Helping Your Child Use TIPP Skills: DBT Calming Games for Parents and Carers of Under-13s

DBT · DBT · Practice-informed

A short guide written to parents and carers rather than the child, turning three of the four TIPP skills into games that suit children under 13: the Fast Feet Game for intense exercise, Smell the Flower, Blow Out the Candle for paced breathing and Robot and Rag Doll for muscle relaxation paired with the breath. Each game has three numbered steps and a count. The temperature skill is deliberately left out at this age, with a plain explanation, and caregivers are asked to notice which game works best and bring that back to therapy.

Underlying mechanism: DBT Distress Tolerance Adapted for Children: Caregiver-Led TIPP Games

What it helps with

  • Giving younger children a way to calm a very big feeling that is modelled and practised with a caregiver, not done alone.
  • Translating DBT distress tolerance into play without adding a temperature skill that is not appropriate for younger children.
  • Helping parents and carers rehearse the skill at home during calm moments, so it is familiar when a big feeling arrives.
  • Bringing the caregiver's observations back into session to tailor the approach.

How clinicians use it

  • Model each game in session with the caregiver and child together before sending the guide home.
  • Check for any heart or other medical condition before recommending the running and jumping game.
  • Ask the caregiver to note which game the child responds to best and review it at the next session.
  • Present the games as teaching tools built on validated skills, not as separately trialled interventions.

Clinical Implementation Guide

  1. Model every game in session with the caregiver present.
  2. Practise at home during calm moments first, never for the first time mid-meltdown.
  3. Leave all temperature-based skills out for this age group.

What the worksheet looks like

Helping Your Child Use TIPP Skills — worked example
GameTIPP Skill It Builds
The Fast Feet GameIntense exercise: jump or run on the spot while counting to 60 together
Smell the Flower, Blow Out the CandlePaced breathing: a slow breath in, an even slower breath out, five times
Robot and Rag DollPaired muscle relaxation: stiff on the breath in, floppy on the breath out

Clinical cautions

The cold water and cold pack skill is not included for children under 13. The games themselves have not been evaluated by name in a controlled trial; they translate skills with a broader evidence base. Ask the child's therapist or doctor before using the running and jumping game if the child has a heart or other medical condition. This tool does not diagnose any condition and is not a substitute for individual face-to-face therapy or for emergency crisis support. Anyone in immediate distress should contact their local emergency service or crisis line.

References

  1. Linehan, M. M. (2015). DBT skills training handouts and worksheets (2nd ed.). Guilford Press.
  2. Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. Guilford Press.
  3. Lundström, A., Karlsson, M., Rydberg, A., & Wiklund, U. (2025). Assessment of arrhythmias and heart rate response in healthy adolescents performing face immersion and body submersion in ice-cold water. Physiological Reports, 13(13), e70430.

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TIPP Skills

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