It’s my sophomore year of college. I wake up at 3 a.m. for the 45th day in a row gasping for air, shaking sporadically, and having full body tingles. This is what I categorize as a nocturnal panic attack. Needless to say, I didn’t get much sleep that year.
My therapist at the time knew I had panic attacks, but they had never been this bad. One day in session, I described my symptoms to her, and she told me about the TIPP skill. For starters, TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation. It’s a coping mechanism commonly utilized in Dialectical Behavioral Therapy (DBT) and is generally recommended for patients during times of high emotional distress and crisis.
Most of my life is filled with high emotional stress due to my mental illness and everyday stressors. Even though I’m on anxiety medication and in therapy, this combo still doesn’t stop my panic attacks from happening, so the TIPP skill is vital to my well-being, and I often use it as a way of managing my symptoms. My favorite parts of it are temperature and paced breathing. When I’m in crisis, my initial response isn’t to go on a run or tense my muscles even more.
As someone who struggles with many mental health issues, finding coping strategies that work and are effective is crucial. In terms of the TIPP skill, not only does it work, but it’s free. Psychiatric medication and therapy can be expensive, and a great benefit of utilizing a method like TIPP is that it’s free. It’s always good to see a medical professional work through mental health conditions, but the TIPP skill can be an excellent addition to your current self-care regimen.
Kelly McKenna, LCSW and private practice owner talks through the basics to provide a closer look into the TIPP skill.
When you’re emotionally stimulated, your heart rate is usually faster, causing your body temperature to increase. This skill involves changing your temperature from hot to cold. I can anecdotally say that I feel better after using this skill, but to put it to the actual test, I used a pulse oximeter to see how much my heart rate dropped. My heart rate was 147 beats per minute at the height of my panic attack. After three 30-second rounds of dunking my head in cold water, it dropped to 70 beats per minute, in the normal range for a resting heart rate.
While dunking my head in a pot of ice water is my go-to, there are other ways to achieve this temperature change. McKenna recommends holding an ice cube, squeezing a frozen lemon, or splashing water on your face. “These methods slow your heart rate and activate your parasympathetic nervous system, helping you calm down,” says McKenna.
Some people go on runs to clear their heads, but getting the mental benefits of exercise can be as simple as doing some jumping jacks, high knees, or butt kicks. Whatever type of movement you prefer or like to do will suffice — it’s just about moving your body, even if it’s only for a short period. “This helps get rid of some anxious energy and release endorphins,” McKenna shares. When you spend all the built-up energy working out, it can help “tire out” the feeling of being overwhelmed, so your emotions feel more balanced.
You might have heard people telling you to take a deep breath when you’re anxious, and there’s a reason for that. Breathing is one of the TIPP skills that you can do anywhere at any time. Plus, you even have full control over how you want to do it and for how long.
“Taking slow deep breaths soothes the nervous system, decreasing your heart rate, and decreasing the intensity of your emotions,” McKenna says. McKenna recommends breathing in for four seconds, holding for seven seconds, and exhaling for eight seconds. However, find a pattern that suits your needs and adjust accordingly.
You can find different breathing exercises on apps like Calm and Headspace.
Paired Muscle Relaxation
Paired muscle relaxation (sometimes referred to as progressive muscle relaxation) is achieved by tensing and releasing one muscle group at a time. You can do this while seated, and most experts will recommend starting from the top of your body (like your neck and upper back) and purposefully tightening those muscle groups for a few seconds before leasing. Work your way down to your arms, stomach, lower back, thighs, and calves. “This helps decrease muscle tension, lower blood pressure, promote a sense of wellbeing, and reduce anxiety,” says McKenna