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The effect of wilderness therapy on adolescents’ cognitive autonomy and self-efficacy: Results of a non-randomized trial

Summary


Participation in a wilderness therapy program improves self-efficacy and cognitive autonomy in at-risk male adolescents

Wilderness therapy (WT) is a type of intervention often used to rehabilitate adolescents at risk of or already engaging in problematic behaviors. Features of WT programs typically include some use of outdoor settings, a model focused on improving communication, a group format, direct involvement of mental health professionals, and both one-on-one and group therapy sessions. There are numerous documented personal and interpersonal benefits of WT for adolescents. Self-efficacy (belief in one’s ability to organize and perform actions necessary for meeting future goals) and cognitive autonomy (ability to assess one’s thinking process, use deductive reasoning, express one’s stance, consider alternatives and their outcomes, conduct comparisons, and use self-evaluation and self-reflection skills) are related concepts that are important to decision-making processes and healthy behaviors. Past research indicates that WT can result in increases in self-efficacy, although research on WT and cognitive autonomy is limited. The major purpose of this study was to examine the effect of WT participation on self-efficacy and cognitive autonomy in hopes that results can contribute to enhanced knowledge regarding the prevention and discontinuation of risky behaviors in adolescents.

Study participants were students (n=93) at a boarding school in Israel specifically for adolescent males at risk of problematic behavior. All boarding school students were from low socioeconomic strata and had been referred to the school because they were identified as at-risk. The WT program was offered free to students by an outside agency and consisted of specific phases including ten weekly preparatory meetings, a four-day backpacking trip, and two closure meetings. During the preparatory meetings, participants completed outdoor experiential activities in a group format; activities were intended to teach useful skills for the backpacking trip. During the backpacking trip, participants performed individual and small group-based survival tasks and participated in group and individual reflection activities. The closure meetings served to help participants process the experience in a group therapy format. The study sample was made up of four groups from within the same boarding school: full intervention (n=21), control (n=29), and two partial intervention groups (n=31 and n=12). The partial intervention groups attended only the ten preparatory meetings, and the control group did not attend any meetings or the trip.

Demographic information collected included age and education, and outcomes were assessed through student-completed surveys. Assessments took place at the beginning of the WT program (wave 1), at the end of the program (wave 2), and 5 months after program completion (wave 3). Self-efficacy was measured using a potency scale consisting of four domains (self-confidence, mastery, alienation, and anomie). Cognitive autonomy was measured with a cognitive autonomy and self-evaluation inventory consisting of five subscales including evaluative thinking, voicing opinion, decision-making, self-assessing, and comparative validation. Quantitative data analysis was conducted to compare groups and their changes in self-efficacy and cognitive autonomy from baseline to program completion and at the time of the five-month follow-up.

At baseline, there were no significant differences in cognitive autonomy or self-efficacy between groups. Study results showed that both cognitive autonomy and self-efficacy significantly increased for the full intervention group when compared to the partial intervention groups, and for the partial intervention groups when compared to the control group. Improvements persisted from wave 2 to wave 3, although self-efficacy did not persist as well as cognitive autonomy in the intervention group. This is reported to be the first study to document the benefit of WT participation on cognitive autonomy in adolescents, and results are consistent with those from other studies on self-efficacy. The researchers posit that cognitive autonomy increases may be mediated through peer bonding and ego resilience, but these factors were not measured in the current study. Possible mechanisms associated with the positive increases in measures of cognitive autonomy and self-efficacy are discussed, including the role of challenging physical activities and the integration of therapeutic features throughout the entire program.

This study provides evidence that participation in WT can improve self-efficacy and cognitive autonomy in male adolescents that persists over several months. The study is well-designed, and strengths include an appropriate control group and a five-month follow-up period. There are several limitations, including lack of randomization, lack of generalizability, and issues with outcome measurement. The control group was significantly oldest but this likely had no effect on study outcomes, as the control group did not experience any improvements in outcomes. It is possible that groups differed by other unmeasured factors potentially related to study outcomes, including risk profile. Assessment tools used in the study were reliable, but validity was not reported. It is unclear how the potency scale used to measure self-efficacy compares to other standardized measures of self-efficacy used in the United States, and future research should utilize standard measures. In addition, the two primary outcomes were correlated, indicating they may not be different enough concepts to measure separately. It is unclear if improvements in the study are clinically or behaviorally significant. There is no discussion on the distinct role of spending time in wilderness on study outcomes, and future research should compare WT to other intensive therapy programs without a wilderness component. The current study adds to the literature on psychological benefits of WT among at-risk adolescents.

Citation

Margalit, D., Ben-Ari, A., (2014). The effect of wilderness therapy on adolescents’ cognitive autonomy and self-efficacy: Results of a non-randomized trial. Child Youth Care Forum, 43(2), 181-194.

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