DBT STOP & TIPP Skills: Distress Tolerance Tools for Building a Life Worth Living — Even in Pain

Kathy Morelli
Feb 23, 2022
6 min read

Updated: Jan 25

Pain and distress are a part of life and cannot be avoided,

Life is worth living even if there is pain.

Dialectic: Both things are true at once

What Are Distress Tolerance Skills in DBT?

Dialectical Behavioral Therapy (DBT) Distress Tolerance skills are techniques you can utilize to navigate through emotionally stressful situations. These skills are applied when your emotions have taken over your body and mind, making you feel like you might act or speak impulsively, leading to future regret. They are for those moments that trigger your fight or flight response, causing you to stop breathing and thinking clearly.

We all encounter situations where we've done or said things we later regret. It's not about achieving perfection; it's about progressing, learning new skills, experimenting with different behaviors, and incorporating those behaviors into your life to enhance your happiness.

When emotions surge or stress feels overwhelming, it can become hard to think clearly or make grounded choices. Distress Tolerance skills from Dialectical Behavior Therapy (DBT) are designed for these exact moments — helping you survive emotional storms without making things worse. Two of the most powerful crisis-response tools in DBT are STOP and TIPP. These skills work quickly to interrupt reactive patterns, calm the nervous system, and create space between intense feelings and your next action.

DBT STOP and TIPS Skills give you room to think before you act.

So, instead of fighting your feelings and thinking, "oh, I shouldn’t be having these feelings" try these Distress Tolerance skills instead.

Bloom Where You Are Planted

Accepting reality is an important part of tolerating the distress of life. Accepting reality doesn’t mean that you approve of everything or that you roll over and be passive when you are disrespected.

The goal of reality acceptance is to accept reality as it is without “…throwing a tantrum or responding with willful ineffectiveness.” (Linehan, p. 451).

In addition, accepting reality is imbedded in the dialectic of acceptance and change. Life is challenging and there is pain, but it is still worth living.

But when challenged with a very triggering event, how do maintain your cool?

If you have an explosive personality, HOW can you get to the point of feeling like you can accept reality AND make changes in your life as well?

But, I can’t stop this from happening, you say!

Well, here are two simple skills to help you stop exploding in the moment, so you live a more skillful life. The goal is not to be perfect, nor to ignore your feelings, but to live a more skillful life. Most people can benefit from methodically learned emotional skills!

STOP & TIPP Skills: Rapid Tools for Emotional Crisis and Nervous System Regulation

STOP and TIPP serve different but complementary purposes within Distress Tolerance:

STOP is a pause skill. It helps you slow down in the heat of the moment, interrupt impulsive reactions, and reconnect with Wise Mind before responding.
TIPP is a body-based regulation skill. It works directly with your physiology to rapidly bring down emotional intensity when your nervous system is in fight, flight, or freeze.

Together, these skills offer both cognitive and somatic pathways for stabilization — STOP creates psychological space, while TIPP supports your body in returning toward balance.

Use these skills to get through a situation without making them worse:

short term
when you’re feeling an emotional tsunami
when all you can is STOP yourself from doing something destructive
when all you can do is know what NOT to do
when you can’t think of anything positive to do
to help you survive a crisis situation without making things worse
to help yourself survive terrible psychic pain
to quiet your fight or flight response.
when things feel unfair and all is stacked against you
when you feel overwhelmed and stuck in bad feelings
get through the next moment without self-harm
get through the next moment without super put-downs of yourself

The initial step in developing the ability to tolerate distress is understanding that pain and suffering are inherent aspects of life and cannot be avoided or eliminated. Learning to distance yourself from the situation and refraining from judging yourself and others for their reactions aids in navigating through the immediate crisis.

The STOP Skill: Creating Space Between Emotion and Action

STOP Skill

STOP

is used when you feel as if your emotions are swamping you and are about to take control. STOP is a mnemonic to help you through an emotional tsunami.

S Stop. Picture a picture a big STOP sign in your mind. Freeze before you act without thinking.

T Take a step back from the situation. Take a deep breath before reacting. Let the oxygen help your body slow down. Give yourself some time to think about things. Yelling back at someone might be your first response, but maybe not the best one.

O Observe. Take a look around at what is actually going on, assess how you are feeling and what you are thinking. Assess what others are doing and saying. Gather relevant facts before acting or jumping in verbally.

P Proceed Mindfully. Before acting or speaking, be mindful o you response, not impulsive. Think: What do I want is from this situation? What are my goals? Which choice will make things better or worse? Can I postpone a discussion until later? Would that be a better choice and help get me what I want in the long run?

The TIPP Skill: Calming the Body When Emotions Spike

TIPP Skill

TIPP

is a mnemonic to help you when you feel stuck in an emotional tsunami. TIP skills act your nervous system and change your body feelings to help unstick your emotions.

T Temperature. Cold water on the face or ice on your wrist for 30 seconds increases the body’s relaxation response and can even set off our dive reflex. In particular, putting cold water on your face stimulates the diving reflex. Th diving reflex is caused by stimulating the vagus nerve, which innervates your facial muscles and innervate down into all your organs. It triggers your body’s response to submersion in cold water which slows your pulse and relaxes your body in order to conserve energy.

I Intense aerobic exercise. 20 minutes of intense exercise increases endorphins thus increases positive emotions

PP Paced breathing, paired muscle relaxation. Slow breathing for 30 seconds and/or muscle relaxation for 40 seconds increases your relaxation response

Learning a skill takes time

The steps to learning such skills are:

learn them in a group or with a private therapist
practice the skill as homework and
then slowly integrate the skills into use in real-life situations
which means being able to use them when under stress
be kind to yourself
remember to come to a place where you can tolerate and survive a crisis while accepting in a non-judgmental way, oneself and one’s situation

Building a Life Worth Living — Even During Painful Moments

STOP and TIPP remind us that healing doesn’t begin by forcing emotions away — it begins by creating safety in the body and space in the mind. These skills are small, practical steps toward building a life worth living, even when pain is present. When combined with a holistic approach that honors emotional health, nervous system regulation, and personal meaning, distress tolerance becomes part of a larger path toward healing. You can learn more about this integrated approach in my Integrative Mental Health framework.

Remember, developing your emotion management skills doesn't require perfect conditions. It’s about bringing gentle awareness to the present moment, even in the midst of daily routines, and interrrupting and stopping a 0 - 60 response. By practicing these simple techniques, you nurture your own well-being.

If you need some more support developing a more mindful approach to your emotional journey, don't be afraid to reach out. Kathy Morelli, LPC, is currently accepting new clients and only practices using the HIPAA-compliant app called Doxy.me. Kathy accepts most insurance plans.

Please contact Kathy via her Psychology Today profile.

References:

Linehan, M. (2014). DBT Skills Training Manual (Second Edition). New York: The Guilford Press.