at a seven, we’re starting to freak out or feel really desperate, it’s so much more challenging to think clearly. And we usually need something that’s just going to help us right in the moment.
Ed Fowler
And that’s why I think that being able to take a moment to measure ,what is my distress level right now, will help us figure out, do I just need something that’s going to bring down this level of emotion right now because it’s becoming intolerable? Or am I at a level where I can think clearly, I can access my Wise Mind, I can use things like Mindfulness or Emotion Regulation, that may have a longer term impact, versus like a real short term, let me get this stress level down.
Marielle Berg
Yeah. And one way to think about this is, once we get more emotionally distressed, when we start moving up from that, on that scale that I laid out a moment ago, from zero to 10, and we get in the six, or the seven, the eight, the nine and we’re super upset, one, a signpost is to think about as your SUDs or your Subjective Units of Distress starts rising, that those are the moments or those are the emotional states when you’re going to be more likely to reach for an addictive or compulsive behavior, self harm, or want to lash out at someone, whatever your thing or things that you might do, when you’re really upset.
Marielle Berg
When you start feeling those impulses or urges, that’s a really good sign that your SUDs are pretty high, right. And those behaviors often serve as a temporary way to bring down the overwhelm.
Ed Fowler
Right.
Marielle Berg
Just over time, they’re usually not effective, they create other problems as well.
Ed Fowler
Right. And so the, our Distress Tolerance skills in DBT, are a more effective way to bring down that emotional overwhelm, so that we can think more clearly. And so they sometimes don’t work as quickly as reaching for some sort of compulsive behavior that we know we have a pattern of reducing distress quickly with that. The TIP skill that we’re going to talk about today is the one thing that will act quickly, which I find really valuable to have.
Marielle Berg
Right, and there’s sort of physiologically intense and we’ll talk about it in a minute, which can be so helpful. So if you’re at that 8, 9, 10 place, and that’s a time that you’re going to reach for an addictive or compulsive behavior, self harm in some way or lash out. And I know, I’ve heard this years ago in my therapy training, you know, the different ways to help people when they’re in that state, like take a walk around the block, or take a bath. Like those are not helpful because you’re so emotionally dysregulated. Those things can be helpful when you’re not so upset. But if your choice is to self harm or take a bath, bath isn’t going to help too much, right, you’re gonna get the relief from self harm.
Ed Fowler
Right, right.
Marielle Berg
There’s a place for taking a bath. And we will talk about that in Self Soothing.
Ed Fowler
But again, like that’s the thing is that when our stress level isn’t an 8, 9, 10 Yeah, like a bath, or a nice cup of tea, or like some mindfulness exercise to really focus on the current moment, that’s not happening. It’s just not happening. And I think that we are laughing because anyone, if we think about it, when you’ve been at a stress level of 8, 9, 10, we’ve all been there. Biologically, for human beings, we’re not supposed to be thinking and saying, oh, rationally, I think I should probably just take a bath right now, we are meant to act. And the problem is that acting may create more problems for us in the long run. And so that’s why we want to have these skills that will help bring that stress down without creating additional problems for ourselves.
Marielle Berg
Yes, so really nicely said. Let’s go into them a little bit. So these are again, we have another acronym. These are called a TIPP skills. So it’s T I P P, so there’s two Ps, because there’s two different skills that start with P. And so we’ll go through each of these. And they really work with your physiology, to help you actually regulate your body, which is going through something really intense when you are completely overwhelmed.
Ed Fowler
Alright, so the T in tip stands for tipping the Temperature of your face with cold water or just temperature. And the theory behind this one is that for human beings, when we simulate diving into cold water, so putting something cold around our eye sockets, all of our energy goes to maintaining our vital functions, and is not going to maintaining the thought process that is causing a lot of distress.
Ed Fowler
And so by putting cold water around our eye sockets and simulating diving, so you know, like, the most effective way to do this is to have something cold, like a bowl of cold water or ice pack or pack of peas from the freezer, something cold, that you can take a deep breath, bend over as if you’re diving and put it around dry sockets. And just to hold it there for the amount of time that you can hold your breath. What it does is it shocks our system into stopping the momentum that was happening before and giving us a pause where we can recollect ourselves.
Marielle Berg
Yes. And so thank you for explaining that. The cold water or this ice skill that you were just talking about it can be so incredibly effective. And I think one of the biggest hurdles is getting people to actually try it. So in our skills group, we have bags of ice and we have people kind of try it there. In the moment, we stand up, we bend over, we hold our breath and we try to simulate, we don’t have bowls of water because it would, that might be too messy. But to get people to actually like take a leap of faith and try it. Because it often is really useful. And so since people are listening on their own, you can pause it if you want to, and try it out. We recommend that people try it, not when you’re super upset, not when you’re at that 10, right, to try it for the first, you know, couple of times to get a sense of what it feels like when you’re feeling okay. And we recommend this with all our skills,
Ed Fowler
Right like a, six or maybe seven. And again, I think that this, all of the TIPP skills in this one in particular can be really valuable at a six or a seven to get you moving down the SUDs scale as opposed to moving up.
Marielle Berg
Yeah.
Ed Fowler
So they can be really valuable at six or seven. It’s kind of the only thing that works at eight, nine, ten.
Marielle Berg
Right, you can think of the more sort of rational mind or you can think of the skills that require you to reason or plan things out or be more mindful as you get higher up. And so this using the ice or the cold water is not going to solve your life problems. And none of the Distress Tolerance skills actually purport to do that.
Ed Fowler
Right.
Marielle Berg
What they’re useful for is instead of that, what we were talking about a moment ago, like oh, you feel like self harming. So just take a nice, lovely bubble bath. This is a replacement for the self harm, it’s something else you can do to calm yourself down in the moment.
Ed Fowler
Right. So again, I think that you know, what works well for me, is I use a bag of peas from the freezer because it’s so convenient. This is one that you have to have access to something cold, but you can use a washcloth, you know soaked in cold water, you can just, people will do the whole thing of splashing cold water on your face. It is the same theory, that’s maybe not as shocking as putting your face in a bowl of cold water. But it also works so that if you’re at work and you want to go to the bathroom and just run cold water on your hands and hold your hands over your eyes, what it does is it just kind of like draws all of your attention to that sensation of how cold that is.
Ed Fowler
And it shocks your system into, like, stopping the direction it was going. So I think the valuable thing is to try it. For me when you know, with DBT, they say you should try these skills yourself before you teach them. And this was one that the first time I heard it, I thought that sounds stupid.
Marielle Berg
You and almost everyone I talked to about this skill.
Ed Fowler
I was like, this is a joke. Put my face in a bowl with cold water. No way, right?
Marielle Berg
Hell no.
Ed Fowler
But when I the first time I tried it, I was like, Oh, wow, this actually works. I do feel differently. And I will use it from time to time. Because and for me, it’s like really like, I don’t feel like waiting to like, let my emotions come down naturally, cause I could just do this, and that will, you know, kind of put a stop to it start to bring it down.
Marielle Berg
Yes, yes. So interesting. I did not have that reaction. When I first heard this skill, though many people do, I’ve had it with a couple other skills, which we’ll get to in subsequent episodes really, about my own dubious reactions. Like that’s not gonna help anyone. But I didn’t have that with the cold water, maybe because I’ve had the experience of splashing cold water on my face and feeling like a bit better.
Marielle Berg
So this just seems like a more intense version of that. And I similar to you, I have ice packs in my freezer, I probably have peas somewhere too, but I’ll often reach for an ice pack. You know, in times of intense distress, I have tried the cold water and actually put my face in it. And that, you know, hands down is the most effective.
Ed Fowler
Right, yeah. the most thorough, really, yeah. Now I think one of the things that with all of the TIPP skills, and we’re gonna go over the other ones in a minute, these skills will take your SUDs level from nine to eight, or nine to seven, or seven to six. This is not going to get you from a nine to a five, or a four, a certainly not going to get you from a nine to a zero.
Ed Fowler
And so what I’ve heard people talk about is like, oh TIPP doesn’t work for me. And in DBT, we really try to be dialectical, holding multiple truths at the same time. But one thing that I’ve heard from DBT practitioners is TIPP is the one skill that will work every time, because it’s physiological. And so it’s I think it’s adjusting expectations of like, putting cold water on your face will get you from an eight to a seven. And then you probably need to follow up with other skills in order to keep that distress going down.
Marielle Berg
Yeah. And I think what you’re talking about here is how we define working. That it’s incredibly effective, or it works in air quotes, and that it brings your distress down a little bit, enough to think about other skills, but it does not, if we’re going to define working as it’s going to make you a zero and you’re totally chill, it’s not going to do that.
Ed Fowler
Right. And that’s where being able to access our wise where we can be in a place of balance, you know, recognizing that like, yes, some sort of compulsive behavior that we’ve practiced so much, will get us significantly down the distress scale. And almost always, there’s longer term repercussions to that. There’s things that we’re going to have to clean up later. There’s shame and guilt that will go along with accessing that. So TIPP skills may not get you quite down the distress scale as something else, but it’s not going to have any negative repercussions.
Marielle Berg
Right.
Ed Fowler
So that’s the trade off.
Marielle Berg
Yes. And that’s a good point, especially for any some of these behaviors that have been going on a long time, or substance abuses involved. It’s not as effective, you know? But people come to DBT and want to engage in these skills because they’ve realized their old ways of coping have actually created a lot of chaos and suffering in their life.
Ed Fowler
Right.
Marielle Berg
I think about all the TIPP skills, but particularly the one about using cold water and ice is like the 911 of Distress Tolerance. It’s an emergency, you need something really quick.
Ed Fowler
Right. This is the one to go to when you’re already feeling overwhelmed. And this is the one that works the quickest of the TIPP skills, the cold water works quicker than the other ones, although they all work pretty quickly.
Marielle Berg
Yes. So let’s move on to the I which is, stands, in the I in TIPP. So the I stands for Intense exercise, which can help calm your body down when it’s super revved up. So when we are approaching those, again, those high suds level and we’re at an eight, nine or ten, our fight flight system is usually on board and we, there’s a lot of energy in our body and it needs to move somehow.
Marielle Berg
And intense exercise can be super helpful in bringing down that emotion very quickly if your body allows. So if you’re a disabled or have any physical ailments, this may not be the one for you, you can try the others, but if you’re able, that can be you know, jumping jacks in place. A jog around the block.
Ed Fowler
Running up and down stairs, push ups, I’ve heard people talk about, anything that’s going to get your heart rate up. And you really only need about two minutes or so of really focused, intense exercise to get the benefit of using that to reduce distress.
Marielle Berg
It happens quickly.
Ed Fowler
I.t happens pretty quickly. So the temperature one with the cold water takes about 30 seconds and intense exercise about two minutes, but you can go a little bit longer. What you want to do is just get your heart rate up, so that your body has to put energy into bringing it back down, which again, reduces the overall level of distress. I think the other benefit of intense exercise is while it will reduce the stress, and kind of gets out the physical energy that goes along with anger, or fear, or those kinds of things, it also increases positive emotion. And so a little bit of intense exercise can actually increase some positive emotion within us. So it has a double benefit in that way.
Marielle Berg
You’re right, and thinking of with the intense exercise, we named some things, you can dance around, if you’re somewhere private, and blast some music you love. That can be like a double, you know, impact of getting out some of that energy and feeling better, or having your mood actually elevate.
Marielle Berg
So I want to differentiate this skill as we’re talking about and hear from general exercise, which can have all sorts of positive benefits for our mood that if people do regularly can be really helpful in general emotion regulation. This is using intense exercise in the moment when you’re really distraught for a short period of time.
Ed Fowler
Right. So this is not like running on a daily basis, or even necessarily going for a run. This is running in place for two minutes, because you’re feeling so overwhelmed. And you don’t know what else to do. Just do this. And again, I have found this one to be really, really beneficial in stopping that rush towards more distress, and starting to turn it in the other direction.
Marielle Berg
I agree, when I think about some of those compulsive behaviors, those addictive behaviors, the self harm kind of behaviors that folks can reach for, it’s affecting their physiology really quickly. If you’re reaching for a substance, or even if you know, you tell someone off, or you slam a door, there is a physiological release. And with the intense exercise, it’s a substitute, you get a similar kind of effect without creating more difficulty in your life.
Marielle Berg
Yeah. So moving on with the TIPP skill as we get to the P in TIPP, which is stands for two different skills that start with P: Paced breathinging and Paired muscle relaxation. We’re going to lead you in some practices, because with all of these skills, it’s really important for you to try it out and have it not just be theoretical. And since we can’t magically hand you ice or a bowl of cold water through your phone, or however you’re listening to this right now or your computer –
Ed Fowler
Not yet.
Marielle Berg
Not yet, right. Oh gosh, when that happens, I don’t know if I want to be alive for that. But we will, so we’ll lead you in some of these practices. And so if you’re able, obviously, you know, find a quiet place to sit down and just take a couple minutes, so you can really experience what these feels like in your body. Otherwise, they’re just nice ideas. They really come alive in practice.
Ed Fowler
Right. And I really appreciate the paced breathing, because again, it works on changing our physical response. And with paced breathing, we want to really focus on basically counting our breaths. So counting as we breathe in and breathe out. So the most valuable way to do it, is to have the exhale be longer than the inhale. The physiological reason for that is that when we inhale, we activate our sympathetic nervous system, which kind of increases our energy, gets our heart pumping just a little bit faster.
Ed Fowler
Whereas when we exhale, we’re activating our parasympathetic nervous system. So it’s increasing our relaxation, and gets our heart pumping a little bit slower. So emphasizing the exhale kind of slows us down, quite literally. And so with paced breathing, we just want to count our breaths as they’re coming in and as they’re going out, and emphasize extending the exhale to get that greater experience of the relaxation that comes from that.
Marielle Berg
So thank you for explaining all the steps of that and how it activates that parasympathetic nervous system, which if people are unfamiliar with that, that’s the part of our nervous system, which is called like rest and digest, because we that’s one of the part of our nervous system that helps us rest and fall asleep and digest our food properly, versus the sympathetic nervous system, which has the fight flight that get ready for action, part of our nervous system.
Marielle Berg
So I’ll lead us in a pace to breathing exercise and you can follow along if you’re able. And so you can do this to a count of either four or six. So that would be breathing in to a count of four, breathing out to a count of six. I’m going to lead us in breathing in for a count of five and breathing out for a count of seven and adjust as you know works for your body.
Marielle Berg
So let’s start by having you sit or lie down in a comfortable manner. And feeling your body making contact with the chair or the floor. You can close your eyes if you want to, whatever feels comfortable. And begin by just noticing how you’re breathing right now, just taking a few breaths, letting your body breathe naturally in and out as it does. And now it can be helpful to place a hand on your stomach while you’re doing this, and also potentially another hand on your chest.
Marielle Berg
Because often when were trying to practice some more deep breathing, we can be more shallow breathers, so breathing into our chest versus our stomach. So if you relate to being a more shallow breather, you can try having that one hand on your belly and other hand on your chest and thinking about as you inhale, having your stomach expand and fill with air. And as you exhale, having your stomach contract so you’ll actually feel that as you’re breathing.
Marielle Berg
So inhaling to a count of five, feeling your stomach expands and fill completely with air, and then exhaling and pushing all the air out to a count of seven. And inhaling again to count of 5. 1, 2, 3, 4, 5 and exhaling, blowing all that air out, feeling your stomach contract to a count of 7. 4, 5, 6, 7.
Marielle Berg
Doing another round, inhaling to a count of five, feeling your belly expand. And then exhaling, blowing all the air out to a count of seven. And if you want, you can make audible exhaling noises, exhaling through your mouth can sometimes be helpful. Maybe one more round, inhaling deeply into your belly, feeling your stomach expand to a count of 5. 3, 4, 5, exhaling to a count of seven, blowing all the air out filling your belly contract for 5, 6, 7. And now just taking a moment to let your body settle and breathe. Naturally letting your body resume its typical state of breathing. Noticing how that feels. So Ed, can you tell me a little bit about how that was for you?
Ed Fowler
As always, this is one of my favorite skills.
Marielle Berg
I like it too.
Ed Fowler
So as always, it was very relaxing. Like physically, I can feel my body more relaxed as a result.
Marielle Berg
One of the things I particularly like about the skills, the other ones, we’re talking about the cold water or ice, intense exercise, and even then one we’re going to do next paired muscle relaxation. Those aren’t ones you can necessarily do in public. Pacedbreathing, you can do anywhere. You can do that, at a tense work meeting, you can do that commuting, you know, you can do that standing in line at the grocery store. So, and it can be so it’s really useful that way,
Ed Fowler
Right. I think that the paced breathing is the most accessible because you can do it the most places. And I also find that with the paced breathing, if I’m already really activated, it’s hard to focus, it’s helpful to count. So the counting of the breaths gives my mind something to do. But sometimes that’s not enough, which is where the other skills, the cold water, the intense exercise, or the paired muscle relaxation are more active. So that can be more valuable if I’m finding it hard to concentrate enough to do the paced breathing. So I would also say for me, like anytime I’m feeling stressed, I will just breathe out really long, as long as I can just one exhale. And that can make a difference. So just that is something that I access quite a bit.
Marielle Berg
Oh, that’s interesting. I hadn’t thought of that. So that maybe that one exhale can be enough to activate your parasympathetic.
Ed Fowler
Just that’s enough to kind of start. Now that does not work when I’m really, really stressed. But at low levels of stress, just one exhale can make a difference. But I do find the pace breathing. Again, what I found with people a lot of times they’re like I couldn’t concentrate enough to do that. Like that was too hard to do. So that’s where you would maybe do one of the other TIPP skills first and then do some paced breathing as a way to continue that downward trajectory of distress.
Marielle Berg
Absolutely. And I also am very fond of paced breathing and will not use it at those higher SUDs level, you know, 8, 9, 10, I use paced breathing really, at any SUDs level or feeling okay, just because I find it relaxing. Yeah, but you might need to reach for some of the big guns we talked about with the cold water, intense exercise, or the paired muscle relaxation when you’re really overwhelmed. So the next P in our TIPP is the paired muscle relaxation. And I’m wondering if you want to talk a little bit about that, and maybe lead us in a practice?
Ed Fowler
Sure. So with the paired muscle relaxation, it’s something that we do with the paced breathing, which is why it’s called paired, whereas we breathe in, we’re really tightening our muscles and tensing them to get a really strong experience of feeling very tense. And then as we breathe out, we’re completely relaxing muscles in order to really accentuate that feeling of relaxation. So it’s a nice combination with the pacde breathing, it’s a little bit more active, and really can emphasize the feeling of relaxation as we go through.
Ed Fowler
And the way it works is we just tense different muscles within our body and go through our body. For me, I like to go from foot up to my head to do it is the easiest way for me to do it, you can really do it any way that works for you. And, you know, tense, for instance, really tense your feet as you’re breathing in, and then completely relax them as you’re breathing out. And people who have done yoga, oftentimes, this can be an activity at the end of a yoga session. Because again, it really does emphasize that relaxation, by starting with noticing the tension and then noticing the relaxation. And again, the focus is to tense as you’re breathing in and relax as you’re breathing out. Notice really try to point your attention towards noticing the feeling of relaxation as you do it.
Marielle Berg
And so obviously, it just want to insert here that for listeners, if you’re practicing along with us, and Ed instructs you to tense part of your body where maybe you have pain, like use your own judgment, and how much tension you’re going to apply.
Ed Fowler
And really, with all the TIPP skills, it’s like you got to do what works for you ,what’s going to be effective for you. So if for some reason intense exercise is not going to be healthy for you, then use the other skills, right? And so for instance, if you have particular areas of your body that tensing those muscles is going to be painful actually, or create problems for you, then skip that part. Or if the whole thing is not going to work for you do one of the other skills, right, so practice one of those other skills, but it’s good to have this opportunity.
Ed Fowler
So let’s go through and do some paired muscle relaxation. So once again, I think it’s helpful just to get comfortable, and you can lay down or sit down. And really notice the sensation of laying or sitting, you know, points of contact between your body and the chair or the floor. Just notice the sensation of breathing in and out without directing it in any way. Just mindfully being aware of that sensation. And then I am going to lead you through a series of tensing and relaxing tensing as you breathe in and relaxing as you breathe out.
Ed Fowler
So we’ll kind of start with our hands and work our way through as maybe a little easier way to do this. So as you breathe in, really make a fist and tense your hands as much as possible. The tightest fist you can, as you’re breathing in, and then as you breathe out completely relax your hands and let them fall. And as you’re breathing in, pull your arms up and tense every muscle in your arms and then relax as you breathe out and drop your arms down as you breathe in. Bring your shoulders up towards your ears and really tense your shoulders. And then let them drop as you relax and breathe out.
Ed Fowler
Bring your attention to your forehead and tense all the muscles of your forehead, really squishing your eyebrows together. wrinkling your forehead. And then as you breathe out, relax. Let that tension go. Now shut your eyes very tightly, really tense eyes. And then as you breathe out, relax and really wrinkle your nose and make your nose and cheeks as tense as possible. And then breathe out and relax. Then purse your lips and really make your lips as tight as possible. And then relax as you breathe out. And then push your head back and look up and tense your neck muscles so that your neck muscles are really tense, and then as you breathe out, drop your head back down and let it relax.
Ed Fowler
And then take a deep breath into your chest, into your lungs so that your chest is really puffed out and very tight. Hold your breath there, feel the tension in your chest, and then relax and push that air out. And then bring your shoulder blades together behind you and arch your back so that your back is really tense. Feel that tension in your back, and then relax. Let your back drop. And then hold your stomach muscles really tight, just extremely tight stomach muscles. Hard to breathe in as you do it. And then relax and let that air out. And then tense your butt and your thighs so that your butt and your legs are really tight and tense. And then relax as you breathe out. And then tense your calves, kind of lift your feet up a little and tense your calves. Have your calves as tense and tight as possible. And then relax. Let them drop. And lift your legs up and point your toes so that your feet or legs, your toes are all really really tense. And then drop them with a thud and relax. And then take one more deep breath in. Exhale as slowly as you can, noticing the relaxation in your body as you do. And then bring your attention back to the room that you are in. And back to the present with your eyes open. Marielle, what did you notice?
Marielle Berg
I feel so relaxed. I usually do when I do this. But maybe because of the time that we’re recording in the afternoon, I just want to go to sleep.
Ed Fowler
So that’s it, that’s over. Again, I think if you’ve done these exercises, with the paced breathing and the paired muscle relaxation, you get a sense of the difference that we can physically feel. If we use these TIPP skills that we actually do go from a state of more activation and energy to a state of more relaxation, typically, will need to if you’re really distressed in the 7, 8, 9, 10 level, you’ll need other skills. And we’ll go into some of those later of other Distress Tolerance skills you can use to continue to keep the distress coming down. But the TIPP skills are the best place to start if you’re already really really overwhelmed.
Marielle Berg
Yeah. And you can lead yourself in this kind of paired muscle relaxation. I know I have tried it and I hear other people talking about trying this before they’re going to sleep if they’re feeling a bit anxious, or something’s on their mind, because it can really help relax the whole body. In your mind, you can run yourself through every body part as you just did it. But it can also be helpful to record your own voice leading you in it that you can play when you need to or just Google paired muscle relaxation. And you can probably find a bunch of audio recordings of people leading you in this if it helps to have another person’s voice guiding you.
Marielle Berg
So thank you so much for running through the skills with me as in explaining them to listeners. And again, a reminder, these skills are useful when your SUDs or your Subjective Units of Distress, start getting really high. They’re the 911 of Distress Tolerance, it means you reach for them when you are really overwhelmed and really emotional in one way or another. They will not solve your life problems.
Marielle Berg
We have other skills that can be an assistance with more complicated things, but they help calm you down and they’re a great substitute for some of the more damaging kind of behaviors that we’ve talked about that you might reach for when you’re really struggling.
Ed Fowler
Absolutely.
Marielle Berg
Till next time.
Ed Fowler
Yeah, thank you.
Marielle Berg
Thanks for listening to today’s episode. To learn more, or if you’re in the Bay Area and want to get started with therapy you can find us online at bayareadbtcc.com. That’s bayareadbtcc.com.