Emotional CPR as a Way of Life

by Lauren Spiro, Leah Harris & Dan Fisher

Emotional crisis can happen to anyone, at anytime. But how many of us are equipped with the skills to support a friend, loved one, co-worker, or even a stranger through a crisis? Actually we all have an instinctive capacity to help others through crises, but just need to gain the skills and confidence to do so.

Many of us are taught to fear the expression of strong emotions, and to hide or suppress big feelings. We have also erroneously been taught that only specially trained people or “professionals” are equipped to handle these experiences. But people knowledgeable in conventional treatment often aren’t exposed to community-based, holistic, common sense, person-to-person approaches. Many people have gained wisdom and resiliency by working through emotional distress, and it is helpful to do this with someone who understands the growth potential in these experiences.

Emotional CPR, a public health education program of the National Coalition for Mental Health Recovery, was developed out the premise that every crisis represents an opportunity for deeper self-awareness, growth, and connectedness with others. eCPR was developed by people who themselves have experienced emotional distress and crisis, and have helped others to move through crisis into a hopeful, empowered place. While Cardiopulmonary Resuscitation (CPR) is used to teach someone how to revive someone’s physical heart, eCPR is designed up help us revive our emotional hearts.

eCPR Skills

eCPR teaches three sets of skills: C = connecting, P = emPowerment, and R = revitalizing.

Connecting is probably the most important process in practicing eCPR. So often we unconsciously allow our own experiences, fears, and expectations to influence our interactions with others. Connecting skills are based on practicing an unconditional, accepting, non-judgmental presence with another person, and developing relationships based on mutual trust and respect.

emPowerment is a process that is designed to help the person experiencing distress or crisis experience their passion and power to live a more fulfilling, grounded, and satisfying life. The support assists the person in distress to envision some practical solutions that would begin to shift the conditions that are causing the distress. This could include discussing a time when the person had felt this way before, what was useful in finding their strength, and taking a positive step. Perhaps the person needs to figure out a strategy to leave an abusive relationship, find a better housing situation, apply for college or for a job, etc. The form that this dialogue takes is fluid, as every individual is unique.

Once people feel a sense of their own power, they move into the Revitalizing process. In this context, “revitalization” means that the person begins to experience their vital center by finding or regaining a valuable role or relationship in the community. This is based on the idea that crisis is so often sparked by a sense of loneliness, isolation, or loss of meaning. Some revitalizing steps could involve getting connected with a peer support or other social group; signing up for a class; connecting with a faith-based group; or finding meaningful work or hobbies. In this way, once the immediate crisis has passed, a person is working to build a different kind of life that has deep significance and purpose for them. Ideally they are on their way to building a support network that will see them through turbulent times as well as good times.

The eCPR approach is very different from the conventional approach, which relies heavily on psychopharmaceuticals and institutionalization to “stabilize” a person, then, in most cases, sends them back out into the same life circumstances that triggered the distress to begin with. Is it any wonder that the “revolving door” syndrome is so common? Through eCPR, people learn more about themselves and gain new skills in using future emotional challenges as growth opportunities.

eCPR and Suicide Prevention

One important application of eCPR is in the realm of supporting people who are having thoughts of self-harm, harm to others, or suicidal feelings. As mentioned above, eCPR practitioners learn how to create relationships of trust and mutual respect. These relationships allow a person to safely express and work through self-harm or suicidal thoughts and feelings. Many eCPR practitioners themselves are people who have experienced self-harm or suicidal feelings in their lives and are in a unique position to help others to make sense of them and to move past them.

It is our experience that suicidal feelings are a part of the human experience, and in many cases are not actually the expression of a true desire to die, but rather a call for help due to a loss of hope and a longing for a better life. eCPR teaches people to regain hope and begin to move towards creating the life they want.

Many people who have had previous unpleasant experiences with mental health systems or treatment are reluctant to share suicidal thoughts and feelings for fear of involuntary commitment. Unlike many conventional mental health providers, the eCPR approach does not call for reacting to suicidal feelings or thoughts of self-harm in a knee-jerk or fear-based manner. eCPR practitioners are trained to adopt an attitude of non-judgmental curiosity  and to ask the person in crisis open-ended questions that give them a safe space to share frightening thoughts and feelings.

In addition, eCPR practitioners explore with the person what specific factors might be contributing to the self-harm or suicidal feelings. For example, they may discuss whether the person’s environment is contributing, and may work with the person to help them find short or long-term solutions to the immediate problems they face. eCPR practitioners also want to consider whether the person’s basic needs for food, sleep, shelter, etc. are met, as hunger or chronic lack of sleep can sometimes exacerbate  emotions and make someone feel desperate for relief from the pain.

eCPR is Trauma-informed

eCPR is helpful for persons who have experienced trauma, such a natural disaster, interpersonal abuse or neglect, and are left with a profound sense of disconnection. Our approach is trauma-informed because the emphasis is on what happened to a person and not what is “wrong” with them. eCPR also emphasizes connecting and empowering the person, and is strengths-based, which are central factors in healing from trauma.

eCPR respects individuals’ dignity and autonomy and believes that forcing people into treatment or any service which they do not want is likely to cause more harm than good.. Whenever possible, natural and holistic, culturally-attuned, recovery-oriented, trauma-informed services and supports in the community will be sought. We may work with a person to help them develop a plan for getting through the next twenty-four hours and will provide information on local resources, such as warmlines, crisis alternatives, and emergency services.

If a person does wish to obtain conventional hospital/emergency services, eCPR practitioners ensure that the person understands their rights and what this will entail, and whenever feasible, accompany the person to the emergency room for additional support.

eCPR is for Everyone.

eCPR is not just designed for people in immediate emotional crisis. In the wake of the Sandy Hook tragedy, there is much debate on how to reduce violence in our society. While this is an important question to discuss, and an issue that involves broad-based community and systems-wide changes, we believe that if the skills and values of eCPR could serve a valuable preventative function if taught more widely in our communities.

People who turn to violence as a means to express their emotions and their pent up frustration typically have been shunned and rejected by others throughout their lives. Out of this isolation and profound sense of disconnection grows the kind of rage and violence that we increasingly see in America. In many situations the person does not yet have a mental health condition, but they need someone to connect with. The skills people learn in the eCPR process are designed to build stronger and more cohesive communities, in which diversity is accepted. eCPR teaches people not to judge or label  emotional distress, but rather to see a human being coping as best they can based on their individual life experience. It gives people concrete skills for connecting with others, building healthy relationships based on heart-to-heart communication, and making sure that everyone knows they belong and have a place in the village.

eCPR Builds Stronger Communities

It is our hope that eCPR can be applied more widely beyond a mental health context and that its concepts can be applied to community development. For example, if eCPR were taught in schools, it could provide a valuable process to enhance relational skills for teachers, parents, and students, and create a deeper sense of community. eCPR could also be used widely in faith-based settings — places to which many people in emotional distress turn first. Law enforcement personnel using eCPR would be less likely to resort to harmful or deadly force, thus decreasing the possibility of unintended tragedies.

Many of the participants in our trainings have pointed out that eCPR becomes a way of life. Although eCPR was originally designed to teach people how to assist others through an emotional crisis, it is apparent that the communication skills of connecting, empowering and revitalizing are valuable means of building cohesive groups and communities. Every contact with another person is an opportunity to deepen that relationship through greater understanding of each other. eCPR is reciprocal, as it is most helpful when based on mutuality. In the process of carrying out eCPR, both the participants are changed through an emotional and verbal dialogue. All these moments of sharing build resiliency in the relationship that then extends into building resiliency in the community. This in turn enables communities to more effectively collaborate, particularly in times of emergency. For example, on a block in a neighborhood, one of the authors has used eCPR principles to organize families to have open house dinners every 3 months for the last several years. As a result, when a snowstorm buried the city in snow, neighbors on the block more easily cooperated on shoveling, parking, and meals.

Our nation is in crisis. It is clear that we need a new way of being with and relating to one another. It is our hope that the movement of people with lived experience of mental health recovery can be the “wounded healers” that help our fractured society move to a place of greater wholeness, interconnectedness, and peace.

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