In the last post, we talked a lot about what distress tolerance is. We also talked about the science behind why we need to improve our distress tolerance levels. This post is all about a couple of my favorite Distress Tolerance skills: TIPP and IMPROVE.
TIPP is one of my very favorite distress tolerance skills. I teach it to every client, and I also use it myself. When we use TIPP, we are engaging both our brains and our bodies to help our darn amygdala see we are still in control.
This skill can take about 30-60 minutes to walk through, because it uses so many different physical components to assist the whole body with distressful feelings. When you practice it regularly (there I go again with that idea of actually using the skills), even if you are not in distress, you slowly rewire your brain to communicate better and automatically turn to these skills. Practicing them daily for 66 days will help it become the healthy habit you dream of.
Okay, enough about why we should practice the skill, lets go over how to use it. First up, we have temperature change. When we feel as if we are in distress, we often start to feel it physically before we feel it emotionally. Suddenly changing our temperature allows our prefrontal cortex to override the message that darn amygdala is sending because it is a physical change. That physical change instantly tells our darn amygdala “hey stupid! something is happening that we should pay attention to.” Suddenly changing our body temperature can be simple. My favorite way is running your hands under cold water and describe the sensations you are experiencing as you are feeling that water on your hands. Many people have squeezed ice cubes, taken a cold shower, or even stuck their face in a snow pile. The key here is to describe and focus on the physical sensation to help give your prefrontal cortex the evidence it needs to tell that darn amygdala to slow down.
The next letter, I, stands for intense activity. Many people think that intense activity means intense exercise. It can mean that, however, I like to use intense activity as there are some people out there who might not be able to intensely exercise. Participating in an activity that requires your full concentration and attention allows that darn amygdala to shut up for a minute and focus on what you are physically doing. By participating in an intense activity for at least 15 minutes, your brain will start to release serotonin and dopamine. That means that the stress neurotransmitters adrenaline and norepinephrine will also decrease in their production. Soon, your brain will start to release endorphins to start decreasing the emotional strain you are experiencing. These intense activities can include exercise, putting together a craft, gardening, cooking, playing a video game, or even playing an instrument. As long as your body is in motion, your brain will be able to produce the serotonin and dopamine.
Paced breathing should sound a bit familiar. I discussed paced breathing a bit in the post Mindfulness: the Art of Becoming Calm, Cool, and Collected. Paced breathing (also known as mindful breathing) helps control the rate of our breathing, which decreases our heart rate and our blood pressure. In turn, that decreases the brains triple F response and decreases the release of adrenaline and norepinephrine. Paced breathing also increases the amount of oxygen in our body, which fuels the prefrontal cortex and strengthens it against that darn amygdala’s stupidity. If you remember, that means our brain will release serotonin and dopamine as we breathe! To recap paced breathing, here are the basic steps:
- sit in a comfortable position
- Slowly inhale through your nose and into your diaphragm ( to make it simple, breathing so that your belly expands) for 6 seconds
- Hold that process in your belly for two seconds
- Slowly at exhale out of your mouth for eight seconds, or until you feel like you have no breath left
- Repeat this pattern of breathing for 3 to 5 minutes (or how long it takes for you to feel calm).
- If you want evidence the deep breathing is working, take your heart rate before you start the deep breathing. After each minute of practicing the breathing, take your heart rate again. Your heart rate will go down!
Progressive muscle relaxation rounds off TIPP. Out of these four steps, progressive muscle relaxation is my favorite skill out of this acronym because it is (in my eyes) the most comfortable one to do. What you do in progressive muscle relaxation is tense up a muscle group (that’s right, tighten those already tight muscles) and then slowly release them. As we do this, it is key to focus and describe the physical sensations you are experiencing as you tighten release the muscles. While you are hard at work, your brain starts to release oxytocin. If you recall, oxytocin not only helps us feel connected, but also helps us feel amazing when we are actively physical. This, along with the release of endorphins, allows our body to naturally relax when it’s feeling distressed.
Practicing TIPP is something that should be done every day (even if you are not feeling distressed) so you can feel it more impactfully when you are stressed. That’s right, I said it again, practice is key to helping the brain rewire itself. At first, this skill set can take up to an hour. With practice, you can see that some of these skills may work better than others for you. In those pinch hit moments, you may only choose to use one or 2 of the letters in the acronym and be successful with it. Again, this happens with practice!
Self-soothing is another form of distress tolerance. When you think of self soothing, what comes to your mind? For me, it’s an image of a toddler who is screaming and a parent trying to help them to calm down. That’s kind of what is happening in our brain: that darn amygdala is throwing a hissy fit and the prefrontal cortex is acting all parental and telling it to calm down.
One way to self soothe is by using your senses. As we’ve talked about in the Brain and Mental Health: A Basic Breakdown (Literally and Figuratively), our senses are the main way our darn amygdala gets information. So let’s give it some positive intake to tell that darn amygdala to calm down.
When going through these skills, we are trying to get that darn amygdala (and the rest of the brain) to see the full picture of what is going on, not just the negative things your brain is picking up on. As we engage in activities that get our senses to give that full picture, we have to pick activities that release the feel good neurotransmitters. For instance, choosing to eat your favorite food, playing your favorite game, or walking in your favorite part of town, or even listening to your favorite song can release endorphins, dopamine, serotonin, oxytocin, and GABA.
Taking time to practice self-soothing (there I go again with practicing) daily for 15 minutes decreases our stress levels and increases the healing of the hippocampus. Plus, the benefits of participating in self-soothing include regular release of those feel good neurotransmitters, which helps keeps our mental health in check. Who would have thought that taking time to, I don’t know, enjoy life, could have some positive outcomes on your life?
Another great way To self-sooth is through the use of the acronym IMPROVE. IMPROVE stands for:
- One thing in the Moment
With using imagery, we are using our hippocampus to recall positive memories, feelings, and experiences (under the direction of the prefrontal cortex of course). As we do, we release the neurotransmitters GABA, dopamine, and glutamate. These, if you remember, help decrease the release of cortisol and the other stress neurotransmitters.
Meaning is a tough one when it comes to self-soothing. With this particular skill, we have to allow our prefrontal cortex time to identify a purpose from the stressful situation. Example: We feel completely overwhelmed by finals week. It is the job of our prefrontal cortex to help identify why finals week is stressful and what the outcomes (both positive and negative) could be from being under that stress. For me, finals week meant I was one step closer to my career and dream job. This fact helps reduce the production of cortisol and improves our fact-checking ability. What does that do for our darn amygdala? It shuts it up, that’s what it does.
Next, we have prayer. Before you go running away from my blog, hear me out. Prayer has been clinically shown to increase the activity in the prefrontal cortex (Sandoiu, 2018). It has been seen that prayer, similar to the meditation we discussed in Mindfulness: The Art of Becoming Calm, Cool, and Collected, improves our ability to focus, decreases the triple F response, and releases the feel-good neurotransmitters. Now, prayer can be directed towards your own higher power. That may be God, Allah, YHWH, Brahman, Vishnu, Shiva (or even the kitchen light when you pay your electric bill).
Ahhh, relaxation. We have spent some time talking about mindfulness, but engaging in an activity that truly relaxes you will help self-sooth by lowering the release of acetylcholine, loosening your muscles, lower your heart rate, and help you breathe easy. Not to mention, doing something that relaxes you also help release those feel good neurotransmitters serotonin, dopamine, and GABA.
The next one, One thing in the moment, is another tricky one. It makes our prefrontal cortex work hard at identifying a neutral activity going on in the stressful situation and making that the focus, not the actual stress. By doing so, we are allowing the prefrontal cortex time to collect all the facts about the stressful situation. We are also buying the hypothalamus and hippocampus time to pull memories similar to this situation to help prove to that darn amygdala we will be okay.
VACATION! Who doesn’t like a mini-vacation? By taking a mental break from our stress, we are accomplishing several things (none of which are labeled as procrastination). First, by taking a break from the stress, we are releasing oxytocin into our brains. We do this because we are enjoying the break. So taking a break and thinking only about the work you need to do isn’t going to help anything. If you feel a bit called out, good! Taking a brain break takes practice. Start first with taking 5 minutes to focus on something you enjoy (like a mini brain vacation if you will). Think only about the positive feelings that come from that mini break. This will help trigger the release of serotonin and dopamine and help you feel fueled up to tackle the stress, again.
Last, but not least, we have encouragement. By offering yourself words of support, you are enforcing a positive self-esteem. I’m not saying you need to be all mushy and positive. Saying “I’m a strong beautiful person” sometimes is overkill. By offering yourself a more realistic support, like “the last time I was this stress I did (insert what you did) that helped.” When we do this, we are pulling facts from our hippocampus and releasing dopamine. We may even produce some oxytocin if we treat ourselves like human beings in that moment of stress.
Thank you for taking the time to learn how to improve your distress tolerance skills. Over the next few weeks, I plan to outline more distress tolerance skills to show the versitility of this particular skill set. Remember, you are worth the work to make your mental health feel like mental wealth.
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- Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press. Reviewed June 14, 2021
- Carissa Weber at www.thatdarnamygdala.com
- Colton Nieman at https://www.instagram.com/the_natural_perspective/