4 Steps to Help Teens Reset When Experiencing Emotional Distress

Editor’s note: This article was sponsored by Seattle Children’s Hospital.

When teenagers in group therapy experience an emotional crisis, Seattle Children’s counselors have a clear plan of action: Get a water bottle filled with ice.

The teen might hold a handful of ice, or circle a cube under their eyes or the back of their neck. Then, they’ll intensely exercise, running in place or doing jumping jacks for another minute. That’s followed by a breathing exercise and, finally, muscle tensing and releasing. If the teen is reluctant, asking if they are willing to try something for four minutes can help.

This four-step strategy can not only ease someone’s emotional distress, but also prevent any potentially harmful impulses that might arise, says Runa Pitoitua, a mental health therapist associate in Seattle Children’s Partial Hospitalization Program. Practicing these skills can be helpful for teens at home, too, giving them a vital tool for tolerating distress.

“You’re doing something to help pass the time so you don’t do something that will make the situation and yourself feel worse,” Pitoitua says. “These strategies aren’t made to make you feel amazing; they’re meant to distract you so that you don’t act on some of the urges you might have.”

The four steps of TIPP

TIPP is a handy acronym for the four steps that can reduce extreme emotional distress: temperature change, intense exercise, paced breathing and progressive muscle relaxation. Each step is practiced for one minute.

The first action aims to lower someone’s body temperature, cooling down their systems, and slowing their racing pulse and breathing. This initiates the divers’ reflex that all mammals experience in cold temperatures.

This can happen in various ways, from putting one’s face in ice water to rubbing an ice cube under the eyes, or along the back of one’s neck.

“First you slow down your heart rate and now you’re going to get it back up,” says Claire Stepherson, a mental health therapist at Seattle Children’s who works with teenagers experiencing suicidal thoughts and self-harming behaviors.

Increasing the heart rate can come from a variety of physical activities such as jogging in place, push-ups or a high-energy dance sequence. Next comes the paced breathing. This refers to a repeated pattern of breathing in, holding the breath and then slowly exhaling. The final act involves a progressive muscle relaxation in which someone will tighten a muscle group for about four seconds, then release it. A teen might start with curling up their toes, then move to their calves, thighs, core and arms before tensing and releasing their full body.

TIPP buys valuable time

TIPP is designed for people who are experiencing a 9 or 10 out of 10 on an emotional intensity scale where 10 is the most intense. Often, they’re so overwhelmed with emotions that they’re not able to think rationally. TIPP provides a temporary strategy to make it through that distressful time. While many teens report the exercise itself is helpful, others might say they feel the same afterward and question the effectiveness. That doesn’t mean TIPP didn’t achieve its key purpose, though.

“Even if you feel the same, you just bought yourself four minutes of not following through with self-harm,” Pitoitua says.

That’s because the most intense emotions only last so long. Think of the emotional trajectory as a wave. While some people might stay at the crest for longer than others, that wave ultimately breaks. If someone is still feeling a level 9 or 10 after one round of TIPP, they can keep practicing the sequence until they experience that inevitable emotional dip.

“Regardless of how long you stay at that intensity, our bodies won’t allow us to stay at 10 out of 10 forever,” she says.

Once a teen reports a 7 or 8, they’ll have more capacity to employ other coping strategies in distress tolerance, such as accepts, improve or self-soothe. At lower emotional levels, people can more easily describe and observe their feelings, through mindfulness and emotional regulation skills or “walk the middle path,” an approach for avoiding extreme thinking.

Practice TIPP before crisis hits

Introducing strategies like TIPP are often most effective when practiced well in advance of an emotionally charged situation. Parents could model the four steps for their teens, and even practice together in a calm moment. Stepherson likens TIPP practice to a fire drill.

“We practice safety protocols when we’re not in crisis,” she says. “We don’t wait until there’s a fire.”

That way, the tools are already familiar when your teen most needs them. A common scenario might be a teen who already feels stressed during the school day, plagued by friend conflicts and a sense of falling behind. They might be at a level 5-to-7 at school, but home life — and the extra requirements of chores and homework — might tip them into the 9-to-10 zone.

“They’re coming home and there are other pieces to add onto their plate and they feel: ‘I just can’t do this,’” Stepherson says. “You’re trying to get that time to pass, for the emotional intensity to go down.”

If your teenager refuses to try TIPP, meet them where they’re at, Pitoitua says. That might mean simply being present and silently sitting with them. You might also provide validation that what they’re experiencing is hard, and create space to process those feelings. While it’s most effective to practice all four TIPP steps together, even one of the steps can be helpful, she added.

Changing thought pathways

Using TIPP does more than deescalate an intense moment, Seattle Children’s experts say. When people regularly practice TIPP, it gives them a different roadmap for emotional intensity — and where it leads. Individuals start to understand how to wait out the wave of high emotions and let self-harming urges pass.

Ultimately, the practice increases an individual’s skill set, and helps deal with life stressors in a healthy and productive way.

“It’s effective to see that time passes and the situation hasn’t gotten worse,” Stepherson says. “That’s data that you can tolerate uncomfortable feelings and problems. Pain is a part of life.”

Parents, caregivers and others should also ask directly if their child or teen is thinking about suicide. While it might feel hard to ask, it is important. Learn how to ask and what to do with the answer. 

How to make a distress tolerance box

While Seattle Children’s mental health team uses TIPP with teenage patients, overwhelmed children of all ages may benefit from a distress tolerance box. Make a box in advance to help provide healthy coping options during times of the most intense emotional distress.

1. Find a space to store the tools, such as a shoebox, backpack or dresser drawer.
2. Fill the space with objects that appeal to your child’s five senses, such as an art pad and supplies, favorite music, clay, photos, scented soaps or lotions, origami paper, or a jigsaw puzzle.
3. Use the box only when your child feels overwhelmed with emotions.