DBT Skills for Distress Tolerance: Creating a TIPP Toolkit

Dialectical Behavior Therapy (DBT) has transformed how many therapists approach emotional regulation, particularly for clients who struggle with intense emotions and impulsive behaviors. DBT skills have proven effective across diagnoses—from anxiety and depression to eating disorders and substance use. This comprehensive worksheet focuses on the TIPP technique, one of DBT's most practical and immediately applicable skill sets. TIPP stands for Temperature changes, Intense exercise, Paced breathing, and Progressive muscle relaxation—four body-based interventions that help clients reset their nervous system during emotional emergencies.

This worksheet includes detailed practice logs for each of the four TIPP techniques, allowing clients to track their stress levels before and after using each skill. This data helps both you and your clients identify which techniques work best for their unique physiology and circumstances. The structured format encourages consistent practice, which is essential for building the muscle memory needed to access these skills during actual crisis moments.

Beyond practice tracking, this worksheet guides clients through creating a personalized TIPP plan. They'll identify their individual distress signals across physical, emotional, behavioral, social, and cognitive domains, then map specific techniques to their most challenging situations. This personalization helps bridge the gap between learning skills in session and applying them in real-world scenarios.

The weekly reflection section prompts clients to analyze patterns in their emotional responses and skill effectiveness. These insights often become valuable talking points in therapy, helping you understand what triggers your clients most and which interventions feel most accessible to them during difficult moments.