We can all likely relate to that moment wherein we feel that we have reached the limit of what we can tolerate. Our environment might be overstimulating, we feel panicked by anxiety triggers, or too many small things have gone wrong in a short space of time. When this happens, our heart starts racing and our breathing quickens as we progress into a fight or flight state of nervous system arousal. At this point, people’s well meaning advice telling us to “look at it differently” or “calm down” fails to land because our “thinking” brain (the part that is able to rationalise, use logic and control our self-talk) has effectively gone “offline” - like someone has disconnected the wifi. This is the space in which we have exceeded our window of tolerance - the threshold that divides the settled/calm space from that of intense emotional overwhelm. When this threshold has been crossed, we are governed by our “survival” brain, which allows our emotions, urges and impulses to control how we respond, rather than allowing us to slow down and think clearly. This experience is known as “hyperarousal”, and the key to getting our thinking brain back online is through our body. Dialectical Behaviour Therapy (DBT) has a set of skills built specifically for these moments, condensed into an acronym called TIPP, which is designed to regulate our nervous system by working through the body first. This post explores what happens in your body when you exceed your window of tolerance, and how each TIPP skill helps bring you back inside it.
What is the window of tolerance?
The window of tolerance is a term coined by psychiatrist Dan Siegel which describes the zone of arousal wherein you can feel things fully AND still think clearly. Inside it you might be sad, anxious or angry, yet you can cope with these feelings safely, make values-based choices and stay connected to and present within the environment around you. When we approach and exceed the top edge of our window, we enter the state of hyperarousal (overt emotion), whilst the bottom edge takes us down into a state of hypoarousal (shutdown state of numbness). Navigating hyperarousal requires its own set of skills (i.e., “upregulating” our nervous system back into our window of tolerance) , however, this post focuses on how to “downregulate” our nervous system (i.e., slowing things down and switching our thinking brain back online).
Both hyperarousal and hypoarousal are protective because our nervous system is doing what it is programmed to do when under threat. Unfortunately, when we are chronically out of our window of tolerance, we have little room for reflection, connection and the capacity to feel safe. Things like trauma, ongoing stress, poor sleep, vulnerability factors and neurodivergence can reduce our window of tolerance, making it easier to exceed our threshold.
What happens when you exceed your window of tolerance?
Within a fraction of a second of sensing threat, the amygdala (our brain’s smoke alarm) goes off, and the sympathetic nervous system (our fight/flight resonse) fires. Our body releases stress hormones like adrenaline, resulting in our heart race and blood pressure climbing, our breathing becoming fast/shallow and our blood shifts towards the muscles in our arms/legs (to help us either fight or run away). Whilst the amygdala is the alarm that triggers instantaneous reactions in our body, our HPA axis is more like a fire brigade in that it arrives slower, and it is our body’s longer-running stress system. The HPA axis releases another stress hormone called cortisol into our body over the coming minutes, leading to us feeling on high alert even once the stress alarm has stopped ringing and the trigger has passed.
Internally this can feel like panic, rage or an immediate urge/impulse to do absolutely anything to make the trigger stop. For many of us, we can notice an accompanying tight chest, clenched jaw, shaky or tingling hands or a drop in our stomach. The first adrenaline surge is fairly short-lived, whereas what keeps people stuck above the window is usually the loop that follows: replaying the trigger or bracing for it to return tells the brain that the threat is still active, which triggers our amygdala to send out a fresh alarm. The process of regulating our nervous system involves interrupting this loop for long enough that our parasympathetic nervous system (our safety/recovery system or “rest and digest” system), can take over.
What are DBT's TIPP skills?
TIPP comes from the distress tolerance module of Dialectical Behaviour Therapy, developed by psychologist Marsha Linehan for managing intense emotions, impulses and instability in relationships. TIPP includes a set of emotional crisis survival skills, designed for moments where emotions are so intense that nothing else feels effective to help manage them. This is known as reaching your “skills breakdown point”, and requires body-based, tangible techniques to help activate our parasympathetic nervous system.
The TIPP acronym stands for Temperature, Intense Exercise (or Intense Self-Soothing), Paced Breathing and Paired Muscle Relaxation.
So why is it that these skills seem to work when gentler strategies don't? During high arousal, a flood of stress chemicals turns down activity in the prefrontal cortex (the front part of our brain behind our forehead) which is responsible for planning, decision making and consequential thinking: hence the “wifi going offline” metaphor. As such, trying to reason with ourselves at this point is like trying to read a map whilst the car is skidding. TIPP is so effective in this scenario because it is bottom up (changing our physiology directly and lets our brain catch up), rather than top down (using thoughts to shift feelings).
This fits with a view of emotion that has gained a lot of support in the neuroscience space, which suggests that our brains are constantly reading signals from inside the body, such as heart rate, breathing, muscle tension and gut sensations and using them to work out how we feel: an inner sensing called interoception. Here, our pounding heart and shallow breath are interpreted as danger by our body, so if we can change these signals, we can effectively trick our brain into sensing safety rather than danger. Importantly, interoception is an experience that many neurodivergent people struggle with, which is one of the many reasons, alongside overstimulating environments, and social and emotional difficulties, that means neurodivergent people may be more likely to sit outside of their window of tolerance than their neurotypical counterparts.
T is for Temperature: the dive reflex
Of the four TIPP skills, this is one that can work surprisingly quickly.
How to do it:
Fill a bowl with cold water, inhale and hold your breath, then lower your face in so that the water covers the area around your eyes and nose, staying here for about 30 seconds. If a bowl isn't practical, holding a cold pack or a zip-lock bag of iced water over your eyes and cheeks while holding your breath can be just as effective. It is important to note that DBT guidance suggests keeping the water cold, though not below 10°C.
The reason this works to reduce hyperarousal and activate our parasympathetic nervous system is because it draws on something called the mammalian dive reflex. This is an old survival response that as humans we share with seals and other diving mammals. That is, cold water on our face in combination with held breath sends signals along something called our trigeminal nerve (our face’s messenger line) to our brainstem. This then signals to our vagus nerve (our whole body’s brake pedal) to slow down our heart rate. In addition to this, the blood vessels in our arms and legs begin o narrow and blood is redirected towards our heart and brain to conserve oxygen for the dive, resulting in this skill allowing our heart rate to drop noticeably within seconds. Because this is a natural reflex, it doesn’t require us to “think” our way into turning it on, but rather, it happens automatically. This is particularly important when our capacity to think clearly has been disabled by distress.
It’s very important to note that the location in which we receive the cold drop in temperature affects how our body responds. That is, cold on our face with a held breath triggers the dive reflex, whereas a sudden cold shock to our body, like an ice bath or cold shower, actually has the opposite effect: increasing our heart rate and sympathetic nervous system activation. As such, if we are already outside of our window of tolerance in hyperarousal, the latter is counterintuitive, so it is more useful to stick with the face.
I is for Intense exercise: giving our surge of energy an outlet
In hyperarousal, our body has already prepared for a fight or a sprint, and as such adrenaline is in our bloodstream and our muscles are primed. It is for this reason that sitting still and trying to relax when we are in this state can feel like revving an engine with the handbrake on. Intense exercise is a way to safely release this energy by way of something vigorous, such as running up and down the stairs, star jumps or a fast walk around the block. This gives our body what it was originally gearing up for in a safe, controlled way. A full workout is not a requirement here, but rather, any short burst of activity that gets our heart rate up is enough. Once we stop, our parasympathetic nervous system is called on to bring our heart rate and breathing back down, and a reduction in distress/emotional arousal is usually a handy flow on effect. Interestingly, through exercise, our body gets to finish a cycle of activation and recovery that was stuck looping halfway.
This is the only TIPP skill that starts by raising arousal by working with the surge before it settles it. As such, it can suit people who find sitting still with breathing exercises unbearable when they are overwhelmed.
Intense self-soothing as an alternative to exercise
Exercise isn't possible or appropriate in all circumstances, nor are all people physically able to exercise intensely. For these moments, Intense Self-Soothing can be an effective alternative which still aims to elicit parasympathetic nervous system activation.
Self-soothing is already a DBT distress tolerance skill, which involves using the five senses to create comfort and safety. The intense version of self-soothing used in TIPP turns the volume up to capture the attention of our nervous system fully. When we are in such an intense state of hyperarousal, something like a mild scented candle or soft pyjamas may not register, which is why the sensation must be strong enough to compete with the amygdala (smoke alarm) for our brain’s attention, whilst balancing comfort. Whilst exercise provides an outlet for our surge of stress hormones, intense self-soothing functions to flood our nervous system with signals of safety:
Deep pressure. Wrap yourself tightly in a heavy blanket, lie under a weighted blanket or ask someone you trust for a long, firm hug. Steady pressure on the body is widely linked with a shift toward parasympathetic calm, which is part of why swaddling settles babies.
Rhythmic movement. Rock in a chair or sway on your feet. Repetitive, predictable movement stimulates the balance system in your inner ear, and DBT counts movement and balance as a sense.
Strong, comforting smells. Smell is the one sense that reaches the brain's emotional centres, including the amygdala, without first passing through the thalamus (our brain's sensory relay station). A familiar, well-loved scent held close, like a partner's jumper or a favourite essential oil gets to our alarm centre fast.
Singing loudly. Put on a song you know by heart and sing along at full volume. Singing forces long, controlled exhales, and the muscles of our voice box are supplied by branches of the vagus nerve (our brain’s brake pedal).
Warm water. A shower or bath that's comfortably warm eases muscle tension and signals rest. This is the opposite of the cold shower warning in the temperature section, since warmth on the body soothes whilst a sudden cold shock alarms.
It’s useful to plan these ahead by choosing one or two options that suit you and keep what you need within easy reach. We want to ultimately minimise the amount of thinking and decision making we need to partake in when our thinking brain is offline.
P is for Paced breathing: the power of an exhale
Breathing advice is often offered as a standard strategy for anxiety, leading to it feeling generic and sometimes ineffective. What differentiates breathing in TIPP is the effectiveness of our out-breath in calming us down.
Our hearts beat at varied rates, speeding up when we breathe in and slowing each time we breathe out. On our exhale, the vagus nerve applies a gentle brake to the heart, so making our exhale longer than our inhale allows us to spend more of every breath with this brake on. For best results, DBT suggests being mindful of breathing pace, slowing down to approximately five or six breaths per minute (for example: breathing in for a count of 4-5 seconds, holding, then out for 6-8 seconds). Research has continuously concluded that slow breathing causes our heart rhythm and breath to fall into sync, and our heart rate variability to increase, which are all markers of a healthy, flexible nervous system.
P is for Paired muscle relaxation
This skill allows us to connect the benefits of paced breathing with the release of tension in our muscles. Begin by breathing in and firmly tensing one muscle group, such as your hands or shoulders, for 5-10 seconds. Allow yourself to notice how the tension feels before exhaling whilst letting the muscle tension go, pairing this with a cue word like “relax” or “soften”. This works because ongoing stress keeps our muscles slightly braced, often beyond our conscious awareness, so by clenching intentionally then letting go we give ourselves a sense of control over what this difference feels like. Secondly, by pairing the release of our exhale, muscle relaxation and cue word, the links between each of them gets stronger. As such, with time, the word on its own can begin to bring a conditioned sense of settled calmness, allowing us to bring this out at any moment without anyone noticing.
Paired muscle relaxation is also particularly effective for sleep, as it allows our body and brain to simultaneously slow down, signalling to our nervous system that we are safe enough to drift off into sleep. Similarly, yoga as a practice combines paced breathing and paired muscle relaxation, alongside intense exercise, which are just some of its many benefits for our nervous system.
Putting it together: strategies for downregulating the nervous system
It’s important to note that we do not always require all four skills in conjunction with one another in every moment of distress. Instead, it can be useful to notice how far outside of our window of tolerance we have travelled, sometimes by placing a number or colour on the level, then working out way back down incrementally. For example:
Intense distress/complete crisis point. We might be shaking, panicking, teary, or can't think at all. In this instance, we can start with temperature or intense exercise because both act directly on the body and ask almost nothing of our thinking brain. Temperature slows the heart by reflex, whilst exercise burns through the surge of nervous energy so that recovery can begin afterwards.
Still high, but some thinking is returning. Here it may be useful to shift to paced breathing, as our heart rate is already easing, and a long exhale keeps the vagal brake engaged to steady us.
Close to the edge of our window. Here it may be useful to try paired muscle relaxation to release the tension our body is still holding, often in the jaw and shoulders.
Back inside the window. Here other skills become available again, like checking the facts or reaching out to someone we trust.
We can think of this as like a ladder down. That is, trying slow belly breathing from the very top can feel like it fails, resulting in people abandoning this as a skill and concluding that breathing “doesn't work for them”. Instead, it may have been that they were on the wrong rung of the ladder, and their nervous system actually required a different skill at that time. Temperature or intense exercise first can make breathing not only easier, but more effective in soothing our distress and providing us with noticeable relief.
Using TIPP skills safely
Check with your GP first before trying the cold water technique if you have a heart condition or a low resting heart rate, take medication that affects heart rate (beta blockers, for example), or have an eating disorder. The dive reflex has a real effect on the heart, and as such, it is important to practice it safely. The same goes for intense exercise if a health condition limits how hard you can push yourself.
Practise when you're only mildly stressed first. Trying skills for the first time whilst we are mid-crisis can backfire, and as such, we should aim to familiarise ourselves with how to do them when we are closer to our window of tolerance first, so our body already knows the routine when we actually need it.
Treat TIPP as a reset. TIPP brings us back into a state in which we can think, use other skills or reach out to someone. The trigger might still be there, and as such, we may be able to explore this in longer term therapeutic work alongside building your distress tolerance.
Get help if you need it. If you're in crisis or worried about your safety, call Lifeline on 13 11 14, or 000 in an emergency.
The term felt sense comes from philosopher and psychologist Eugene Gendlin. He used it to describe the body's wordless knowing about a situation, the kind of thing we can sense before we can name it. TIPP sits alongside this idea, as each of these skills asks us to tune into what is happening beneath the words. Each time we use a skill to find our way back into our window, our nervous system collects evidence that we are capable of coping with distress, and these experiences can eventually accumulate to widen our window of tolerance. Whilst this may not widen overnight, repeated experiences of regulation teach our body that emotional intensity is survivable.
At The Felt Sense Counselling, we draw on DBT alongside approaches like schema therapy and EMDR to help people understand and regulate their nervous system and build skills that fit their needs. If you'd like support working with intense emotions, get in touch for a free 15-minute chat.
