The DBT skills manual includes a section on distress tolerance, and one of the skills noted is TIP, or Temperature, Intense Exercise, and Pressure breathing. The nuclear weapon of distress tolerance is ice water. Nothing – no thought, emotion or body sensation can withstand it.
Place a large bowl with ice on your kitchen counter, island or table. Fill a pitcher with water and have a hand towel nearby. Fill the bowl with water and allow the water to get very cold.
Now, put your face in the ice water. 20 seconds max please. I don’t use a timer or anything, because when my mind (and your most likely) “reboots” the very first thought/urge will be to get your face out of the water because it’s freakin’ COLD! And it hurts. Notice this urge but don’t give in to it. Wait a beat or two and then CHOOSE to remove your face from the water.
The next thing to load is the urge to grab the towel and dry off your face. Again, wait a beat and then choose to dry your face.
Now, notice what loads next. This is your Wise Mind being very aware of your thoughts, emotions and urges. If what is loading is unwanted it is much easier to dismiss it. I learned this from a patient who used a hand gesture much like a dismissal, shooing the unwanted emotion away. And it didn’t come back.
Try this. Don’t worry about the “mess” or whatever – it’s water… I look forward to your observations!
Stephen Marks LPC, CPCS 
When I first heard the explanation and usage of this method I thought to myself yes, the next time I am having a panic attack the first thing I’m going to think about is dunking my face into ice water. Well of course not. And after milling over the idea the rest of Monday and the majority of Tuesday, I decided tonight just to try it and see if anything happened. Not expecting but experiencing. I felt anticipation but not the kind that invokes dread. And it was almost like casting a spell because the necessary items have to be gathered and assembled. To be honest I had the knee-jerk reaction of immediately removing my face from the water, possibly because I have a severe dislike of being immersed but primarily because it was just damn cold. And after stopping, STOP… I took a breath and reminded myself that I was in control of the situation and was not going to drown. Although I was only in the water long enough to slowly exhale through my nose I was still very proud of the second dunk and prouder still when I did not immediately clasp the towel to my face. But nothing happened. In fact it was the first time that I had ever noticed my mind being completely devoid of any thought, absolute quiet. So as I sit here contemplating the addictive properties of absolute quiet I wonder if one could be desensitized to this radical wonderful therapy?
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What a great recounting of the experience! “Casting a spell…” Love it! I have been of the opinion that this is not a practical tool to use when severely disregulated as it takes too much doing. However, I have had patients who keep a bowl of ice, a pitcher of water and a towel on the counter just in case. Proved very effective, although many accounts include making quite a mess dumping the water into the bowl.
As far as desensitization, I would imagine that of course you can over-do it and have it be less effective (if at all.) However, as a re-boot it is quite useful – what I like is the concept that once you have experienced the very noticeable quiet you can recall it from memory. Without the mess… I use the STOP skill (Stop, Take a breath, Observe, and Participate on purpose) for pleasant events too.
There are many Mindfulness (meditative) practices that you can use to experience a quiet(er) mind – try the breathing skill from a previous post and let me know. Thanks for the response!
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