Distress Tolerance Group Discussion

Discussion Guidelines

• Respect confidentiality: what’s shared here stays here.
• Listen actively and speak from your own experience using “I” statements.
• Allow space for each person to share without interruption.

1. Identifying Real-Life Triggers (10 minutes)

Prompt: Think of a recent situation when you felt overwhelmed or on the verge of an emotional crisis. Briefly describe the triggering event and the physical or emotional sensations you noticed.

Notes:

Follow-Up Questions:

• What specific thoughts raced through your mind at that moment?
• How intense was your distress on a scale of 1–10?

2. Mapping TIPP Skills to Your Experience (10 minutes)

Prompt: Review the four components of TIPP on the DBT Distress Tolerance Skills Handout. Which one(s) do you think would have helped you most in that moment? Explain why.

Notes:

Follow-Up Questions:

• How easy or difficult would it be for you to use that skill in a real crisis?
• What about your environment or routine supports or hinders using TIPP?

3. Exploring Barriers and Solutions (15 minutes)

Prompt: In small groups (2–3 people), discuss the biggest barrier you anticipate when trying to apply TIPP skills in everyday life (e.g., time constraints, discomfort with the technique, forgetting in the moment).

Group Discussion Points:

• List common barriers on flip chart.
• Brainstorm at least one practical strategy to overcome each barrier.

Reconvene & Share:

• Which barrier felt most challenging to address?
• Which solution felt most realistic and why?

4. Planning for Practice and Accountability (10 minutes)

Prompt: Use the Distress Tolerance Practice Worksheet to plan a specific time and context this week when you will practice one TIPP skill. Write down:

1. The chosen skill component
2. When and where you will practice it
3. A peer or reminder system to keep you accountable

Worksheet Notes:

5. Closing Reflection (5 minutes)

Round-Robin Share:

• One word that captures how you feel after today’s discussion.
• One personal commitment to practicing TIPP before our next session.

Thank you for your honesty and support. Remember: distress tolerance is like a muscle—the more you practice, the stronger you become.

TIPP Technique Role-Play

Time: 20 minutes
Materials:

• DBT Distress Tolerance Skills Handout
• Bowl of ice water or ice packs
• Chairs or mats for pairs
• Timer or stopwatch

Objectives

• Give hands-on practice with each TIPP component
• Build confidence in guiding yourself or others through the skill

Instructions

1. Introduction (2 minutes)

   • Explain that each pair will role-play one TIPP component, alternating roles as “coach” and “client.”
   • Emphasize use of clear verbal prompts and attention to safety (e.g., for cold water use).

2. Pair Assignment (1 minute)

   • Divide into pairs.
   • Assign each pair one TIPP component:
     • Temperature
     • Intense exercise
     • Paced breathing
     • Paired muscle relaxation

3. Role-Play Practice (12 minutes total)
   a. Round 1 (6 minutes)

   • Partner A describes a brief distressing scenario (e.g., work stress, argument).
   • Partner B guides Partner A through their assigned TIPP skill step by step, narrating instructions and checking in (“How do you feel on a scale of 1–10?”).
     b. Switch Roles (6 minutes)
   • Partners swap roles but keep the same TIPP component.
   • Partner B now plays coach and guides Partner A.

4. Teach-Back Demonstrations (4 minutes)

   • Reconvene as a group.
   • Each pair gives a 30-second demo: one person plays coach, one plays distressed client.
   • Highlight key verbal cues and actions (e.g., slow inhalations, muscle clench/release sequence).

5. Pair Reflection (1 minute)

   • In pairs, discuss:
     • What felt most challenging about coaching this skill?
     • What did you notice in your body or mind?

6. Group Debrief (remaining time)

   • Invite 1–2 volunteers to share insights or questions.
   • Reinforce that repeated practice builds skill fluency and comfort.

This role-play helps you move TIPP from theory into real-time self-soothing—and prepares you to teach or remind peers in moments of crisis.

Distress Tolerance Practice Worksheet

Use this worksheet to reflect on a recent distressing moment, select appropriate TIPP skills, and plan for practice and accountability.

1. Recall a Recent Distressing Moment

Describe a situation in the past week when you felt overwhelmed or on the verge of an emotional crisis. Include what happened, where you were, and how you felt physically and emotionally.

2. Rate and Reflect

1. On a scale of 1–10, how intense was your distress? _____
2. What thoughts or images ran through your mind in that moment?
   
   
   
   
   
   
   

3. Choosing TIPP Skills

Review the four components of TIPP on the DBT Distress Tolerance Skills Handout.

a. Which TIPP skill(s) would have helped you most in that moment?
• Temperature ☐ • Intense Exercise ☐
• Paced Breathing ☐ • Paired Muscle Relaxation ☐

Explain why you chose these skill(s):

4. Anticipating Barriers and Solutions

For each chosen skill, identify one barrier you might face when using it and brainstorm a solution.

Skill: ____________________
Barrier: ____________________
Solution: ____________________

Skill: ____________________
Barrier: ____________________
Solution: ____________________

5. Planning for Practice

Select one TIPP skill to practice this week. Complete the plan below:

1. Chosen Skill: ___________________________
2. When (day & time): _____________________
3. Where (location): _______________________
4. Accountability (peer reminder, alarm, etc.):
   
   
   
   
   
   
   

Commitment statement:
"I will practice my chosen TIPP skill at the planned time and place because…"

Good work! Bring this worksheet to our next session to discuss your experience and adjust your plan as needed.

DBT Distress Tolerance Skills Handout

What Is Distress Tolerance?

Distress tolerance is the ability to endure and cope with intense emotions and crises without resorting to impulsive or harmful behaviors. These skills help you stay safe, reduce emotional suffering, and maintain focus when you feel overwhelmed.

The TIPP Technique

TIPP is a four-part method for quickly lowering high emotional arousal. You can use each skill on its own or combine them for greater effect.

1. Temperature (T)

• Step:
  • Fill a bowl with ice water or use ice packs.
  • Splash your face or press ice to your cheeks, forehead, or back of your neck for 30–60 seconds.
• Why it works: Activates the dive reflex, slowing your heart rate and calming your nervous system.
• Example: When you feel panic rising before a meeting, press an ice pack to your face to ground and calm yourself.

2. Intense Exercise (I)

• Step:
  • Perform a brief burst of vigorous activity (e.g., 20–30 jumping jacks, a 60-second sprint in place, or run up and down stairs).
• Why it works: Releases built-up tension and floods your body with endorphins, which counteract stress.
• Example: If you feel anger boiling after an argument, do push-ups or run in place to release the charge.

3. Paced Breathing (P)

• Step:
  • Inhale slowly through your nose for 4 seconds.
  • Hold your breath for 2 seconds.
  • Exhale slowly through pursed lips for 6 seconds.
  • Repeat for 3–5 minutes or until you feel calmer.
• Why it works: Engages the parasympathetic nervous system, lowering stress and slowing your heart rate.
• Example: When workload stress mounts, step away for a 5-minute breathing exercise in a quiet spot.

4. Paired Muscle Relaxation (P)

• Step:
  • Tense one muscle group (e.g., clench fists, tighten shoulders) for 5–7 seconds.
  • Release and fully relax that group for 10–15 seconds.
  • Move systematically from your feet up to your neck and face.
• Why it works: Alternating tension and release enhances body awareness and reduces overall muscle tension.
• Example: Before bedtime, tense and relax each muscle group to ease into a more restful state.

Tips for Effective Practice

• Plan Ahead: Identify specific times and contexts to practice each TIPP skill (e.g., first thing in the morning, during breaks).
• Use Reminders: Set alarms, post sticky-note cues, or partner with a peer to prompt you to use the skills.
• Reflect & Adjust: Keep a brief journal of which techniques helped most and under what circumstances. Modify your plan based on what you learn.

Keep this handout accessible—on your phone, desk, or wall—to remind yourself that you have powerful tools at hand when distress strikes.