Runfan YangAmidst the familiar sunshine of a normal day, perhaps over the steam of the comforting ritual of coffee, everything suddenly falls silent and a rush of memories flood in. What once seemed trivial, resolved, or even suppressed surges back. The familiar surroundings became overwhelming, like being caught in a whirlwind on a carousel. The spin quickens with every breath and the distress mounts beyond control. It’s a frantic race with no end in sight. A little voice rushes, yelling to stop the chaos, but how does one stop something when they can’t even trace it back to its origin?
Intense emotions greet you before you even recognize its presence. The hypothalamus of the brain receives the distress and sounds the alarm, setting off the cascade of stress hormones like norepinephrine and epinephrine that courses through the bloodstream. The beating of your heart is the only sound you can hear. You start to feel the heat rise in your cheeks and the tension gripping your limbs. As the surroundings blur, vivid imagery floods your mind until it’s all you can see. This sensation is not just psychological; emotion equally manifests as a physical sensation.
The heightened bodily response fuels the rush of thoughts, driving them forward until they exhaust themselves. In these instances, employing tools of distress tolerance, frequently utilized in dialectical behavior therapy (DBT), can assist in fostering clear thinking and effective problem-solving. In this article, we introduce a collection of DBT distress tolerance skills known as “TIPP”, standing for four techniques: tip the temperature, intense exercise, pace breathing, and paired muscle relaxation. Together, they offer a lifeline in the throes of overwhelming emotion. Though they may seem simplistic at first glance, these seemingly basic actions catalyze the physiological shifts that anchor us, preventing us from being swept away by the tumultuous currents of our minds.
Tip the temperature of one’s face with cold water for 30 seconds. Hold your breath and submerge your face into a bowl of cold water, or gently press a cold pack against your eyes and cheeks. Maintain this position for 30 seconds, ensuring the water temperature remains above 50°F (10°C).
Distress often induces hyperthermia, and emerging research suggests that stress-induced “hyperthermia” may be psychogenic fevers instead. Conventional fevers caused by infection or inflammation involve the release of inflammation mediator Prostaglandin E2 from the hypothalamus. In contrast, stress activates the sympathetic adrenal-medullary system, preparing the body for vigorous physical activity. In response, core body temperature increases through active adrenergic receptors and promotes vasoconstriction. This non-shivering thermogenesis conserves heat and balances the heightened energy expenditure.
When stress strikes, submerge your face in cold water or apply a cold pack to your eyes and cheeks. The sudden cold stimulus stimulates the vagus nerve, which connects the brainstem and spinal cord and runs through the face and thorax. Activation of the vagus nerve drives the parasympathetic nervous system, acting as a brake to promote the “rest and digest” response and calms the body. This results in a reduction in heart rate, respiratory rate, and blood pressure, counteracts the effects of psychogenic fever, and slows the sensation of spinning surroundings. Furthermore, the external evaporation of water absorbs heat, aiding in cooling the body.
Exercise intensely for a short while. Engage in activities that help release your body’s pent-up energy for a brief period. You can achieve this by running, brisk walking, jumping, playing basketball, or lifting weights.
The “fight or flight” response begins with the release of adrenaline from the adrenal medulla in response to distress. The release of adrenaline discharges almost the entirety of the sympathetic system simultaneously. The shrouding insecurity spreads throughout the body, increasing arterial pressure and metabolic rate while blood flow to nonessential organs decreases to conserve energy. Cortisol is concomitantly released into the bloodstream, mobilizing glucose from storage to fuel energy production and maintaining the body in a state of high alert.
To alleviate heightened alertness, physical activity such as exercise can help diminish the “fight or flight” response. When feeling emotionally charged, participating in brief yet intense exercise sessions expend excess physical energy. Interestingly, even without distress, intense exercise under normal emotional states can elevate cortisol levels to meet increased metabolic demands. Intense exercise upon stress accommodates the release of cortisol as part of the body’s stress response while also promoting the adaptation of hormonal responses. Additionally, blood flow redirects to active skeletal muscles upon exercise to increase cardiac output and release “feel-good” neurotransmitters such as dopamine, serotonin, and endorphin. These endorphins bind to opioid receptors, stimulating the dopamine reward system and eliciting feelings of pleasure and well-being.
Paced breathing. Breathe deeply into your stomach, slowing down the pace of both inhaling and exhaling. On average, this should reach a rate of five to six breaths per minute. Focus on exhaling more slowly than inhaling. There are several paced breathing exercises available, and beginners may find it helpful to count their breaths to better grasp the skill.
Paced breathing is widely embraced for recentering the mind and body during periods of distress. Paced breathing, with its varying rhythms chosen according to personal preference, emphasizes the deliberate slowing and regulation of breathing. These slowed breathing techniques typically occur at a rate of about 4-10 breaths per minute, compared to the normal respiratory rate range of 12-16 breaths per minute. Despite being a fundamental process that people do every second throughout their lives, breathing is a complex interplay of essential functions and is crucial to govern various bodily systems. Tidal breathing, the natural inhaling and exhaling during relaxation, involves the coordinated motion of respiratory muscles. The contraction of the diaphragm flattens it, causing the lower ribs to move upwards and downwards, while other respiratory muscles expand the ribcage and raise the chest. Changes in transdiaphragmatic pressure and ventilation of the lungs facilitate the exchange of pulmonary gas. When the diaphragm returns to its resting state, the lungs deflate to expel the air and prepare for the next tidal breathing. During paced breathing, to maintain minute ventilation homeostasis, as the respiratory rate decreases, tidal volume increases, and respiratory muscles become more active. The increase in oxygen flow through the lungs corresponds with a decrease in overall cardiac output. Notably, paced breathing is particularly beneficial for enhancing ventilation in patients with chronic heart failure and hypertension, resulting in improved exercise performance.
Paired muscle relaxation. As you breathe deeply into your stomach, gently tense each muscle group of your body one at a time (avoiding overexertion to prevent cramps). Notice the tension in your body, then exhale and release it. Pay attention to the contrast in your body as you relax each muscle.
Muscle tension and relaxation are often paired with paced breathing. Consciously tensing muscles while inhaling and releasing tension while exhaling aids in relaxation. Regulated muscle relaxation prompts the body’s relaxation response, countering the physiological effects of stress. When paired with paced breathing, this dual approach reduces heart rate, blood pressure, and cortisol levels, fostering a calmer state of mind.
In moments of unforeseen turmoil, when the world seems to dance on the edge of chaos, it’s natural to feel overwhelmed and spent. Yet, even within the tempest’s fury, there exist tools to anchor us and guide our passage through the storm. Though our minds may seem the architects of our distress, they also hold the key to finding our way back to calmness. Adjust our breathing, immerse ourselves in cold water, and tune into the tension and relaxation through every fiber of our being… we tap into the deep connection between our physiological and psychological selves. They are both of us, woven together, sometimes entangling us in distress, yet ever guiding us through the night.
* More distress tolerance and emotion regulation skills can be found here via Counseling and Psychological Services at University of North Carolina.
Peer Editor: Yexinyu “Yolanda” Yang