DBT04. TIPP

Session Online Version

Theme song: “I am a Rock” video.

1. Progressive Muscle Relaxation is the first ‘P’ in the TIPP DBT skill introduced during this session. It offers a way to slow down the body and regulate emotions. Deep muscle relaxation can also help your body recover from stress when you combine it with deep breathing. Practice this at night before you sleep to train your body to relax. Do a shorter version of this exercise during the day any time you feel overstressed.

MINDFULNESS “PROGRESSIVE MUSCLE RELAXATION” EXERCISE ACTIVITY

Step 1: Lie or sit comfortably and close your eyes. Take five deep slow breathes.

Step 2: Tense one part of your body at a time for five seconds. Inhale deeply when you tense your muscles. Avoid holding your breath, which can cause more tension.

Step 3: Consciously relax that part of your body for 10 seconds and exhale deeply. Feel all of the tension draining away, like sand running through your fingers. Then move on to the next part of your body.

Step 4: Move in a sequence that works for you, focus on one area at a time. 1. head and face; 2. eyes; 3. jaw; 4. neck; 5. shoulders and back; 6. arms; 7. hands and fingers; 8. chest and abdomen; 9. legs; 10. feet and toes. Or you can start with your feet and toes and move up your body.

Step 5: After you finish mentally scan all of your body for any remaining areas of tension. If you are not sure if there is still tension, tighten that part of your body for 5 seconds; then relax it for 10 seconds. (Anxiety Canada, How to Do Progressive Muscle Relaxation, 2019).

Discuss: What was your experience like? What did you notice? ____________________________________________________________________________________________________________________________________________________________________________________________________________________

Review your commitments from the What & How Skills session:

·      Complete the “Let Go of Judging Worksheet”.

·      Use the “What & How Skills Practice Worksheet” to practice these skills.

·      Complete the Weekly DBT Diary.

·      Come prepared to the next session to share your experience using DBT principles and skills.

2. DBT’s Distress Tolerance skills (see “DBT Coming Attractions Handout”) emphasize changing one’s experience of being alone “in a deep and dark December”. These strategies help us survive the crisis of the day without making it worse through impulsive action. All of these crisis survival skills require us to first use our mindfulness skills. You can’t make use of the skills if you are not aware or mindful that you are distressed and need skills in the first place. “When Emotion Mind takes over, you may find that you often act impulsively without thinking. When you react impulsively, you do not have time to use your skills and get to your Wise Mind. To be able to use your skills, you need first to stop yourself from reacting.” (Linehan, 2015).

Discuss: Describe a crisis when your Emotion mind took over. How effective was your response?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. TIPP skills are for those moments when nothing you try seems to work and when “running away” from a crisis is not an option. A TIPP skill can help bring down your distress just enough so that you can think of other skills to try that reduce painful emotions. It is useful when:

·      You can’t think straight,

·      You feel totally overwhelmed,

·      You are emotionally aroused,

·      You are very angry and hurt.

Watch: “Jurassic Park: Film series” video.

4.When we are stressed, threatened, or upset, the body’s Sympathetic Nervous System (SNS) activates: our heart rate, blood pressure, and saliva production increase; our pupils become dilated; our digestion slows and yes, we may even scream. Like these characters from the “Jurassic Park” films who are trying to survive a crisis we prepare to go into “fight-or-flight” mode. DBT’s four TIPP skills change our body chemistry by activating the Parasympathetic Nervous System (PNS), the opposite of fight or flight, so that our emotions decrease quickly.

Watch: “SpongeBob” video.

5. We can TIPP the Temperature of our face with very cold water. This quickly activates the PNS “mammalian dive reflex” and calms us down by exposing our faces to cold water or cold temperatures. (Sponge Bob is a sea sponge, so he is going to respond differently and “Pinky Out” is NOT a DBT skill.) One way to use this skill is to bend over, hold your breath, and place your face—up to the temples—in a bowl of very cold water for 10–20 seconds, or shorter if you can’t hold your breath that long. Then lift your face, breathe, and repeat the process up to three times. The longer the immersion and the colder the water, the better it works. However, do not make the water too cold. Water below 50 degrees may cause facial pain during immersion. You can substitute this immersion approach with putting an ice pack, refrigerated gel eye mask, cold wet compress or cold beverage can to your cheek bones just below your eyes.

Watch: “Footloose” video.

6. Intense aerobic exercise for 10–20 minutes or so can have a rapid effect on decreasing negative mood and increasing positive mood. Emotions organize our body for action. For example, anger prepares us to attack, fear to run, and so on. Kevin Bacon’s “Footloose” film character is trying to overturn a small town’s ban on dancing. Smoking a cigarette and drinking a beer has no effect on his current anger and frustration. He had to dance his heart out alone in a warehouse to change what he was feeling. Rather than acting impulsively on an emotional urge to, we can intensely exercise to re-regulate the body, reduce our emotional intensity, and gain control over our behavior. (Please note that Bacon used four stunt doubles in this dance sequence. Use proper medically informed judgement regarding the degree and duration of exercise, as well as exposure to cold temperatures.)

Discuss: Can you share an experience with using intense aerobic exercise (dancing, swimming, biking, running, working out, etc.) to regulate your emotions?____________________________________________________________________________________________________________________________________________________________________________________________________________________

Watch: “The Karate Kid” video.

7. “When you feel life out of focus, always return to basic of life. Breathing. No breath, no life.”, Pat Morita’s “The Karate Kid” character. The Paced Breathing Skill is the second TIPP ‘P’ and entails changing our breath cycle by making our exhale longer than our inhale. Pacing our breathing by slowing it down has been found by researchers to quickly bring down emotional dysregulation by activating the PNS. This strategy can be used anywhere, any time because we always have access to our breath, which may not be the case with ice packs or intense exercise.

8. The Subjective Units of Distress Scale, or SUDS for short, is a tool for measuring the intensity of your feelings and other internal experiences, such as anxiety, anger, agitation, stress or other painful feelings. The scale allows you to measure the intensity of your feelings from none or almost none a “1”, to the highest or most intense level of the feeling you could possibly have a “10”. By using this scale regularly to measure your feelings, and with regular Mindfulness practice, the intensity of your feelings will shift. What is your SUDS rating right now?_____

PACED BREATHING ACTIVITY

During this activity you will want to be able to watch a clock or watch to count your breaths, or you can count them in your head.

Step 1:  Place one hand on your abdomen and notice the rise and fall with each deep breath. This is the type of breathing you want to do, not shallow breaths only from your chest.

Step 2: Slow your breaths so that exhales are longer than inhales. Try breathing in for about 4 seconds and exhaling for longer—about 6–8 seconds, or about 10–12 seconds per breath cycle. A complete breath cycle is the entire in-breath and out-breath

Step 3: Count your complete breath cycles for 2 minutes. Your heart rate should increase slightly during inhalation, and decrease slightly during exhalation.

Step 4: As you practice this skill lengthen your exhalations to promote the slowing-down effect and activate the Parasympathetic Nervous System (PNS).

Discuss: What is your SUDS level after doing Paced Breathing? Did it go down, stay the same or go up. Which of the TIPP ‘P’ skills worked better for you, Paced Breathing or Progressive Muscle Relaxation? Why?____________________________________________________________________________________________________________________________________________________________________________________________________________________

Watch: “TIPP End Credits” video.

As we roll the TIPP - DBT Skill end credits think about what is the most important thing you learned in this session and what will you do differently because of what you learned. Write your thoughts below.

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Session Commitments

Use the “TIPP Skill Practice Worksheet” for at least one painful situation. 

Complete the Weekly DBT Diary. 

Come prepared to the next session to share your experience using DBT principles and skills.