What is the purpose and effectiveness of peer support in providing help and guidance to individuals facing challenges or difficulties?

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.

A peer has “been there, done that” and can relate to others who are now in a similar situation. Trained peer support workers are required to obtain Continuing Education Units, like all other clinical staff.

Underlying theory

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 schools and education

Peer mentoring

Peer mentoring takes place in learning environments such as schools, usually between an older more experienced student and a new student. Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling in to the whole new schedule and lifestyle of secondary school life. Peer mentoring is also used in the workplace as a means of orienting new employees. New employees who are paired with a peer mentor are twice as likely to remain in their job than those who do not receive mentorship.

Peer listening

This form of peer support is widely used within schools. Peer supporters are trained, normally from within schools or universities, or sometimes by outside organizations, such as Childline’s CHIPS (Childline In Partnership With Schools) program, to be “active listeners”. Within schools, peer supporters are normally available at break or lunch times.

Peer mediation

Peer mediation is a means of handling incidents of bullying by bringing the victim and the bully together under mediation by one of their peers.

Peer helper in sports

A peer helper in sports works with young adults in sports such as football, soccer, track, volleyball, baseball, cheerleading, swimming, and basketball. They may provide help with game tactics (e.g. keeping your eye on the ball), emotional support, training support, and social support.

Peer support in mental health

Consumers/clients of mental health programs group together to form 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 House, Emotions Anonymous, the Depression and Bipolar Support Alliance (DBSA), GROW, and Recovery International. 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 Samaritans, Nightline, 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. Alcoholics Anonymous promotes 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 first responders

Peer support programs have also been implemented to address stress and psychological trauma among law-enforcement personnel and firefighters. Peer support is an important component of the Critical incident stress management program used to alleviate stress and trauma among disaster first responders.

Peer support for people with disabilities

Peer support has been widely used by organizations that work with people with disabilities, including the Amputee Coalition of America and Survivor Corps. Since 1998 the ACA has operated a National Peer Network for survivors of limb loss. The Blinded Veterans Association has recently launched Operation Peer Support (OPS), a program designed to support men and women returning to the US blinded or experiencing significant visual impairment in connection with their military service. Peer support has also benefited survivors of traumatic brain injury and their families.

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.” Peer support is a fundamental strategy in the rehabilitation of landmine survivors in Afghanistan, Bosnia, El Salvador and Vietnam.

Peer support for survivors of trauma

Peer counseling has been used to help survivors of trauma, such as refugees, cope with stress and deal with difficult living conditions. Peer support is integral to the services provided by the National Center for Trauma-Informed Care. Other programs have been designed for female victims of domestic violence and for women in prison.

Pandora’s Aquarium, an online support group operating as part of Pandora’s Project, offers peer support to survivors of rape and sexual abuse and their friends and family.

Peer support for veterans and their families

Several programs exist that provide peer support for military veterans in the US and Canada. In 2010 the Military Women to Women Peer Support Group was established in Helena, MT.

The Tragedy Assistance Program for Survivors (TAPS) provides peer support, crisis care, casualty casework assistance, and grief and trauma resources for families of members of the US military. Operation Peer Support (OPS) is a program for US military veterans who were blinded or have significant visual impairment.