DBT Skills 

Choosing to embrace discomfort can sometimes trigger some pretty intense emotions. For instance, if you have ever delivered a speech to a large audience and felt like you might pass out from nervousness, you may be able to relate. In these moments, it can be difficult to remain calm and engaged with the task at hand when your body’s fight-or-flight system is telling you to do just that—fight, flee, or freeze.  

Let’s explore a few techniques that you can use to soothe your nervous system in high-stress situations. These skills come from dialectical behavior therapy (DBT), which was originally developed by Dr. Marsha Linehan to help individuals at risk of suicide. DBT is now used to treat a variety of conditions, such as borderline personality disorder, post-traumatic stress disorder, and severe anxiety and depression, but its principles can be helpful for anyone who experiences strong emotional reactions.  

TIP Skills  

“TIP” stands for Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. These skills can be used to quickly ease intense emotional arousal by activating various calming pathways in the body. The following instructions are outlined in the DBT Skills Training Manual (Linehan, 2014).  

Temperature 

The goal of this technique is to trigger the dive reflex, which slows the body’s heart rate after exposure to cold water without oxygen. Note that individuals with heart problems or an allergy to cold should consult their doctor before practicing this skill. 

Put it into practice: 

1. Bowl of cold water: “Bend over, hold your breath, and put your face (up to your temples) in a bowl of cold water for between 30 and 60 seconds, or until you start to become uncomfortable... The colder the water and the longer the immersion, the better it works. However, do not have the water too cold” (p. 433).  

1. Ice pack, bag of ice water, or cold compress: “Sit in a chair, and hold the ice pack or zip-lock bag (wrapped in a cloth to keep from being too cold) or cold compress over the eyes and upper cheeks. Wet the side touching your face. Standing, bending over, and holding your breath at the same time appears to increase the effect” (p. 433).  

1. Cold water splash: “Splashing cold water on your eyes and cheeks may even be sufficient. To make it work even better, stand, bend over, and hold your breath” (p. 433).  

Intense Exercise  

One function of emotion is to “organize the body for action” (p. 435). For example, feeling love may motivate us to serve others, while feeling guilt may lead us to apologize. Participating in physical activity can allow emotions to run their course in a healthy, productive way, especially if other forms of action would not be helpful.  

Put it into practice: “Engage in intense aerobic activity of any kind for at least 20 minutes” (p. 434).  

*Vigorous exercise (at least 70% of your maximum heart rate) is recommended due to its potential for greater results, but light or moderate exercise can also be beneficial. 

Paced Breathing  

By slowing your breathing, you can reduce your heart rate and activate the parasympathetic nervous system, which helps the body relax. Exhaling for a longer duration than inhaling can enhance this effect.  

Put it into practice: Using a clock or watch to count seconds, “get to a comfortable slow breathing rate, where the count is longer breathing out than breathing in” (p. 436). For example, inhale for five seconds and exhale for seven seconds.  

Paired Muscle Relaxation 

This technique (a form of progressive muscle relaxation) involves systematically tensing and relaxing muscle groups in sync with the breath. Tension is produced during inhalation, and relaxation occurs during exhalation. By first contracting the muscles, a greater sense of relaxation can be achieved when releasing muscle tension.  

Put it into practice: Move through the major muscle groups in the body (calves, thighs, abdomen, shoulders, hands, etc.), tensing for 5-10 seconds and then relaxing for 5-10 seconds.  

*If you would prefer to follow along with a guided practice, there are numerous PMR videos available on YouTube.   

Opposite Action 

While TIP skills can be effective at reducing emotional arousal, they are not guaranteed to work in all situations. Sometimes, you simply need to move forward even if you feel stressed, afraid, or upset. In these moments, another DBT skill can come in handy: opposite action.  

As we discussed earlier, emotions can motivate us to take action. However, not every emotionally driven decision is productive or appropriate. If acting on your emotions will not ultimately be beneficial, the solution is to do the opposite of whatever that emotion is urging you to do. This is especially important because acting on your emotions can sometimes strengthen them. For instance, contrary to popular belief, venting anger (e.g. by hitting a punching bag) actually increases anger and aggression (Bushman, 2002). Similarly, avoiding objects or situations out of fear can reinforce that aversion—this is why exposure therapy, which involves confronting one’s fears, is often used to treat anxieties and phobias.  

Consider this example: You feel apprehensive about attending a networking event for your job, but staying home would prevent you from making important connections with others in your field. Doing the opposite action would mean attending the event, even if you feel anxious. When you arrive, you realize that you are still able to function despite your nerves, and you start to feel calmer and more confident as you socialize with your peers.  

Put it into practice: When faced with uncomfortable emotions, “ask [yourself]... ‘Will acting on my emotion solve the problem I am faced with? Is expressing my emotion a wise thing to do?’ If the answer is no... do the opposite of your action urges” (p. 365).