eCPR: A Health Promotion Approach

Lauren SpiroLauren SpiroLauren Spiro

eCPR is a public health education program designed to teach people to assist others through emotional crisis through three steps: C = connecting, P = emPowering, and R = revitalizing. eCPR recognizes that the experiences of trauma, emotional crisis, and emotional distress are universal; they can happen to anyone, at anytime, anywhere.

eCPR was developed by over twenty experts with lived experience of crisis and mental health recovery. We know firsthand what helps, and what can potentially exacerbate crisis. One lesson we have learned is that, in general, healing begins in the context of respectful, authentic human relationships. If we project our interpretation onto others' experiences, for example, by starting the interaction with attempting to assess or diagnose them, we may disrupt the connecting process. However, if we focus on listening and believing in individuals’ ability to make it through crisis, we can greatly increase their odds of doing so.

eCPR teaches concrete skills for authentically connecting to persons in crisis through listening to and supporting them in an open-minded, curious, non-judgmental way. Instead of asking "what's wrong with you?" we proceed from the trauma-informed question "what happened to you?" eCPR practitioners also support people to access desired community-based, culturally relevant, trauma-informed, and recovery-oriented resources, so they may move through the crisis and into a meaningful life in their communities.

Breaking the “Revolving Door” Cycle

Conventional treatment for psychiatric crisis or suicidal behavior typically involves a brief inpatient "medication and stablilization" period, usually with little or no attention to the circumstances that caused the initial crisis or distress. A traumatizing and costly revolving door cycle can often ensue, leading to individuals falling into worsening distress.

A recent article by a military veteran seeking help after a suicide attempt illustrates some of the major flaws in the system, as described above. After negative experiences with treatment, people may stop reaching out for help, hiding their suffering from even their friends and loved ones, and retreating into painful isolation. It is this very isolation that fuels emotional distress and crisis. The eCPR approach seeks to break this cycle.

Studies indicate that “the risk of suicide is higher during the period immediately following discharge from in-patient psychiatric care than at any other time in a service user’s life” (Crawford, 2004), due in large part to a lack of social supports upon discharge. Researchers studying poor outcomes for people in developed countries receiving costly treatment for schizophrenia suggest that “something essential to recovery is missing in the social fabric” (Jablensky and Sartorius, 2008). Clearly, our eroded social safety net is a major contributor to individuals’ distress and crisis.

A Health Promotion Approach

Health promotion is defined as “the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions” (World Health Organization).

Our society has evolved to believe that emotional distress and crisis are solely the responsibility of mental health professionals. eCPR was developed with the concept that everyone -- not just mental health professionals -- can and should play a role in helping individuals to achieve wellness and live meaningful lives in the community.

It is our experience that the well-being of individuals is deeply connected to that of the community, and vice-versa. By learning to use the concrete, life-saving skills of eCPR to promote well-being, our communities become stronger and more resilient, preventing crises before they occur. In this way, eCPR is a primary prevention approach, which is considered the most cost-effective form of health care (US Preventative Services Task Force).

It is our hope that if we can build this sense of collective responsibility for one another, we can help many people avoid crisis in the first place, or move through crisis far more quickly and avoid the revolving door cycle. eCPR skills, if applied on a large scale, could go a long way in helping to address our frayed social fabric: the critical missing variable in recovery.

To learn more about eCPR, visit

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    • Robert,
      We provide trainings for organizations or groups anywhere in the world. Typically an organization invites us in but we do on occasion offer independent trainings that individuals may sign up for. We charge a fee and this fee varies depending on where the training is – using local trainers saves money. Please email or call us directly for more information. There is a 2-day certification training in Austin, Texas (for $200 per person) on Dec 2-3, 2013. We list our upcoming trainings on the web at

      we look forward to hearing from you.

  1. eCPR ! Great idea. Back when I was still sick I always expected someone to ask “what happened to you?” when I came into the E.R with panic attacks but it never happened. I really wanted to explain it and for someone to listen. Finally once I knew ‘help’ was just waiting in ‘observation’ alone hoping for a Xanax scared of the possibility of inpatient I would just buy a pint of vodka on the way to the hospital and drink as much as I could before walking in to carry me through the get in the gown- take all my things and wait in captivity alone part.

    Also, most people who goto the E.R with anxiety have already tried just taking deep breaths and it didn’t work and never does.

    If I was doing eCPR on a person in crisis I would be able to connect by making a joke about the deep breath thing.

    • Yes, people say “eCPR is help that helps”.

      We are all able to connect. eCPR reminds us of our human capacity to be with and support other people in a way that is deeply meaningful and often life-changing.

      Thanks for writing in Copy_cat

    • I was in an ER with a panic attack due to guillain barre syndrome.I was already depressed.Lying on a cot inside a crowded ER can be very distressing.And the GBS had already caused paresis of one half of the body.Its very scary and hellish when an acute medical emergency strikes you,the attendant psychiatric problem also pops out.They do not have any mechanism to handle such dual situations.Ear plugs can be good to mask the noise which can further compound the panic attack.Especially when you are alone.

  2. “Clearly, our eroded social safety net is a major contributor to individuals’ distress and crisis.”

    Finding oneself basically alone in the world is a reality that happens to alot of people. I started to get crazy like Tom Hanks in ‘Castaway’ , I could still be around people but being around strangers in crowded suburbia isn’t that much better than home alone.

    “isolation that fuels emotional distress and crisis” Spot on.

    Like rocket fuel.

    • actually having a psychiatric diagnosis itself isolates the individual,because people do not care for your problem.Its not visible like a physical handicap.The individual gets isolated from all spheres of social activities,all rights taken away,tossed around without any apologies.

  3. I think the main reason that 12 step meetings ever help anyone is they are a way out of isolation and back into the world, the trick is to not let any illogical contradictory stuff said distract you from the main point. Meeting people.

  4. We developed emotionalCPR, to combat isolation and give everyone the skills and confidence to be with people in distress, without feeling they immediately need to refer them to professional help. We find that when we can be with a person in distress, in the present moment, new life emerges for both persons. I and others who have taken the 2-day certification or 4-day train-the-trainer course, find it improves our day-to-day communication and thinking as well. Thus one participant said,”EmotionalCPR is a way of life.” Our next training will be Dec. 2 and 3rd, just prior to Alternatives in Austin,Texas. To sign up, go to our website,

  5. you had advised through the New Freedom Commission to improve the public mental health system.Has it been successful? It was in 2002 that you reported this to the US News and World report.You also favour herbs and natural remedies.Are you totally against pharmaceutical agents?