Generic TIPP Worksheets Don't Work in a CrisisGenerate One Built for Their Triggers
At 8/10, they won't remember generic advice. "That tightness before presentations" beats "when you feel overwhelmed." Specificity in crisis.
TIPP Skills for Crisis Intervention
What Are TIPP Skills in DBT?
TIPP Skills are DBT distress tolerance techniques designed for rapid emotional regulation during crisis moments when emotional intensity is at 7/10 or higher. TIPP stands for Temperature (using cold to activate the mammalian dive reflex), Intense exercise (burning off adrenaline and stress hormones), Paced breathing (activating the parasympathetic nervous system), and Paired muscle relaxation (releasing physical tension through progressive relaxation). Unlike cognitive strategies that require clear thinking, TIPP works through physiology. When the emotional brain has hijacked the thinking brain, you change the body first. Research on the dive reflex shows cold applied to the face can slow heart rate by up to 25% within 30 seconds. TIPP skills are part of the DBT distress tolerance module developed by Marsha Linehan.
"TIPP skills changed how I work with clients in acute distress. Having a personalized worksheet means they actually use it in the moment. Generic handouts sat in folders."
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Who This Tool is NOT For
We believe in being direct about fit. This tool works best for certain use cases:
- xClinicians who want static crisis cards to print in bulk. We generate fresh worksheets per-client. No batch printing of generic TIPP handouts.
- xTherapists who prefer pure DBT manual adherence. Personalization means adapting techniques to client preferences. If protocol fidelity is paramount, this tool adds variation.
- xGroup practices needing shared template libraries. We generate, we don't store. If you want a central repository of pre-made PDFs, Therapist Aid is better for you.
- xAnyone uncomfortable with AI-assisted tools. If you're skeptical of AI in clinical work, we respect that. Try the 10 free worksheets to see if it fits your practice.
The Problem with Generic TIPP Worksheets
Standard TIPP handouts list techniques without context. In a crisis moment, your client won't remember which technique works for them. Personalization matters most when thinking is compromised.
"One-Temperature-Fits-All"
Generic sheets say "put ice on your face." But some clients hate cold on their face. They panic more. They need alternatives like holding ice cubes in their hands or cold drinks against their wrists.
"Exercises That Don't Fit"
Standard lists include running and jumping jacks. Your client with chronic pain, mobility issues, or who works in a cubicle needs adapted options they can actually do in crisis. Generic worksheets ignore this.
"No Crisis Context"
Template TIPP worksheets say "use when overwhelmed." Your client needs their specific warning signs: "When you notice your jaw clenching before difficult calls with your mom..."
How Personalization Changes Everything
A personalized TIPP worksheet uses your client's specific crisis triggers, physical limitations, and preferred methods. In a crisis, recognition speed matters.
10 free worksheets. Export as PDF. No signup.
The Science Behind TIPP Skills
TIPP works because it targets physiology directly. Here's what the research shows about each component.
heart rate reduction from dive reflex
Cold on face activates within 30 seconds
Dive reflex researchto significant cortisol reduction
Intense exercise burns off stress hormones
Exercise and cortisolpaced breathing activates vagus nerve
Extended exhale triggers parasympathetic
Breathing researchengagement increase with personalization
82.5% vs 55.3% for standardized content
Meta-analysis 2025
When to Use Free TIPP Skills Worksheets
TIPP is a first-line crisis intervention. Here's where personalization makes the biggest clinical difference.
Crisis Moments
When emotional intensity hits 7/10 or higher and cognitive strategies feel impossible. TIPP changes physiology first, making other skills accessible. The dive reflex can interrupt a crisis spiral within 30 seconds.
Generate free worksheetIntense Emotions
For overwhelming emotions that feel uncontrollable. Whether it's rage, panic, or despair, TIPP works through the body when the mind is flooded. Intense exercise burns off the stress hormones driving the emotion.
Generate free worksheetPanic Attacks
TIPP is particularly effective for panic because it directly counters the sympathetic activation. Temperature activates the dive reflex, slowing heart rate. Paced breathing extends exhales to trigger parasympathetic response.
Generate free worksheetAdolescents in Distress
Teens often reject "therapy exercises" but respond to concrete physical actions. TIPP reframes crisis skills as body hacks. Cold water challenges and exercise bursts feel less clinical and more actionable.
Generate free worksheetGenerate a Free Personalized TIPP Worksheet
From client description to printable crisis card in under 60 seconds.
Describe Crisis Patterns
Share your client's typical triggers, physical symptoms during distress, and any limitations. Include what's worked or not worked before. Write like you're in case consultation.
Select Your Approach
Choose DBT as your modality. Adjust strictness based on whether you want pure DBT protocol or integration with other approaches.
Generate and Export PDF
Get a personalized TIPP worksheet in seconds. Edit specific techniques if needed. Export as printable PDF for session use or as a wallet-sized crisis card.
10 free worksheets. Export as PDF. No signup required.
Frequently Asked Questions
Are the TIPP Skills worksheets free?
Yes. You get 10 free worksheets without signup. Generate a personalized TIPP worksheet, export to PDF, and use with your client immediately. No credit card required.
What are TIPP Skills used for in therapy?
TIPP Skills are DBT distress tolerance techniques for crisis moments when emotional intensity is at 7/10 or higher. They're effective for panic attacks, intense urges, overwhelming anxiety, and moments when cognitive strategies feel impossible.
When should clients use TIPP vs other DBT skills?
TIPP is for acute crisis moments when physiology is activated. Use TIPP first to bring intensity down, then transition to Wise Mind, DEAR MAN, or other skills. TIPP works through the body when thinking is compromised.
How does the Temperature skill work physiologically?
Cold (below 50 degrees F / 10 degrees C) on the face activates the mammalian dive reflex, triggering a parasympathetic response. This can slow heart rate by up to 25% within 30 seconds. The effect works through the trigeminal nerve around eyes and cheeks.
Can I export to PDF?
Yes. Every worksheet can be exported as a printable PDF. Perfect for crisis cards clients can keep in their wallet, car, or on their phone. The PDF includes your practice branding.
What if my client has physical limitations?
Personalized worksheets adapt to limitations. Clients with mobility issues get seated exercise options. Those with temperature sensitivity get alternatives like cold water on wrists. Every component has adaptable variations.
Can TIPP be used with children and adolescents?
Yes, with modifications. Temperature might be holding a cold juice box. Exercise could be jumping jacks or dancing. Breathing can use visual metaphors. Personalized worksheets make techniques engaging and age-appropriate.
Is client information stored when generating worksheets?
No. Reframe uses zero-retention architecture. Client descriptions are processed in memory and never stored on our servers. HIPAA-compliant by design, not just policy.
Related Therapeutic Tools
Complement free TIPP Skills worksheets with these related DBT and crisis intervention tools.
Wise Mind
DBT mindfulness tool for finding balance between emotional and rational thinking. Use after TIPP reduces intensity to help clients access their inner wisdom.
Learn moreCBT / DBTAnger Iceberg
Explore hidden emotions beneath anger. Pairs well with TIPP for clients whose crises involve anger. Use TIPP to regulate, then iceberg to understand.
Learn moreCBTCircle of Control
For anxiety about uncontrollable situations. Use after TIPP to process what triggered the crisis and identify what they can actually influence.
Learn moreSee How We Compare
Understanding Each TIPP Skill
TIPP works because each component targets a different aspect of the physiological stress response. Understanding the mechanism helps you explain it to clients and troubleshoot when techniques aren't working.
Temperature
Cold (below 50 degrees F / 10 degrees C) applied to the face activates the mammalian dive reflex. This evolutionary response conserves oxygen by slowing heart rate and redirecting blood to vital organs. The trigeminal nerve around the eyes and cheeks triggers this parasympathetic response within 30 seconds. Methods include: cold water splash on face, ice pack on forehead/cheeks, holding ice cubes, cold shower on face, frozen spoon on cheeks. For clients who hate cold on their face, wrist immersion or holding a frozen water bottle can provide partial benefit through general cold exposure.
Intense Exercise
High-intensity physical activity for 5-20 minutes burns off adrenaline and cortisol that accumulate during stress. The goal is to elevate heart rate significantly. Methods include: running, fast walking, jumping jacks, burpees, dancing, climbing stairs, punching a pillow, wall push-ups, arm circles (for mobility limitations). The key is intensity matching the emotional intensity. A client at 9/10 needs vigorous movement, not gentle stretching. For clients with physical limitations, any repetitive movement that increases heart rate will help.
Paced Breathing
Extended exhales activate the parasympathetic nervous system through the vagus nerve. The classic pattern is 4-7-8 (inhale 4 counts, hold 7 counts, exhale 8 counts), but any pattern with longer exhales than inhales works. The key mechanism is that extended exhalation stimulates the vagus nerve, triggering the relaxation response. For clients who find counting stressful, alternatives include: breathing to music tempo, visual breathing guides, bubble breathing (imagining blowing bubbles), box breathing apps. The exhale phase is what matters most.
Paired Muscle Relaxation
Progressive muscle relaxation works by deliberately tensing muscle groups, then releasing. The contrast between tension and relaxation helps the body recognize and release chronic holding patterns. The "paired" aspect comes from pairing the physical release with a cue word (like "relax" or "calm") that can eventually trigger relaxation on its own. Start with major muscle groups: clench fists for 5 seconds, release and notice the difference. Move through forearms, biceps, shoulders, face, abdomen, legs. For clients in acute crisis, a simplified version focusing just on hands and shoulders can provide quick relief.
When NOT to Use TIPP Skills
TIPP is a powerful tool, but it's not appropriate for every situation. Clinical judgment matters.
Medical Contraindications
Cardiac conditions, pregnancy, Raynaud's disease, or other conditions where cold exposure or intense exercise could be harmful. Always screen medical history.
Low Intensity Emotions
TIPP is for crisis-level intensity (7/10+). For everyday stress or mild anxiety, other skills like mindfulness or cognitive restructuring are more appropriate.
When Avoidance is the Problem
If the client's pattern is avoiding emotions rather than being overwhelmed by them, TIPP could reinforce avoidance. Consider whether the goal is regulation or tolerance.
Without Proper Introduction
TIPP works best when practiced in non-crisis moments first. Introducing it during acute crisis without prior training reduces effectiveness.
Related Worksheets
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Your Client's Crisis Triggers Are Specific. The Worksheet Should Be Too.
Stop handing out generic TIPP handouts. Describe your client's crisis patterns, generate a worksheet built around their actual triggers, and export as a crisis card they'll actually use.
Under 60 seconds. Zero data retention. 10 free worksheets, no signup.
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