This study used a convergent mixed methods pre-post design, in which quantitative and qualitative data were collected during the same study phase, analyzed separately, and integrated during interpretation. The quantitative component assessed changes in self-reported well-being, empowerment, and social connectedness through validated psychological measures. In contrast, the qualitative component explored participants’ experiences and perceptions through focus group discussions. The integration of both data types allowed for a deeper exploration of the training’s effects and areas for future improvement.

Emotional CPR is designed to be facilitated by individuals with lived experience of mental health challenges, including anxiety, depression, bipolar disorder, schizophrenia, and trauma. Facilitators may include peer support specialists, community members, and professionals such as educators, administrators, and first responders. The emphasis on lived experience and relational understanding reflects the program’s grounding in peer support and recovery-oriented principles.

The Emotional CPR training is a 12-hour web-based course delivered over 3 consecutive days through live, synchronous videoconference sessions (Zoom). The curriculum includes the following modules: (1) establishing emotional connection, (2) recognizing and utilizing nonverbal communication, (3) fostering cultural empathy across different worldviews, (4) applying trauma-informed practices, (5) responding to emotional distress and suicidal ideation, (6) promoting empowerment, and (7) fostering revitalization.

Sessions combine didactic instruction with facilitated group dialogue, structured real-play exercises conducted in breakout rooms, and guided reflection activities. Modules are sequenced to move from foundational concepts of emotional connection and trauma-informed engagement toward applied practice in cultural empathy, responding to distress, empowerment, and revitalization. Experiential learning is integrated throughout the training to reinforce skill development and encourage reflective practice.

Trainers facilitating Emotional CPR complete a structured 60-hour certification program that includes experiential training in trauma-informed engagement, cultural humility, crisis response, and supervised practice sessions, and they must demonstrate competency through evaluated real-play and a final assessment prior to certification [10,11]. In this study, a total of 7 certified trainers facilitated the sessions. Each training cohort included approximately 6 to 16 participants, with smaller breakout groups used for real-play and discussion exercises to support interactive learning and engagement.

Facilitators included individuals with lived experience of mental health challenges, as well as professionals such as peer support specialists, educators, and community-based practitioners. Facilitators identified as BIPOC, including Black/African American, Native American, and multiracial individuals. Many facilitators had personal and professional lived experience within the mental health system, including roles in peer support and community-based services, which informed their facilitation approach. Cultural relevance was not assumed solely on the basis of shared racial identity. Instead, it was operationalized through culturally responsive facilitation practices, including cultural humility, validation of diverse lived experiences, and the intentional creation of a space where participants could engage without needing to explain or justify culturally specific experiences. Facilitators drew on their lived experience and community-based knowledge to support relational engagement and trust-building.

Participants were recruited online through community-based networks and were not restricted by geographic location. As a result, participants likely represented diverse regional and cultural contexts within the United States; however, geographic data were not systematically collected. This limits the ability to assess the influence of shared place-based experiences on culturally responsive engagement within the training environment.

The study was approved by the WCG Institutional Review Board (application number 1284189). All participants provided electronic informed consent prior to participation. Participation was voluntary, and participants could withdraw at any time without penalty. Data were deidentified prior to analysis and stored on secure, password-protected systems. Participants were not compensated for their participation.

Participants were recruited through community-based outreach efforts, including email listservs, social media announcements, and partnerships with community organizations serving BIPOC populations. Recruitment materials described the Emotional CPR training as a peer-led mental health education opportunity facilitated by BIPOC trainers. Interested individuals self-enrolled in the training through an online registration platform. Inclusion criteria required participants to (1) identify as Black, Indigenous, or a Person of Color and (2) be 18 years of age or older. Participants were not required to have lived experience with mental health challenges to enroll in the training, as the program is designed for a broad audience, including community members, individuals with lived experience, and professionals seeking to strengthen their capacity to support others in emotional distress. Lived experience with mental health challenges was not systematically assessed as part of the study. Participants were recruited online and were not restricted by geographic location; however, geographic data were not systematically collected, which limits the interpretation of shared cultural context related to place.

Of those enrolled in the training, 85 participants completed both presurvey and postsurveys. For the qualitative component, purposive sampling was used to invite survey completers to participate in focus groups. Invitations were distributed through email following training completion, and participants were selected based on availability and willingness to ensure diverse representation across gender and racial identities. A total of 17 participants participated in 2 focus groups (n=7, 41%; n=10, 59%).

Participants completed a battery of validated psychological measures at 2 time points: immediately prior to the first training session (pretraining) and immediately following the completion of the third training day (posttraining).

The reliability of each scale was assessed using Cronbach α. Reliability analysis was conducted to determine the reliability and internal consistency of presurvey and postsurvey Emotional CPR, UCLA Loneliness Scale, Revised Social Connectedness Scale, Empowerment Scale, PANAS, Active-Empathic Listening Scale, Flourishing Scale, Mindful Attention Awareness Scale, and Herth Hope Scale. The results indicate that all presurvey and postsurvey scales have acceptable to excellent reliability and internal consistency since Cronbach α coefficients ranged from .63 to .91 (Table 1).

Descriptive statistics were calculated to summarize participant characteristics. Internal consistency and reliability of each scale was assessed using Cronbach α. Pretraining to posttraining changes across outcome variables were examined using paired-samples 2-tailed t tests, and effect sizes were calculated using Cohen d. Cohen d values reflect the direction and magnitude of change from pretraining to posttraining, with positive values indicating higher posttraining scores and negative values indicating lower posttraining scores; effect sizes were interpreted using conventional benchmarks (0.20 for small, 0.50 for medium, and 0.80 for large), with scale directionality considered in interpreting substantive meaning. To explore potential gender differences over time, repeated-measures ANOVA were conducted with time (pre vs post) as the within-subject factor and gender as the between-subject factor. Statistical significance was set at P<.05. All analyses were conducted using IBM SPSS Statistics.

Two focus group discussions were conducted through Zoom, with the first session held on January 6, 2025 (n=10, 59%) and the second on January 13, 2025 (n=7, 41%). Each session lasted approximately 60 minutes and was audio-recorded for accuracy. The lead researcher conducted both focus group discussions, and a professional transcription service was used to transcribe the recordings.

A semistructured interview guide was used to explore participants’ experiences with the Emotional CPR training, covering the following questions:

The interview guide included questions aligned with the training objectives, which may have shaped or directed participants’ responses toward specific domains of interest.

A reflexive thematic analysis informed by phenomenological principles [24] was used to analyze qualitative data. While the analysis emphasized participants’ lived experiences and meaning-making, it also incorporated both inductive coding and deductive attention to domains reflected in the interview guide and training objectives. Transcripts were independently coded by 2 members of the research team using an iterative thematic process. Coding discrepancies were discussed and resolved through consensus to enhance credibility and dependability. Themes were generated through a reflexive and iterative analytic process that prioritized participants’ language and interpretations while situating findings within the context of the training content. The integration of quantitative and qualitative strands is summarized in Table 2.

Building on this approach, the analysis was designed to systematically identify patterns across participants’ accounts while remaining grounded in the exploration of lived experience and meaning-making [24,25]. It focused on interpreting how participants described, understood, and made sense of their experiences with Emotional CPR training. A reflexive 6-phase thematic analysis process guided the analytic procedures [25]:

Several steps were taken to strengthen the rigor of the qualitative analysis. Two members of the research team independently reviewed and coded the transcripts, meeting regularly to discuss differences and refine themes until consensus was reached. Including direct participant quotations in the Results section allows readers to see how interpretations are grounded in participants’ own words.

The analytic process followed a structured and documented approach. Coding decisions and theme development were tracked throughout the analysis to ensure consistency and transparency. This process helped maintain alignment between the raw data and the final themes.

Reflexivity was also an important part of the analytic process. The lead researcher identifies as Black, which was particularly relevant given the focus of the study on BIPOC participants and facilitators. This shared cultural context contributed to building trust during focus groups and may have shaped how participants felt comfortable expressing their experiences. Throughout the analysis, care was taken to remain attentive to how lived experience and insider perspective could influence interpretation, ensuring that themes reflected participants’ narratives rather than researchers’ assumptions.

Qualitative themes were then examined alongside quantitative results to provide a comprehensive interpretation of the training’s impact. This integrative step allowed experiential insights to contextualize and deepen the understanding of measurable outcomes.

By using thematic analysis informed by phenomenological inquiry, the study generated an interpretive account of participants’ lived experiences rather than seeking to identify universal or essentialized structures of consciousness, defined here as fixed or generalizable features of experience. The findings highlight how Emotional CPR training shaped participants’ perceptions of personal growth, relational connection, and emotional resilience within the BIPOC community.

A total of 85 participants completed both pretraining and posttraining surveys. Of these, 65 (76%) identified as female participants, 17 (20%) as male participants, 2 (2%) as another gender, and 1 (1%) as Two-Spirit, transgender, gender-nonconforming, or nonbinary. Most participants were identified as Black or African American (70/85, 82%) and were employed full-time (64/85, 75%). The mean age of participants was 41.93 (SD 11.21; range 19‐69) years (Table 3).

Seventeen participants participated in the focus group discussions. Of these, 14 (82%) were identified as female participants and 3 (18%) were identified as male participants (Table 4).

Additional demographic characteristics beyond gender were not systematically collected for focus group participants, which limits the ability to further contextualize the qualitative findings.

Paired-samples t tests examined pretraining to posttraining changes in Emotional CPR scale items (Table 5). Significant increases were observed in items reflecting solution-focused support (P<.001), uncertainty in helping someone in distress (P<.001), and attempts to solve others’ problems (P<.001). Significant decreases were observed in items related to being with another person (P<.001), understanding nonverbal communication (P<.001), emotional self-care (P<.001), and openness to new approaches (P=.008). No significant changes were observed in emotional awareness or trauma recognition.

Significant pretraining to posttraining changes were observed across several standardized measures (Table 6). Loneliness scores decreased (P=.02), and positive affect increased (P=.002). Significant declines were observed in empowerment (P=.03), active-empathic listening (P=.02), flourishing (P=.02), and hope (P<.001). No statistically significant changes were observed in social connectedness or mindfulness.

Qualitative analysis of focus group discussions identified 6 primary themes and related subthemes. Themes and representative participant quotations are presented in Table 7.

Qualitative analysis of focus group discussions identified 6 primary themes: (1) empowerment through training, (2) active listening and empathy, (3) emotional impact of training, (4) building social connections, (5) application of skills in daily life, and (6) training structure and recommendations. Representative quotations are presented in Table 7.

Empowerment through training included increased confidence, greater awareness of personal biases, and personal growth. Participants described feeling more prepared to engage with others in emotionally supportive ways and more aware of how their communication patterns and assumptions influenced interactions.

Active listening and empathy reflected shifts in how participants approached conversations. Many emphasized learning to listen with intention rather than focusing on responding or solving problems. Participants also described an increased awareness of nonverbal communication and acknowledged the need to manage personal emotional triggers when supporting others.

The theme Emotional impact of training captured experiences of vulnerability, self-reflection, and self-care. Participants described emotionally meaningful discussions, particularly within culturally affirming spaces. The importance of maintaining personal boundaries and engaging in self-care when emotionally activated was also emphasized.

Building social connections highlighted the role of cultural safety and trust in shaping the training experience. Participants noted that having BIPOC facilitators contributed to a sense of openness and shared understanding. Several participants described developing a stronger sense of community during the sessions.

Under Application of skills in daily life, participants reported using training principles in family interactions, professional settings, and peer relationships. Skills such as asking whether someone wanted listening or advice, maintaining boundaries, and being present in conversations were described as particularly useful.

Finally, Training structure and recommendations included suggestions for additional practice time, in-person options, follow-up sessions, and broader dissemination of training to professionals and youth populations.

The integration of qualitative and quantitative findings provides a more comprehensive understanding of how participants experienced the training. While quantitative analyses demonstrated reductions in loneliness and increases in positive affect, they also showed modest declines in empowerment, hope, flourishing, and active-empathic listening.

These qualitative themes provide context for the quantitative findings, particularly the observed declines in empowerment, hope, and active-empathic listening. Participants described increased self-awareness and emotional vulnerability following training, which may have temporarily influenced their self-evaluations of competence and confidence.

Reductions in loneliness were consistent with qualitative themes of Building Social Connections and Emotional Impact of Training. Participants described increased feelings of connection, cultural safety, and shared understanding within the training space. These relational experiences align with the observed decrease in self-reported loneliness.

In contrast, empowerment scores declined slightly, despite participants describing experiences of increased confidence and personal growth. Qualitative data suggest that the training may have heightened awareness of the complexities involved in supporting others, including recognition of personal biases and emotional triggers. This increased self-awareness may have influenced participants’ posttraining self-assessments, resulting in more cautious ratings.

A similar pattern was observed for active-empathic listening. While participants described a deeper understanding of “being with” someone rather than solving problems, they also acknowledged the emotional effort required to practice these skills. This suggests that increased awareness of the challenges involved in sustained empathetic engagement may have contributed to modest declines in self-reported listening scores.

Declines in hope and flourishing may also be understood in light of the emotionally vulnerable discussions described in the qualitative findings. Participants engaged in dialogue related to trauma, systemic racism, and lived experiences. Although these conversations fostered connection and validation, they may have also surfaced unresolved stressors, temporarily influencing perceptions of well-being.

Taken together, the integrated findings suggest that the training promoted relational connection and emotional awareness while simultaneously increasing reflection on personal limitations and systemic realities. These processes may explain the combination of relational gains and short-term shifts in self-perceived empowerment and well-being observed in the quantitative data.

This study examined pretraining to posttraining changes among BIPOC participants who completed Emotional CPR facilitated by BIPOC trainers. Using a convergent mixed methods design, we integrated quantitative and qualitative findings to better understand participants’ emotional and interpersonal experiences following the training.

Quantitatively, participants reported reduced loneliness and increased positive affect immediately after training. These findings were supported by qualitative accounts describing feelings of connection, validation, and cultural safety. Participants frequently emphasized that being in a space led by BIPOC facilitators fostered trust and openness. Statements such as “It let me know I wasn’t alone in how I was feeling” reflect the relational environment that likely contributed to decreased loneliness. These results are particularly meaningful given the systemic challenges and racial stressors that affect BIPOC communities, where culturally resonant spaces for connection can promote belonging and support [26].

At the same time, modest declines were observed in empowerment, active-empathic listening, flourishing, and hope. Although participants described increased confidence and emotional awareness, qualitative findings suggest that the training increased recognition of emotional complexity, personal triggers, and systemic barriers. Greater self-awareness may have influenced posttraining self-ratings, resulting in more cautious evaluations of competence. Conversations about racism and systemic inequities can evoke strong emotional responses and may temporarily affect perceptions of agency [4].

Similarly, declines in active-empathic listening may reflect heightened awareness of the effort required to sustain emotional presence. Participants acknowledged that deep listening requires emotional regulation and self-reflection. This aligns with the literature on emotional labor, which suggests that engaging in emotionally intensive dialogue can affect one’s capacity for sustained empathic engagement [27]. While positive affect increased, mindfulness and overall social connectedness did not change significantly, suggesting that while the training fostered immediate relational gains, the longer-term integration of skills into daily life may require continued reinforcement.

Declines in hope and flourishing also warrant attention. Participants described engaging in emotionally vulnerable conversations about trauma and lived experiences. While these dialogues fostered connection and validation, they may have simultaneously surfaced unresolved stressors. Research suggests that confronting systemic realities can influence hope and perceptions of well-being, particularly in marginalized communities [2,28]. Recent work on radical healing frameworks emphasizes that processes of naming and processing racial trauma may initially surface emotional strain before fostering longer-term resilience [28]. These findings highlight the complexity of short-term emotional shifts following reflective, trauma-informed interventions.

These findings extend previous research on peer-led mental health interventions. Prior studies of peer support models demonstrate improvements in empowerment, engagement, and emotional well-being [5-8]. Recent knowledge syntheses further highlight that peer-based models strengthen relational continuity and trust within community mental health systems [8]. Similarly, earlier studies of Emotional CPR and peer-delivered interventions have demonstrated feasibility and preliminary effectiveness in community-based settings [10,11,29]. This study builds on this work by examining a culturally responsive implementation facilitated entirely by BIPOC trainers for BIPOC participants.

The reduction in loneliness aligns with the literature emphasizing the importance of culturally responsive spaces in fostering belonging and relational safety [26]. Increases in positive affect are also consistent with research linking emotional connection to resilience and stress buffering [30,31]. At the same time, the observed declines in empowerment and hope highlight that reflective and trauma-informed interventions may produce complex, nonlinear outcomes. Literature on emotional labor and counselor listening exhaustion suggests that engaging deeply with distress can temporarily affect self-perceived competence [27].

The findings also underscore calls for culturally tailored mindfulness and emotional regulation strategies within BIPOC communities [28]. While mindfulness scores did not change significantly, participants described increased awareness and reflection, suggesting potential areas for future adaptation.

Several limitations should be considered. First, the study used a single-group pre-post design without a comparison group, limiting causal inference. Observed changes cannot be attributed solely to the intervention. Second, outcomes were measured immediately posttraining, and longer-term effects remain unknown. Third, all measures were self-reported and may be influenced by social desirability or momentary emotional states.

The sample consisted primarily of Black or African American participants and women, which may limit generalizability to other populations or BIPOC subgroups. Additional demographic characteristics of focus group participants were not collected, which limits the ability to contextualize qualitative findings across participant backgrounds. Additionally, participants had access to internet-enabled devices and were able to participate in web-based training, which may exclude individuals with fewer resources. Finally, while qualitative integration strengthened interpretation, future studies using longitudinal designs and control groups would provide more robust evidence.

Participation in a culturally responsive, peer-led Emotional CPR training facilitated by BIPOC trainers was associated with short-term reductions in loneliness and increases in positive affect, alongside modest declines in self-rated empowerment, hope, flourishing, and active-empathic listening. Qualitative findings suggest that increased emotional awareness and engagement with systemic stressors may influence short-term self-evaluations of competence and well-being.

These results highlight the importance of culturally responsive peer-led spaces in fostering connection and emotional safety, while also underscoring the need for follow-up support, mentorship, and continued skill practice to sustain empowerment and resilience over time. Future research should examine longer-term outcomes and explore strategies for reinforcing gains in culturally responsive mental health interventions.