Understanding Emotion Regulation Challenges in ADHD (plus a DBT skill to better manage emotions)
If you have ADHD, you've probably experienced moments when your emotions feel overwhelming—frustration that boils over, rejection that stings more than it should, or anger that erupts before you can stop it. Here's something that might surprise you: these intense emotional experiences aren't a personality flaw or a sign of poor self-control. They're actually a core feature of ADHD that doesn't get nearly enough attention.
As ADHD specialists here in New York City, we were recently reminded in a training just how significant emotion regulation challenges are for people with ADHD. Yet so many people—including those living with ADHD themselves—don't realize this connection exists. That gap in understanding often leads to harmful labels and unnecessary stigma.
Let me walk you through why emotion regulation is so difficult when you have ADHD, and more importantly, share a powerful skill from Dialectical Behavior Therapy (DBT) that can help you manage those intense emotions in real-time.
Why ADHD and Emotion Regulation Challenges Go Hand-in-Hand
Think about what ADHD affects: executive functioning. These are skills that help us manage impulse control, planning, decision-making, and many other crucial tasks. Now think about what it takes to regulate your emotions effectively. You need to assess a situation clearly, resist the urge to react impulsively, plan an exit strategy if things get heated, and make thoughtful decisions about how to respond.
See the problem? The very brain functions that ADHD impacts are the same ones we rely on to manage our emotions.
When you have ADHD, you might experience:
Intense frustration that feels impossible to contain
Overwhelming sadness that crashes over you
Anger outbursts that seem to come out of nowhere
Profound sensitivity to rejection (which could be Rejection Sensitivity Dysphoria)
Feeling completely overwhelmed by tasks or situations
Take a deep breath… these aren't character defects.
The Stigma Problem: When Emotion Regulation Gets Mislabeled
Here's where things get particularly frustrating. When people observe someone with ADHD struggling with emotions, they often jump to the wrong conclusions. They might describe that person as "short-tempered," "having no frustration tolerance," or just being "irritable" or "snappy."
These judgmental labels miss the mark entirely. They suggest a choice or a character flaw when the reality is that emotion regulation challenges are often beyond someone's control in that moment.
On the flip side, emotion dysregulation sometimes gets misattributed to other mental health conditions entirely—like Borderline Personality Disorder or Bipolar Disorder. While emotional challenges can certainly be part of those diagnoses too, overlooking the ADHD connection means people miss out on ADHD-specific strategies that could genuinely help.
In this brief article, I wanted to bring this fact about ADHD to the forefront. Now on to the bonus - a DBT skill to help you manage emotions.
A DBT Fan Favorite: The TIPP Skill
While there are many emotion regulation strategies out there, I want to teach you one specific skill that our clients with ADHD have found incredibly helpful: the TIPP skill from Dialectical Behavior Therapy.
The TIPP skill comes from the distress tolerance module of DBT, which focuses on tolerating difficult emotions and intense feelings. What makes this skill particularly valuable for people with ADHD is that it works on a biological level—it's not about forcing yourself to "think positive thoughts" or cognitively reframing the situation. Instead, it directly impacts your nervous system to help you regulate.
TIPP is an acronym that stands for:
T-emperature
I-ntense Exercise
P-aced Breathing
P-aired Muscle Relaxation
When to Use the TIPP Skill
Before I break down each component it is important to know that the TIPP skill is to be used mainly for distress tolerance. In other words we do not need to use this skill consistently, everyday at the same time. Rather we want to use this skill in moments of distress. The hope is that we can keep our emotional state at bay or reduce the intensity rather than skyrocket form 0-100, making the situation much worse. Let’s dive in (no pun intended).
Temperature: Activating the Human Dive Reflex
The most effective way to use the temperature component is to submerge your face in a bowl of ice water. Here's how it works:
Fill a bowl with very cold water (add ice cubes if possible)
Hold your breath and submerge your face
Come back up for air
Repeat several times until you feel calmer and your heart rate has decreased.
What's happening biologically? This activates, what's called, the human dive reflex, which triggers your parasympathetic nervous system (responsible for calming you down) and decreases your sympathetic nervous system activity (the fight-or-flight response). You'll actually notice your heart rate slow down.
Now, I realize you can't always dunk your face in ice water, especially if you're at work or out in public. A less effective but still helpful alternative is to splash cold water on your face repeatedly. It's not quite as powerful, but it can still provide some relief.
Intense Exercise: Releasing Built-Up Adrenaline
This isn't about going to the gym or following a workout routine. This is about quick, intense bursts of movement that elevate your heart rate rapidly:
Jumping jacks
Running in place
Push-ups
Any movement that gets your blood pumping
The theory here is simple: when you're emotionally activated, you have adrenaline, a hormone, built up in your body. Intense exercise provides a release valve for that hormone rather than forcing you to hold it in (which doesn't work for anyone). This physical release helps tremendously
Paced Breathing: Slowing Down Your System
Paced breathing is straightforward but powerful:
Breathe in
Breathe out slowly (exhale should be longer than your inhale)
Repeat this pattern quietly for several minutes
As you continue this practice, you'll notice your body naturally begins to regulate. Your heart rate steadies, and you feel more in control.
Paired Muscle Relaxation: Grounding in Your Body
Think of this as a bonus technique that pairs beautifully with paced breathing. Here's the process:
Start at your head and tense those muscles
Hold the tension briefly
Release and relax
Move down to your facial muscles and repeat
Continue working through your entire body
This practice grounds you in your physical body and the present moment, rather than being swept away by overwhelming thoughts or emotions swirling around you. When combined with paced breathing, it's particularly effective.
How to Actually Use This in Your Life
The key to making the TIPP skill work for you is preparation. You can't expect to remember a new coping strategy in the heat of an emotional moment if you haven't planned ahead.
Identify Your Triggers
Most of us aren't surprised by what sets us off. You probably already know that your boss triggers you, or that your morning routine when you're running late sends you into overwhelm, or that certain social situations spike your anxiety.
Instead of being optimistically hopeful that "it won't happen next time," let's be realistic and prepare for it. Write down your main triggers. Talk them through with people you trust. The goal isn't to avoid all triggers (that's impossible), but to walk into triggering situations with a plan.
Prepare Your Tools
If you know ice water submersion works for you, keep ice cube trays stocked at home. Have a bowl designated for this purpose. If intense exercise is your go-to, make sure you have space to do jumping jacks, even in a small apartment.
Practice Ahead of Time
Don't wait until you're in crisis to try these techniques for the first time. Practice the TIPP skill when you're calm so your body learns the pattern. That way, when you really need it, it'll be familiar rather than foreign.
Why This Works So Well for ADHD
Our clients with ADHD are often skeptical at first about the TIPP skill—particularly the ice water component. It sounds strange, and let's be honest, it's not exactly comfortable. But here's what we consistently hear: once they actually try it, they find it remarkably helpful.
Why? Because it's impacting their biology directly. It's not asking them to "think differently" or "reframe the situation", instead, it works with their nervous system to create immediate, physical change.
The TIPP skill is actually one of the most popular DBT skills across the board (not just for ADHD), and it complements other DBT techniques beautifully.
Moving Forward: From Stigma to Strategy
Understanding that emotion regulation challenges are a legitimate part of ADHD—not a character flaw—changes everything. It shifts us from judgment to compassion, from criticism to strategy.
If you're someone with ADHD who's struggled with intense emotions, please know: you're not "too sensitive," "too reactive," or "impossible to deal with." Your brain is navigating emotion regulation with different tools than neurotypical brains, and that requires different strategies.
The TIPP skill is one evidence-based approach that can help. Give it a try. Practice it. Prepare for your known triggers. And remember: knowledge is power, especially when it comes to understanding your own neurobiology.
If you're in New York City and looking for ADHD-specialized therapy that truly understands these challenges, we're here to help. Our group practice focuses specifically on helping adults with ADHD develop practical strategies for managing emotions, productivity, relationships, and all the daily challenges that come with ADHD.
You deserve support that sees your struggles as neurobiological realities, not character flaws. That's the approach we take with every client who walks through our door.
