TIPP: Fast Body-Based Crisis Skills
A DBT distress tolerance handout explaining the four TIPP crisis skills, with safety guidance and a log to track emotion intensity before and after use.
1-page fillable PDF · US Letter (prints on A4) · Distress tolerance
- Approach / concern
- DBT
- Technique
- Distress tolerance
- Format
- Fillable PDF, 1 page (US Letter / A4)
- Access
- Pro and Advanced plans (3-day free trial)
- For
- Licensed clinicians to use with clients
- Updated
- October 2026
Key facts
What is the TIPP: Fast Body-Based Crisis Skills?
TIPP is a set of DBT crisis survival skills designed to rapidly reduce extreme emotional arousal by changing body chemistry: Temperature, Intense exercise, Paced breathing and Paired muscle relaxation. It is used when emotions are too intense for cognitive skills to work.
Why it works
Physiological strategies can reduce arousal more quickly than cognitive strategies during extreme distress. TIPP is a core part of the DBT distress tolerance module (Linehan, 2015), which has strong support across emotion dysregulation, self-harm and BPD populations.
When to use it
- Emotional crises and very high arousal
- Urges to self-harm or act impulsively
- Panic and rage spikes
- DBT skills groups
How to use it in session
- Explain when TIPP is useful (very high arousal).
- Screen for medical cautions.
- Practise paced breathing and paired relaxation in session.
- Plan which TIPP skill suits different settings.
- Track before-and-after intensity.
Clinician tips
- Keep a cold pack in the freezer as part of a crisis plan.
- Pair TIPP with STOP for a full crisis sequence.
- Once arousal drops, move to problem-solving or other skills.
Worked example
Sharing with clients
Members can download the PDF to print or email, or copy a private client link from the download box. Your client opens the link and downloads the worksheet on any device. No client account is needed, and nothing your client writes is stored on TherapyAid.
Frequently asked questions
Is the cold water technique safe?
For most healthy people, yes. People with heart conditions, low blood pressure or eating disorders should consult a doctor first.
When should I use TIPP instead of other skills?
When emotion is so intense (about 8/10 or higher) that thinking clearly is hard.
References
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Linehan, M. M. (2015). DBT skills training handouts and worksheets (2nd ed.). Guilford Press.
This worksheet is an educational tool for use by, or under the guidance of, a licensed or registered mental-health professional. It is not a diagnostic instrument or a substitute for clinical judgement. If a client is in crisis in Canada, call or text 9-8-8 or call 9-1-1.
