How To Decrease Intense Panic, Anxiety, & Anger

I previously wrote about DBT, and how I use that perspective with many of my clients. I’m going to share with you the TIPP Skill for Decreasing Intense Panic, Anxiety, & Anger (This skill was developed by Marsha Linehan), which is based on DBT.

Lately I’ve been hearing many of my clients say that they know how to cope with emotions like anger and anxiety most of the time, but occasionally these feelings are so strong that they can’t think clearly enough to follow through on the things that usually work for them.  When anger, anxiety, and panic get too overwhelming, the part of our brain that problem solves and makes well informed choices doesn’t get as many of the resources it needs, making it harder to think clearly.  Instead, the emotional parts of the brain get those resources and we might start to feel physical signs of these emotions like, sweating, shallow breathing, crying, and nausea among other things.  We might even feel like we’re having a heart attack or dying.  When this happens, we sometimes get desperate to escape these unpleasant feelings and make choices that down the line can be dangerous or make our situation worse.  This is when we might self-harm, fight with someone we love, break things, or become aggressive.  When this happens, we have to find ways to trick our brain in to realizing that we’re safe so the intensity of these emotions decreases enough for us to think clearly and cope effectively.   The TIPP skill does this, and the best part about it is that it requires very little thinking and works super quickly. 

Goal of This Skill: Reduce intensity of overwhelming emotions without making the situation worse.

Why it Works: Each part of this skill works by quickly changing your biology to reduce intense feelings.  When we’re overwhelmed by emotions, we’re in a state of “fight or flight”, which means we are geared up and ready to act, even if those actions aren’t really helpful.  TIPP skills help turn off fight or flight and instead trigger “rest and digest”, which makes us feel calm and in control. 

When to use it:

-       You’re completely overwhelmed by your emotions and can’t think clearly.

-       You’re in crisis and might engage in dangerous or harmful behaviors (example: self-harm).

-       You’re too overwhelmed to do something that really needs to get done.

-       You can’t use coping skills that typically work for you because you’re too overwhelmed.

How To:

Temperature: this involves changing the temperature of your face with ice or cold water while holding your breath.  Generally, I will have my clients start by holding an ice pack over their face, making sure to cover their forehead.  While holding the ice over your face you also hold your breath the best you can for 30 seconds. 

-       The idea behind this is that it tricks your body in to thinking you are in extremely cold water.  When our brain thinks we’re in cold water, our bodies try to conserve our energy for survival by making us calm and relaxed. 

-       I’ve had clients find a variety of creative ways to practice this skill.  Some of these strategies include holding a bag of ice over their face, jumping in a cold shower, or stepping outside on a cold, snowy day.  The important part is that your face (particularly your forehead) is cold and you’re holding your breath.    

Intense Exercise: spend 20 minutes engaged in some type of exercise that will get your heart rate up (running, jumping jacks, jumping rope, etc.). 

-       Not only will this distract you, but once you’re done with that exercise your body has to start working to let you rest and recover, so you’ll start to feel calm and relaxed.

Paced Breathing: this involves slowing down your breaths so you’re breathing at a rate of 5-6 breaths per minute.  The key here is to breathe deeply from your abdomen and to have your exhale be longer than you’re inhale.

-       There are a number of different strategies for paced breathing.  I personally like to use 4-4-6 breathing (4 seconds inhaling, 4 seconds holding the breath, and 6 seconds exhaling), but you can adjust those numbers to be comfortable to your personal preferences.  If you’re focused on your breath and your exhalation is longer than your inhalation, you’re doing it right! There are tons of videos to help guide you through this on YouTube.  Just go to YouTube’s search bar and type in “paced breathing”.  You can test them out and find what works best for you.

-       Unlike some of the other parts of TIPP skill, this one works best if you practice it regularly when you’re not in an overwhelmed state.  If you practice it when you don’t need it then it’s more likely to work for you when you’re in a crisis situation and you have limited resources.  It’s like a runner preparing for a marathon.  They don’t just show up on the day of the marathon and successfully run the race, they have to get in shape and practice in order to be successful. 

Paired Muscle Relaxation:  this involves pairing the tensing and relaxing of muscles with your breath.  To do this you breathe deeply and slowly, just like you would when paced breathing, but with each inhale you tense a group of muscles and on each exhale, you relax those muscles.  Generally, people will run down muscle groups from head to toe or vice versa. 

-       Just like with paced breathing, you can find tons of videos on YouTube to guide you through a paired muscle relaxation exercise. 

Though the TIPP skill works quickly, it’s important that after we use it we move on to other activities or other coping skills.  If we use the TIPP skill and then immediately go back to focusing on whatever triggered those strong emotions, then we’ll just return to feeling overwhelmed. 

The mental health therapists at our office offer counseling for a variety of issues including trauma using EMDR, depression, anxiety, grief, and couples counseling. We work with teens, adults, and couples. We also offer online counseling services which can be great for people with busy schedules or for people who live in parts of Pennsylvania with limited counseling options. You can check out our website to see the full list of counseling services that we offer. Or, Request An Appointment here.