The problem
You are past the point where thinking helps. Your heart is pounding, your hands are shaking, and every option on the table is the wrong one. Someone is telling you to take a breath and reframe it, and you cannot find the part of you that could.
That is the moment this set of skills is aimed at. Linehan's stated aim for this set is to bring a very emotional state down fast. She calls that state emotion mind: the stretch where how you feel is steering and arguments, however sound, do not land. TIPP starts with the body instead of the argument.
Read this first
Linehan's handout says to check with a clinician before you try these if you have an eating disorder, a cold allergy, or any heart or other medical condition, or if you take a beta-blocker or any medication that lowers your resting heart rate. Two of the four skills pull on the heart in opposite directions: the cold slows it, the hard exercise speeds it. If cold is an allergy for you, leave the ice out entirely.
Match the skill to your state. The Self-Care book lists cold water on the face among its calming tools for when you are above your window of tolerance: anxious, racing, panicked. For a shut-down, numb state it says to keep cold off the face, because cold on the face slows the heart rather than waking you up (Ch. 3). TIPP is for a nervous system running hot.
These are crisis skills, not a plan. Linehan's overview treats them as a way to ride out a bad stretch when nothing you can do will fix it yet. They do not solve what set the crisis off.
The mechanism
Linehan groups the four skills as ways of changing your body chemistry so that extreme emotion drops quickly (Linehan, 2015). The Self-Care book arrives at the same order from another direction: if you are above your window, calm the nervous system first, then think (Ch. 10).
Temperature. Linehan leans on the dive response. A held breath plus cold on the upper face is the cue that sets it off, and the body shifts toward saving oxygen for the heart and brain. She says it needs 15 to 30 seconds to build and goes better if you are sitting still. The diving reflex page has the physiology.
Intense exercise. Linehan's idea is that a hard burst of movement gives a keyed-up body somewhere to put its energy. The Self-Care book disagrees about who this is for: it says that if you are in sympathetic overdrive, vigorous movement can push you further into overwhelm (Ch. 3). Both sources are describing a body running hot. They draw opposite conclusions, and this page cites no study that settles it.
Paced breathing. This is slow belly breathing with a longer exhale than inhale; the protocol below gives the rate and the counts. The Self-Care book teaches the same longer-exhale pattern (Ch. 3; Appendix B). The resonance breathing page covers the research on that slow rate.
Paired muscle relaxation. This skill ties a muscle squeeze to the in-breath and the release to the out-breath. Linehan's step-by-step sheet says the skill gets better with practice, and suggests learning it somewhere quiet, one muscle group at a time. The Self-Care book lists progressive muscle relaxation as a down-regulation tool that teaches the nervous system the difference between activation and rest (Ch. 3).
The protocol
Four skills, described in THF's own words from Linehan's handouts (2015). This is a summary, not the handout. Linehan lists them side by side and does not say to do them in order or all at once. Read the cautions above before step one or two.
Temperature: cold water on the face
Bowl of cold tap water, above 50°F (10°C) so it is cold and not icy, breath held, face in for about 30 seconds. If you cannot submerge, a cold pack held over the eyes and upper cheeks stands in. The full how-to, including the no-bowl version, is on the diving reflex page.
Intense exercise: short and hard
Get your heart rate up hard for a short stretch: sprint a flight of stairs, do jumping jacks, power-walk a loop of the block. Linehan's idea is that a hard burst of movement gives a keyed-up body somewhere to put its energy, and she says even a brief burst counts.
Paced breathing: slow, with a longer exhale
Aim for a rhythm of roughly five or six full breaths a minute, with the out-breath stretching past the in-breath so the belly keeps softening. Linehan's own counting example is 5 seconds in and 7 out.
Paired muscle relaxation: squeeze, then release
Match a muscle to your breath. Squeeze one group as you breathe in, hard enough to feel it but not enough to cramp, then breathe out and let it go, with a silent cue word of your choosing if that helps. Afterward, check what changed.
Our guidance, not drawn from Linehan's handouts: if you are thinking about harming yourself, do not rely on these skills alone. In Canada, call or text 9-8-8 (Suicide Crisis Helpline), any time. If you are in immediate danger, call 911.
The printable: a wallet card
Print this. The cautions are on the card, because the card is what you will have in your hand when the page is not open.