Individuals’ evaluation of ISGs shifted from initial expectations toward a more realistic assessment. This change is driven by the discrepancy between anticipated support and the reality of group dysfunction. As individuals engaged with ISGs, their criteria for evaluating recovery gradually shifted. Initially, they relied on group norms or the experiences and judgments of others, seeking validation and support from the collective. Over time, this orientation gave way to a more introspective approach. Individuals began to assess their own experiences and recovery needs according to personal standards and self-reflection. This transition from external reference to internal judgment reflects what the empowerment framework describes as acting as an independent agent, drawing on the tools of autonomy it identifies, namely, knowledge, self-confidence, and the availability of meaningful choices [10].

Among the 18 patients, most joined ISGs to seek emotional or informational support, motivated by a desire for empathy and improved disease management. These initial expectations were often shaped by an “oasis illusion” (C19), in which the group was seen as a potential refuge. For instance, P13 shared:

However, as the gap between expectations and reality became clear, participants’ accounts traced a shift from passive recipients of support to active evaluators of the group. They began to recognize factors within the group environment that they experienced as hindering or even harming their recovery. The decision to leave thus grew out of this renewed exercise of independent judgment. This process involves 3 themes: recognizing risks within the ISG environment, de-idealizing the functions of ISGs, and making strategic decisions to withdraw, a step in which an emerging sense of obligation to their own health also came into play.

As their engagement in the ISG deepened, many participants reported experiencing negative effects of the group. Rather than offering the expected support, the group often became a source of stress according to participants’ accounts. Frequent displays of negativity, such as self-harm rhetoric and competitive venting, caused considerable distress. Through ongoing interaction, individuals described gradually learning to identify and navigate these environmental risks.

Recognizing these risks marked a growth in autonomy. What changed in these accounts was less the group itself than participants’ knowledge of the group. This knowledge led them to feel that safeguarding their own well-being mattered more than maintaining ties with the ISG. Both P9 and P18 described distancing themselves as essential for psychological self-protection when the stress generated by the group surpassed what they felt able to cope with.

Individuals further exercised autonomy by critically evaluating the effectiveness of the ISG. Their assessment went beyond simply recognizing negative emotions. They questioned whether the group genuinely provided meaningful support. Some participants joined ISGs expecting constructive information exchange and professional guidance, only to find a lack of substantive interaction. As P16 noted, an unresponsive ISG failed to meet her need for genuine interpersonal connection.

She also highlighted the shortcomings of ISGs that claimed professional expertise, suggesting that her evaluation was grounded in the quality of interactions rather than mere credentials or authority.

Many individuals no longer regarded ISGs as consistently effective avenues for recovery. This shift reflects a growing sense of autonomy, grounded in the knowledge of the group that participants had accumulated. Rather than relying on the group for solutions, participants started to chart their own paths to recovery by acknowledging the limitations of ISGs.

First, participants described a lack of professionalism in the information shared within ISGs. Groups that primarily serve as outlets for emotional venting often lack clinical guidance, compelling participants to rely on their own judgment to filter out misinformation. Rather than accepting advice uncritically, they evaluated the content carefully to avoid potentially harmful recommendations.

Second, participants felt that heterogeneity among members could hinder genuine empathy. Differences in age and life circumstances often made it difficult for peers to truly understand one another. Coming to feel that a shared diagnosis did not necessarily lead to shared understanding, they began to prioritize their own needs over a generalized sense of group belonging.

Finally, participants described the support of ISGs as limited in duration. They observed that while a group may be beneficial at first, it can become less valuable and even a source of stress as their condition evolves. This perception leads them to view the ISG as a temporary resource rather than a lasting solution.

Once they perceived the ISG as risky and of limited value, participants moved from contemplation to action and made a decisive choice to leave. In their accounts, they no longer hoped for improvement within the group and instead prioritized their own well-being. At this point, a second dimension of empowerment surfaced in a germinal form. Alongside the independent judgment that defines autonomy, participants voiced a felt obligation to protect their own health, an early expression of the responsibility that would be fully enacted only after withdrawal. In their accounts, the decision to leave grew out of the interplay of the 2.

P7 voiced this obligation in stark terms, weighing her recovery against her inability to stay away from the group.

In her account, leaving was at once the conclusion of an independent assessment and an act of self-preservation. Quitting the group outright was her way of ending a pull she felt unable to resist while remaining inside it.

This concern with self-protection ran through the more specific reasons participants gave for leaving. On the one hand, individuals chose to leave to conserve their energy. Engaging with an unresponsive ISG came to feel like a waste of their time. Whether they were offering support or seeking it, the absence of meaningful feedback left their efforts feeling futile. In their accounts, such interactions consumed more energy than they provided. As a result, they decisively severed these connections to prevent further emotional depletion.

On the other hand, some individuals left because they came to view the ISG as a temporary resource rather than a long-term solution. They no longer regarded the group as the primary means of addressing their challenges but rather as a tool with limited utility. When the ISG ceased to be effective or failed to resolve their problems, they chose to move on. This decision reflects a prioritization of practical problem-solving over a mere sense of belonging.

Withdrawing from an ISG demanded the courage to break free from psychological inertia. In participants’ accounts, this bravery stemmed from the sense that the distress of staying in the group outweighed the anxiety of leaving. Although withdrawal may lead to feelings of loneliness and uncertainty [35], remaining in an ISG that they experienced as failing to foster healing or even worsening their condition ultimately felt more harmful. This courage manifested in 3 ways, including practicing voluntary disconnection, asserting the self through voice, and distancing from the group.

Courage was first demonstrated through the act of disconnecting. Whether the departure was abrupt or gradual, individuals broke the habit of remaining in the group to reclaim control over their lives. They resisted the inertia of the ISG and made a deliberate decision to leave. Not every exit in the data was of this kind. P13 recalled groups from her school years that simply disappeared.

Exits imposed in this way involved no exercise of choice, and participants did not narrate them as their own acts. The courage participants described presupposed that a meaningful choice existed to be made [10].

For some people, this disconnection was a decisive act. Once they sensed the ISG as detrimental, they severed ties without looking back to safeguard their mental well-being. In their telling, the group remained absorbed in distress while they themselves wanted to move on with life, and leaving came as a relief rather than a loss.

For others, disconnection was a gradual process, unfolding as they took time to weigh the pros and cons. Unlike those who left decisively, these individuals transitioned from uncertainty to clarity. Some remained in the group to actively assess its value, while others hesitated due to reliance on the ISG or fear of isolation. Whatever the reasons, the emotional cost of staying was described as outweighing any potential benefit. Once they judged that the ISG drained more than it provided, leaving followed as a considered step to prevent further harm.

For others, disengagement could occur without the behavioral marker of exit. P15, for example, described a period during a personal crisis when her attention and emotional investment had already become completely detached from a group she still nominally belonged to before she eventually left it. P13, the only patient who never actively exited a group, described her disengagement as a quiet withdrawal of attention that followed the fading of her need for the groups.

Muting could likewise serve as an intermediate stage rather than an endpoint. Four patients muted a group before eventually exiting it. Across these accounts, explicit exit, muting, and ceasing to check the group appeared as points on a single continuum of intentional disengagement. They differed in behavioral form and emotional intensity, but not in kind.

Whichever route participants took, the felt obligation to protect their own health that had surfaced during evaluation carried over into the act itself. P11 framed her exit as a rule of self-protection.

In her account, the obligation that had helped drive the decision to leave was already being acted on at the moment of disconnection.

For a smaller number of participants, the clarity reached at one exit did not settle. P9 described a cycle of joining and leaving that tracked the fluctuations of her condition.

Each of her exits followed an appraisal of the group, yet the appraisals themselves shifted with her emotional state. Such accounts indicate that the courage of disconnection, and the judgments behind it, could be enacted in unstable and reversible ways.

Courage is not only about leaving quietly but also about breaking the silence. For individuals prone to social withdrawal [56], speaking out against the group was a significant act of risk-taking. By voicing dissent, they stopped hiding and reasserted their boundaries, making a statement about who they are before departing.

Courage often manifested as a defense of dignity. When the ISG crossed a line, such as spreading rumors or attacking others, individuals refused to remain passive. They spoke up, not merely to vent anger, but to push back against how the group defined them. By asserting themselves, they made their departure, in their own eyes, an act of strength rather than defeat.

Courage also means refusing to remain invisible. In ISGs, individual struggles often go unnoticed. Speaking out becomes a last attempt to make the group pause and recognize someone’s pain. When these heartfelt words are ignored or drowned out by arguments, staying comes to seem pointless, and speaking up becomes the final act of separation.

The final aspect of courage was the ability to mentally distance oneself from the ISG, which required the strength to stand alone. This strength rests on what the empowerment framework calls self-confidence, a tool of autonomy that persisted here beyond evaluation into the moment of separation [10]. Individuals stopped identifying with the group’s collective struggle and began to prioritize their own reality over the comfort of belonging, separating their personal experience from the group’s atmosphere.

Distancing often started with validating one’s own reality in contrast to the group’s behavior. Individuals described no longer questioning the authenticity of their illness. Observing others’ exaggerated symptoms displayed for attention, they spoke of gaining clarity about their own condition and accepting their depression as a genuine issue to be managed, not a role to be performed. In their accounts, this contrast supported self-acceptance without the need for validation from the ISG.

Distancing also means perceiving personal progress by comparison. Participants described sensing that they had improved because they no longer shared the group’s deep despair. Seeing others still trapped in painful situations led them to feel they had moved forward, even if the ISG had not.

Finally, distancing means letting go of an environment that holds them back. Individuals came to see ISGs not as a source of support but as a burden. Staying in the group felt like sinking deeper into the same problems, so leaving becomes a necessary step toward moving on and embracing a new life.

Responsibility, in this context, refers to the transition from dependence on others to active management of one’s own health. This dimension did not first appear after exit. The felt obligation to protect one’s own health had helped drive the decision to leave and was already being acted on at the moment of disconnection. After withdrawal, that obligation matured into the sustained management of one’s own recovery. While some participants described having achieved full recovery, many remained in the process of healing. They came to feel that passively waiting for comfort from external sources was ineffective and that progress required proactive effort. In the empowerment framework, such responsibility encompasses developing goals, working with providers and others, taking on decision-making tasks, engaging in self-care, and living with the consequences of one’s choices [10].

Living with those consequences often came first. Leaving the group removed a familiar source of relief, and some participants described bearing the loneliness and uncertainty that followed.

Against this background, the journey toward responsibility unfolded across 3 themes. Participants redirected their personal energy, refined their avenues for recovery, and internalized recovery as a felt obligation.

The first step in assuming responsibility was to redirect one’s energy consciously. Rather than expending effort on the ISG, participants began to invest in their own lives. They shifted their focus from the distractions of the online environment to tangible actions in daily life. In their accounts, dwelling on group dynamics had drained their mental resources without yielding meaningful change. They therefore turned their attention to daily routines and practical tasks, where they felt able to exert genuine control.

Additionally, individuals channel their energy toward sources of constructive support. Taking responsibility means actively seeking out environments and relationships that foster growth, rather than perpetuate negativity. The emotional resources freed up by leaving the ISG are invested in new hobbies, meaningful connections, and activities that promote well-being.

Taking responsibility also meant curating a support system tailored to personal needs rather than relying on the unpredictable interactions of large ISGs. Individuals learn to prioritize safety and stability, often gravitating toward smaller, interest-based communities or even nonhuman forms of support, such as AI agents. In participants’ accounts, what these alternatives had in common was the absence of the volatility and judgment they had encountered in larger groups.

Furthermore, responsibility entailed acknowledging the physiological aspects of depression and seeking appropriate medical intervention. In their view, emotional support alone could not address the physiological underpinnings of their condition. Combining professional treatment with self-education was their way of working toward lasting recovery rather than temporary comfort.

For some participants, recovery was to be found not in conversation but in purposeful action. When neither peer support nor counseling brought relief, they turned to concrete goals, such as advancing their education or career, as a means of managing distress. In their accounts, achievement and progress became therapeutic, offering a sense of control and accomplishment.

Ultimately, responsibility meant internalizing recovery as a felt obligation, one recognized from within rather than imposed from outside. Individuals described no longer relying on the ISG for solutions and instead taking ownership of their healing process. In this shift, recovery was no longer a passive hope but an active commitment sustained by planning, self-care, and follow-through.

Some participants talked about how they learned to plan their own treatment, moving from vague discussions to concrete steps. Because ISGs often lack professional guidance, participants described having to navigate the complexities of medical care on their own.

Others emphasized the importance of self-care and daily discipline. Rather than surrendering to helplessness or rumination, they focus on practical routines and personal growth. Taking action, no matter how small, becomes their way of maintaining stability and fostering resilience.

Finally, some participants learned to derive their sense of worth from within, rather than seeking validation or security from the group. Having come to feel that depending on others for stability was precarious, they cultivate an internal foundation for self-esteem and well-being.

Not all participants, however, attributed this rebuilding to the exit itself. P10, whose treatment and self-education appear above, was explicit that her recovery had proceeded on its own track.

Her experience marked the limit of what can be attributed to withdrawal itself. Leaving could clear the space in which treatment and self-directed effort proceeded, but in accounts like hers, these efforts, not the exit, accounted for the recovery.

This study investigates the lived experiences of individuals with depression who choose to withdraw from ISGs. While previous research often interprets member attrition as a sign of intervention failure or waning motivation for mutual aid [19,25,57], our findings offer a different perspective. Withdrawal is not necessarily the termination of empowerment but can be an active strategic process. We conceptualize this as strategic withdrawal, a journey shaped by autonomy, courage, and responsibility. Through this process, participants disengage from dysfunctional digital connections and reclaim agency in their recovery. In the context of digital health, empowerment is thus not only about forming connections [3,11] but also about exercising the autonomy to disconnect when necessary.

The process of strategic withdrawal begins with a realistic reassessment of the ISG. Unlike studies that focus on the benefits of community support [3,11,12], this study shows that empowerment often arises when individuals come to perceive the group as limited or even harmful. This shift from idealized expectations to critical evaluation allowed participants to conserve their energy. Their accounts traced a movement from passive recipients to agents who made decisions based on their own well-being.

Leaving the group is also an act of courage. Whether the departure is abrupt or gradual, individuals break free from the inertia of habitual connection. Decisive exits establish boundaries through immediate action, while more measured withdrawals allow individuals to test their limits and reduce anxiety through rational trial. Both approaches demonstrate that empowerment involves the willingness to step outside familiar routines and reclaim control over personal boundaries.

Responsibility, finally, surfaced during evaluation as a felt obligation to protect one’s own health. This obligation was itself part of what drove the decision to leave. After withdrawal, responsibility matured into enacted self-management. Participants redirected their energy toward constructive activities and alternative forms of support, including offline pursuits and support from AI agents. They also came to treat recovery as their own undertaking. The movement here is not from one dimension to the next but from a germinal to a mature form within the same dimension.

Taken together, the 3 dimensions operated jointly rather than separately. Separation imposed from outside, with no choice exercised, was not experienced as empowering. Critical judgment alone did not amount to withdrawal until courage carried it into action. And responsibility was already present, in germinal form, in the very decision that autonomy grounded. Withdrawal took on its empowering character through this staggered unfolding and interplay across the process, rather than through any single dimension.

It is important to note that withdrawal is not without its challenges. Individuals must navigate the social isolation and uncertainty that can follow detachment. Nonetheless, many participants confronted these difficulties rather than remaining in a sense of belonging they no longer experienced as genuine. In their accounts, this choice reflected their maturation as active managers of their own recovery.

These claims are subject to limits that our negative cases made visible. Exits imposed from outside involved no exercise of choice. Some participants cycled between joining and leaving as their condition fluctuated, and their judgments proved provisional and reversible. Others attributed their recovery to treatment and self-directed effort and regarded the exit itself as inconsequential. Strategic withdrawal thus designates a particular kind of leaving rather than all forms of leaving, and the empowerment it carries should not be read as a property of attrition in general.

Our findings challenge the retention-focused paradigm that has dominated ISG research. Traditionally, empowerment has been equated with ongoing participation and frequent interaction [19,24], leading to the assumption that attrition signals failure [21,25,57]. However, this perspective overlooks the risk of digital dependency, where constant connectivity can undermine autonomy [10]. We argue that strategic withdrawal is not a setback but a corrective action. It is an exercise of autonomy and self-regulation when the group environment no longer supports recovery.

Strategic withdrawal also embodies courage. While previous studies highlight the role of anonymity and group empathy in fostering self-disclosure [3,11], our results suggest that leaving the comfort zone of an ISG requires equal, if not greater, bravery. Individuals must overcome the fear of loneliness and break free from the inertia of collective dependency to protect their personal boundaries [10]. In digital spaces rife with emotional contagion, empowerment is reflected not only in the ability to connect but also in the capacity to disconnect when necessary [37,38].

Finally, strategic withdrawal enacts a responsibility that had already begun to form before the exit. The felt obligation to protect one’s own health, which helped drive the decision to leave, matured after withdrawal into active self-management [10]. ISGs can serve as practice grounds for reintegration into real life [3], and those with greater motivation for recovery may choose to exit earlier [3]. In this sense, withdrawal is not necessarily a sign of failure but can signal progress: the transition from “digital patient” to an autonomous, self-sufficient individual.

Given the episodic and fluctuating nature of depression, individuals’ involvement in ISGs tends to evolve and fluctuate over time [3]. Building on prior research that highlights variations in participation styles [3,41,42], our study broadens this perspective by examining fluctuations not only in engagement but also in the processes of connection and disconnection. While previous research has focused on retention factors [19,24,25,57] and often portrayed participants as passive actors shaped by network positioning [13,21], our study reveals that individuals are capable of strategic, independent decision-making.

This perspective reframes high attrition rates in ISGs [19]. Rather than signaling intervention failure, attrition can be seen as a purposeful reallocation of energy in response to changing needs. Individuals do not simply wait for support; instead, they actively assess and adjust their resource use [3,58]. Withdrawal, like lurking or active posting, is a deliberate choice tailored to recovery goals [3]. The cyclical accounts in our data illustrate that withdrawal may function as a periodic adjustment rather than a permanent break. This recognition underscores that even disconnection can be part of an active, self-directed recovery process.

Our findings corroborate prior research on the pressures of constant online engagement and the risks of emotional contagion in ISGs [31-33]. When negative group dynamics lead to empathy fatigue, withdrawal becomes a vital strategy for managing digital boundaries [59]. What was once a sanctuary can become a source of emotional exhaustion [11,60], prompting individuals to sever ties and protect their energy.

More importantly, this act of boundary-setting is not an escape but a deliberate reconstruction of control. When individuals come to see the ISG as perpetuating a patient identity rather than supporting recovery, withdrawal becomes a means of self-governance [61]. The subsequent shift to AI-powered support or offline activities is not merely a change of environment but a move toward interactions that participants experienced as safer and more manageable. By choosing low-pressure interactions, individuals avoid information overload and unmet needs [3,11,30], reclaiming a sense of autonomy within more manageable boundaries [6].