perature (cold water), I ntense exercise, P aced breathing, and P aired muscle relax -
ation. (Note that there are two P skills, although there is only one P in TIP.) There are also handouts on individual TIP skills as listed below. Distress Tolerance Work -
sheet 4: Changing Body Chemistry with TIP Skills covers all the TIP skills and can be used to track your practice.
••Distress Tolerance Handout 6a: Using Cold Water, Step by Step. This hand -
out goes over how to use cold water to reduce emotional arousal quickly.
••Distress Tolerance Handout 6b: Paired Muscle Relaxation, Step by Step. 
Paired muscle relaxation is the pairing of relaxing your muscles with breathing out. 
The idea is to practice combining the two enough so that relaxing when highly emo -
tional becomes easier and sometimes even automatic as you breathe out. This hand -
out describes in detail how to practice paired muscle relaxation. To track your prac -
tice of this skill, use Distress Tolerance Worksheet 4a: Paired Muscle Relaxation.
••Distress Tolerance Handout 6c: Effective Rethinking and Paired Relaxation. 
This is a method of combining rethinking what you are telling yourself with paired 
relaxation to bring down emotion rapidly in moments of high stress. To track your practice of this skill, you can use Distress Tolerance Worksheet 4b: Effective 
Rethinking and Paired Relaxation.
••Distress Tolerance Handout 7: Distracting. Distracting methods work 
by reducing your contact with whatever set off the distress or its most painful 
aspects. The methods are listed on this handout and can be remembered with the