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Peer Support

Forest Hike

Peer Support

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet as equals to give each other support on a reciprocal basis. Peer in this case is taken to imply that each person has no more expertise as a supporter than the other and the relationship is one of equality.
The effectiveness of peer support is believed to derive from a variety of psychosocial processes described best by Mark Salzer in 2002: social support, experiential knowledge, social learning theory, social comparison theory and the helper-therapy principle.


  • Social support is the existence of positive psychosocial interactions with others with whom there is mutual trust and concern. Positive relationships contribute to positive adjustment and buffer against stressors and adversities by offering emotional support (esteem, attachment, and reassurance), instrumental support (material goods and services), and information support (advice, guidance, and feedback).

  • Experiential knowledge is specialized information and perspectives that people obtain from living through a particular experience such as substance abuse, a physical disability, chronic physical or mental illness, or a traumatic event such as combat, a natural disaster, domestic violence or a violent crime, sexual abuse, or imprisonment. Experiential knowledge tends to be unique and pragmatic and when shared contributes to solving problems and improving quality of life.

  • Social learning theory postulates that peers, because they have undergone and survived relevant experiences, are more credible role models for others. Interactions with peers who are successfully coping with their experiences or illness are more likely to result in positive behavior change.

  • Social comparison means that individuals are more comfortable interacting with others who share common characteristics with themselves, such as a psychiatric illness, in order to establish a sense of normalcy. By interacting with others who are perceived to be better than them, peers are given a sense of optimism and something to strive toward.

  • The helper-therapy principle proposes that there are four significant benefits to those who provide peer support: (a) increased sense of interpersonal competence as a result of making an impact on another person's life; (b) development of a sense of equality in giving and taking between himself or herself and others; (c) helper gains new personally-relevant knowledge while helping; and (d) the helper receives social approval from the person they help, and others.

Peer support in mental health
Peer support can occur within, outside or around traditional mental health services and programs, between two people or in groups. Consumers/clients of mental health programs have also formed non-profit self-help organizations,  and serve to support each other and to challenge associated stigma and discrimination. Organizations that offer peer support services for people with mental health problems include Fountain HouseEmotions Anonymous, the Depression and Bipolar Support Alliance (DBSA), GROW, and Recovery International. Peer support is a key concept in the recovery approach. The role of peer workers in mental health services was the subject of a conference in London in April 2012, jointly organised by the Centre for Mental Health and the NHS Confederation. Research has shown that peer-run self-help groups yield improvement in psychiatric symptoms resulting in decreased hospitalization, larger social support networks and enhanced self-esteem and social functioning. Organizations such as the SamaritansNightline, and Aware provide peer support to people in emotional distress.

Peer support in addiction
Twelve-step programs for overcoming substance misuse and other addiction recovery groups are often based on peer support. Since the 1930s Alcoholics Anonymous has promoted peer support between new members and their sponsors: "The process of sponsorship is this: an alcoholic who has made some progress in the recovery program shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA. Other addiction recovery programs rely on peer support without following the twelve-step model.
Peer support for anxiety and depression
In Canada, the LEAF (Living Effectively with Anxiety and Fear) Program is a peer-led support group for cognitive-behavioral therapy of persons with mild to moderate panic disorders.
In a 2011 meta-analysis of seven randomized trials that compared a peer support intervention to group cognitive-behavioral therapy in patients suffering from depression, peer support interventions were found to improve depression symptoms more than usual care alone and results may be comparable to those of group cognitive behavioral therapy. These findings suggest that peer support interventions have the potential to be effective components of depression care, and they support the inclusion of peer support in recovery-oriented mental health treatment.
Peer support in chronic illness
Peer support has been beneficial for many people living with diabetes. Diabetes encompasses all aspects of people's lives, often for decades. Support from peers can offer emotional, social, and practical assistance that helps people do the things they need to do to stay healthy. Peer support groups for diabetics complement and enhance other health care services.

Peer support has also been provided for people with cancer and HIV. The Breast Cancer Network of Strength trains peer counselors to work with breast cancer survivors.
Peer support for people with disabilities
Peer support is considered to be a key component of the independent living movement and has been widely used by organizations that work with people with disabilities.

Survivor Corps defines peer support for trauma survivors as "Encouragement and assistance provided by a colleague who has overcome similar difficulties to engender self-confidence and autonomy and to enable the survivor to make his or her own decisions and implement them."[50] Peer support is a fundamental strategy in the rehabilitation of landmine survivors in Afghanistan, Bosnia, El Salvador and Vietnam. A study of 470 amputees in six countries showed that nearly one hundred percent said they had benefited from peer support.
Peer support for survivors of trauma
Peer support has been used to help survivors of trauma, such as refugees, cope with stress and deal with difficult living conditions.

last edited by Jean Pierre Wilken March 2013

Further reading:
Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. (1999).

Peer support among individuals with severe mental illness: A review of the evidence. 

Clinical Psychology, Science & Practice, 6, 165–187. Solomon, P. (2004).

Peer support/peer-provided services: Underlying processes, benefits, and critical ingredients. 

Psychiatric Rehabilitation Journal, 27(4), 392–401.

Recommended by Jean Pierre Wilken

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