TIPP Skill (Temperature, Intense exercise, Paced breathing, Progressive relaxation)

A four-component protocol for the rapid lowering of arousal and physiological stress. It works through direct activation of the parasympathetic nervous system. Cold water on the face triggers the dive reflex and lowers heart rate by 10–25% in 1–2 minutes. Intense exercise redirects energy. Paced breathing with a long exhale activates the vagus nerve. Progressive relaxation lowers muscle tension.

Step-by-step guide

1. T — Temperature: lower the face into cold water (0–15°C) or apply ice to the neck for 30–60 seconds
2. I — Intense exercise: 20 minutes of fast running, push-ups, or jumps (if health allows)
3. P — Paced breathing: inhale on a 4-count, exhale on 8 (or longer); 5–10 minutes
4. P — Progressive muscle relaxation: tense the muscles for 5 sec, release for 10 sec; work through the body

When to use

• In a panic attack or hyperarousal — first choice
• In a suicidal crisis — to lower arousal before further work
• In a self-harm urge — for an emergency drop in intensity
• In an aggressive impulse — physical discharge of energy
• In a session before emotional work, if the client is in panic

Key phrases

Follow-up questions

Alternative phrasings