DBT Distress Tolerance TIPP and ACCEPTS

This week in my DBT Skills Group we looked at two of the Crisis Survival skills from the Distress Tolerance module.

The first was the TIP/ TIPP skill, which consists of perhaps the most ‘urgent’ skills in all of DBT. TIPP stands for –

  • Temperature
  • Intense Exercise
  • Paced Breathing
  • Progressive/ Paired Muscle Relaxation

These skills should be used when you are too deep within a crisis to use any other skills to regulate yourself. When the building is burning, it’s not going to be possible to access cognitive skills in a way that will put out the fire. During these times, skills need to be about keeping yourself safe and as contained as possible. This is where the TIPP skills come in. They act to regulate your body chemistry immediately so that you can stay safe and not make a situation worse. 


My favourite of the TIPP skills is the T – which stands for Tipping your Temperature – because it is so notably and quickly effective. It has helped me get through many near crises; from high urges and distressingly high emotions , to helping me move out of highly dissociative states. It is a number one go-to skill during moments of uncontainable distress.

The way I find the T in TIPP to be most effective is by Ice Diving. This involves filling up a large bowl or basin of cold water and putting ice cubes in it, before submerging your face into it for between 30-60 seconds at a time. Having a cold bath or shower will work in much the same way. Holding ice cubes to the space on your cheeks just beneath the eyes may be helpful too.

The mechanism behind this skill is based on biology. When parts of the face which contain the vagus nerve are exposed to freezing cold water, it activates a response of the parasympathetic nervous system, called the Dive Response. After 15-30 seconds, the body goes into a state of mild shock in which the heart rate is massively slowed down and blood flow becomes restricted to the vital organs (brain, heart).

Try doing this skill during a time you are not feeling dysregulated just to give it a go, and see whether it feels possible to think about anything else…

In my experience, the shock of the cold water is intense enough that my attention becomes completely redirected from whatever thoughts, feelings and urges I am experiencing. This skill almost ‘resets’ your system and brings you back closer to a baseline level so that you become more able to implement other skills which will help to get through the crisis in the longer-term.

I also find the T in TIPP highly effective when I am feeling dissociated. It is remarkable how it can both increase and decrease arousal in this way, depending on what state I am in before engaging in the skill.

Just remember the TIPP skills are effective in the short-term (around 20 minutes) so need to be followed up with other skills, for example Self-Soothe or IMPROVE.

The second skill we learnt about was the ACCEPTS skill. It stands for –

  • Activities
  • Contributing
  • Comparisons
  • (opposite) Emotions
  • Pushing Away
  • (other) Thoughts
  • Sensations

This is a Distraction-based skill which is helpful in reducing a negative or harmful thought, feeling or urge, and replacing it with a more effective and healthy alternative. For example, if I am feeling extremely sad and tearful, I may consciously choose to engage in an Activity such as going out for a walk with my dogs or meeting a friend for lunch, instead of going with the Emotion Urge to stay in bed and cry for hours on end.

Alternatively, I may choose the in ACCEPTS – eliciting different Emotions (e.g. to sadness) – by watching funny videos of cats on youtube to try evoke an alternative emotional response that would help me remain effective for longer.

I could also use Sensations which I find soothing to calm myself down, such as lighting and smelling a lavender scented candle and taking a soak in a warm bath whilst listening to relaxing music.

Here are some more examples:

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8 thoughts on “DBT Distress Tolerance TIPP and ACCEPTS

  1. Had a terrifying set of anxious episodes today…I just stumbled on this today. Can anyone tell me where I can get this module or workbook? I am a dude who is struggling with it and I need to take care of my new infant little girl!! I sooo appreciate it!!!

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  2. Am revisiting this. I got a bucket and ice…and that is helping. I have almost TOO many books on DBT (among a myriad of other books as well, many e-books). I find I need to simplify my strategy b/c I simply lack one. I go to the gym for vigorous exercise when I can do it…and the head immersion is helpful. My wife and I joke that I am waterboarding myself or witch dunking. Life has been difficult…it would be nice to find a support group online. If anyone knows of a supportive place, I am all ears.

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