A new study led by researchers from Ulm University and the BKH Günzburg, a partner clinic of Ulm University Hospital, shows that the peer-led group programme ‘In Würde zu sich stehen’ (IWS) effectively reduces self-stigma among adults with mental disorders. The multicentre study, published in “The Lancet Regional Health – Europe”, provides robust data on the programme’s effectiveness and also demonstrates positive effects on so-called stigma-related stress, quality of life and social inclusion.
People with mental disorders are often confronted not only with the symptoms of their condition but also with prejudice and discrimination. Such prejudices can come from outside, but may also be internalised by those affected. Experts refer to this as self-stigma: those affected direct negative societal perceptions against themselves (“Because I have a mental disorder, I must be lazy and am to blame for my condition”). Stigma and discrimination make it difficult for many people with mental disorders to seek help, recover and participate in society. Self-stigma can lead to shame, keeping the condition secret and a loss of morale.
The peer-led group programme ‘In Würde zu sich stehen’ (IWS; English: ‘Honest, Open, Proud’) supports people with mental disorders in developing a self-determined approach to deciding whether and when to disclose their condition to others. The programme is led by people with personal experience of mental disorders (peers). Peers were also very actively involved in all phases of the study.
The effectiveness of IWS has now been investigated in a multicentre study, the results of which have been published in “The Lancet Regional Health – Europe”. The study was conducted by Professor Nicolas Rüsch and Professor Nathalie Oexle, both researchers at the German Centre for Mental Health (DZPG), in collaboration with colleagues from Ulm University, BKH Augsburg (Professor Alkomiet Hasan and his team at the DZPG’s Augsburg-Munich site) and Leipzig University Hospital, amongst others. Professor Rüsch heads the Public Mental Health Section, whilst Professor Oexle leads the Suicide Prevention Working Group at the Department of Psychiatry and Psychotherapy II at Ulm University, based at the BKH Günzburg.
Objective: To enable self-assured and strategic decision-making
Specifically, IWS comprises four group sessions, each lasting two hours, which are conducted according to a fixed framework. The programme supports participants in weighing up the opportunities and risks of disclosing their own illness and in making decisions about disclosure that are appropriate to their own situation and personal goals. IWS is explicitly not designed to persuade people to disclose their condition, but rather to enable them to make a confident and strategic decision for or against disclosure, depending on the context.
Prior to the recently published IWS study, there was no robust evidence of the effectiveness of programmes designed to reduce self-stigma in real-world healthcare settings. Smaller randomised controlled trials from various countries had shown that IWS can reduce self-stigma and the experience of stigma-related stress. However, a large-scale study across different regions and healthcare settings was lacking. The study now published closes this research gap.
IWS was therefore evaluated in a randomised controlled trial at nine sites in Germany. The study involved 457 adults of working age with mental disorders. Participants were randomly assigned either to receive IWS in addition to standard care or to a control group without IWS. The study was funded by the Federal Ministry of Health. The study demonstrated significant positive effects of IWS on self-stigma and stigma-related stress. Furthermore, positive effects were observed on depressive symptoms, quality of life, social inclusion, recovery (recovery orientation) and shame regarding one’s own illness. Some of these effects persisted at the follow-up assessment five months after the end of the IWS programme. IWS also proved to be cost-effective in terms of improvements in quality of life.
“These results represent a significant step forward for IWS and for anti-stigma work in Germany as a whole,” says Professor Rüsch, summarising the findings. “For the first time, we have convincing data for Germany showing that a group programme for adults with mental disorders reduces self-stigma and its consequences.”
The study shows that IWS is a valuable addition to standard psychiatric and psychotherapeutic care for adults with mental health conditions. The programme is non-commercial, cost-effective and flexible enough to be used in various settings. It helps those affected to cope with stigma and its consequences. IWS should therefore be offered alongside standard treatment in both clinical and non-clinical settings.
Publication reference:
Rüsch N, Schulz C, Weisshap C et al.
Real-World Effectiveness of the Peer-Led Honest, Open, Proud Programme for Self-Stigma Among Adults With Mental Illness: A Pragmatic, Multicentre, Randomised Controlled Trial. The Lancet Regional Health – Europe 2026; 67
DOI: https://doi.org/10.1016/j.lanepe.2026.101751
‘In Würde zu sich stehen’ (IWS) programme: iwsprogramm.org
Text: Ulm University Hospital