“Patients in distress are often hijacked by their emotions,” explains Judith Margolin, PsyD, Clinical Director of the Women’s Program at Penn Medicine Princeton House Behavioral Health. “In that moment, they may not have the necessary skills to help regulate their emotions, or they may be unable to use them. The goal is to move them back into their window of tolerance—the zone in which they can think clearly, be aware of their feelings, and function most effectively.”
Opening the Window of Tolerance
As part of a dialectical behavior therapy (DBT) approach, therapists at Princeton House’s partial hospital and intensive outpatient Women’s Program often use “TIPP” tools to return patients to their window of tolerance. TIPP stands for:
- Temperature—Cooling the face activates the parasympathetic nervous system to stimulate a “diving response” that slows the heart rate and can change emotion quickly. Splashing cold water on the face, taking a walk in the cold, or even pressing a frozen orange to the face can help.
- Intense exercise—Going outside for a rapid walk or going to the gym (with cognizance of moderation in certain patients) can provide distraction, physical and emotional benefits, and a return to the window of tolerance.
- Paced breathing—Deep, slow breathing slows down the body while promoting mindfulness.
- Progressive muscle relaxation—Tightening and releasing muscle groups throughout the body increases awareness of where tension is being held, and allows for a release.
“Once patients are out of the red zone, they reach a place where they can respond differently and then begin to problem-solve,” says Dr. Margolin.
Coaching Services an Added Benefit
At Princeton House, women in the DBT program have access to coaching on these skills throughout the therapy day as well as during evening hours.
If a patient feels dysregulated during program hours, therapists trained in milieu coaching are accessible for a 5- to 10-minute one-on-one coaching session to discuss what distress tolerance skills might work best in the moment. Likewise, in addition to a 24/7 crisis hotline, DBT patients can call a dedicated phone line weekdays from 7 to 9 p.m. for similar coaching assistance.
“Fears, negative beliefs, and trauma are all factors that can pull someone out of the window of tolerance,” adds Dr. Margolin. “To help patients stay in or even widen that window, we provide training in distress tolerance skills while also teaching mindfulness, emotion regulation, and interpersonal effectiveness. The intent is to help our patients in ways they can generalize to their everyday environment and use as effective tools moving forward.”
For more information about the Women’s Program at Princeton House, visit princetonhouse.org/women or call 888.437.1610.
Article as seen in the Spring 2018 issue of Princeton House Behavioral Health.
