When anxiety is mounting and a panic attack is bubbling up (or already in full effect) it is difficult to feel you have any control or influence over it. Distress tolerance skills are of vital importance when anxiety is in high gear in order to reduce the overall intensity and duration of the unpleasant experience. TIPP is a set of distress tolerance skills that utilize some biological hacks to help reduce the impact of high anxiety or a panic attack.

TIPP

Temperature

• Put ice on your face, just below your eyes
• Hold your breath for a couple of seconds
• Triggers Diver’s Reflex that has a calming effect on body and reduces heart rate
• Great option for high anxiety or distraction from urges to engage in a problem behavior

Intense Exercise

• 2-3 minutes of cardio exercise to elevate heart rate
  • Examples: Jumping Jacks, high knees, butt kicks
• Releases Endorphins
• Externalizes high intensity emotion
• Once you stop exercising the body is no longer experiencing physical stress and vitals such as heart rate and respiration rate decrease, allowing emotional intensity to decrease as well as it is no longer being supported physiologically 
• Great option for restlessness and anger 

Progressive Muscle Relaxation

• Tense (5-10 seconds) and release one muscle at a time from head to toes (or toes to head)
• Release tension on exhale
• Great option for decreasing noticeable muscle tension, before bed to increase relaxation, upon waking to warm body up for the day, releasing anger/anxiety/fear

Paced Breathing

• Square Breathing
  • Inhale for count of 4, hold breath for count of 4, exhale for a count of 4, hold for a count of 4, REPEAT 
  • Inhale through nose, exhale through mouth
• 4, 7, 8 Breathing
  • Inhale (nose) for count of 4, hold breath for count of 7, exhale (mouth) for count of 8 
• Alternate Nostril Breathing
  • Close right nostril with thumb
  • Inhale slowly through left nostril 
  • Close left nostril with pointer finger (both nostrils closed) and hold breath momentarily
  • Open right nostril (release thumb) and exhale slowly 
  • Inhale through right nostril
  • Close both nostrils and hold for moment
  • Open left nostril (release pointer finger) and exhale slowly
  • Repeat this pattern
• Great option for managing anxiety, increasing relaxation, mindfulness

Let’s set things straight: utilizing these skills is not going to drop you into a state of instant calm and bliss. Distress tolerance isn’t about eradicating difficult emotions, it is about managing them; tolerating them-as the name would suggest. Anxiety and discomfort may persist (so engaging in self-soothing activities will be helpful after a panic attack), but an intensity score of 4 is easier to sit with than a 9. 

Try out these TIPP skills for yourself to see what works best for you. Bear in mind that reviewing the TIPP skills regularly will help prepare you for engaging with them during a strong emotional experience. People often experience “tunnel vision” when experiencing strong emotion making it difficult to access and engage with helpful tools. Keep these skills fresh by reviewing them periodically for easier recall in a desperate situation. 

Choose one TIPP skill, or make a combo to alleviate the symptoms you are experiencing. My signature combination has been dubbed “The Chill Pill” and incorporates T (temperature) and P (paced breathing) at the same time. Try out what skill or combination of skills works best for you. I hope you found a helpful TIPP here!