A Meta-analysis of Wilderness Therapy Outcomes for Private Pay Clients

Abstract

Wilderness therapy is becoming a more widely used intervention for adolescents, but there have not been any meta-analyses focused solely on its clinical effectiveness for private pay clients. This study’s objective was to conduct outcome-based meta-analyses of private-pay wilderness therapy programs, benchmark primary features of this approach, and educate the clinical community as to its effectiveness. The authors conducted a review of all available databases, as well as manual searches. Searches resulted in a meta-analysis based on 36 studies, totaling 2399 participants receiving wilderness therapy. Our meta-analyses found medium effect sizes for all six constructs assessed: self-esteem (g = 0.49), locus of control (g = 0.55), behavioral observations (g = 0.75), personal effectiveness (g = 0.46), clinical measures (g = 0.50) and interpersonal measures (g = 0.54). Subgroup analyses included age of participants, duration of program, open or closed model, presence of a mental health practitioner, and publication year.

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References

References marked with an asterisk indicate studies included in the meta-analysis

  1. *Anderson, A. L. (1995). Effect of a wilderness therapy program on youth-at-risk, as measured by locus of control and self concept (Master’s thesis). Brigham Young University, Provo, UT.

  2. *Bandoroff, S. (1992). Wilderness family therapy: An innovative treatment approach for problem youth. University of South Carolina.

  3. *Bateman, K. V. Jr. (1990). Changes in self-concept and behavior of adolescents in wilderness therapeutic camp (Doctoral dissertation). East Texas State University, Commerce, TX.

  4. Beck, A. T., Ward, C. H., Mendleson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    Article  PubMed  Google Scholar 

  5. Becker, S. P. (2010). Wilderness therapy: Ethical considerations for mental health professionals. Child & Youth Care Forum, 39, 47–61.

    Article  Google Scholar 

  6. Bedard, R. M., Rosen, L. A., & Vacha-Haase, T. (2003). Wilderness therapy programs for juvenile delinquents: A meta-analysis. Journal of Therapeutic Wilderness Camping, 3, 7–13.

    Google Scholar 

  7. Behrens, E., & Satterfield, K. (2006, August). Report findings from a multi-center study of youth outcomes in private residential treatment. Report presented at the 114th annual convention of the American Psychological Association, New Orleans, LO.

  8. Behrens, E., & Satterfield, K. (2008). Longitudinal family and academic outcomes in residential programs: How students function in two important areas of their lives. Journal of Therapeutic Schools and Programs, 2, 81–94.

    Google Scholar 

  9. *Bettmann, J. E. (2005). Shifts in attachment relationships: A quantitative study of adolescents in brief residential treatment (Doctoral dissertation). Smith College School for Social Work, Northampton, MA.

  10. Bettmann, J. E., & Jasperson, R. A. (2007). Adults in wilderness treatment: A unique application of attachment theory and research. Clinical Social Work Journal, 36, 51–61.

    Article  Google Scholar 

  11. *Bettmann, J. E., Russell, K. C., & Parry, K. J. (2012). How substance abuse recovery skills, readiness to change and symptom reduction impact change processes in wilderness therapy participants. Journal of Child and Family Studies, 22, 1039–1050. doi:10.1007/s10826-012-9665-2.

    Article  Google Scholar 

  12. Bettmann, J. E., & Tucker, A. (2011). Shifts in attachment relationships: A study of adolescents in wilderness treatment. Child & Youth Care Forum, 40, 499–519. doi:10.1007/s10566-011-9146-6.

    Article  Google Scholar 

  13. Bickman, L., Vides de Andrade, A. R., Lambert, E. W., Doucette, A., Saptya, J., Boyd, A. S., et al. (2004). Youth therapeutic alliance in intensive treatment setting. Journal of Behavioral Health Services & Research, 31, 134–148.

    Article  Google Scholar 

  14. Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2005). Comprehensive meta-analysis [computer program], version 2. Englewood, NJ: Biostat.

    Google Scholar 

  15. Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2009). Introduction to meta-analysis. West Sussex: Wiley.

    Book  Google Scholar 

  16. Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2014). Comprehensive meta-analysis [computer program], version 3. Englewood, NJ: Biostat.

    Google Scholar 

  17. Bowen, D. J., & Neill, J. T. (2013). A meta-analysis of adventure therapy outcomes and moderators. The Open Psychology Journal, 6, 28–53.

    Article  Google Scholar 

  18. Burlingame, G. M., Wells, M. G., & Lambert, M. J. (1995). The youth outcome questionnaire. Stevenson, MD: American Professional Credentialing Services.

    Google Scholar 

  19. Card, N. A. (2012). Applied meta-analysis for social science research. New York, NY: The Guilford Press.

    Google Scholar 

  20. Cason, D., & Gillis, H. L. (1994). A meta-analysis of outdoor adventure programming with adolescents. Journal of Experiential Education, 17, 40–47.

    Article  Google Scholar 

  21. Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18. doi:10.1037/0022-006X.66.1.7.

    Article  PubMed  Google Scholar 

  22. *Christensen, N. E. (2008). Effects of wilderness therapy on motivation and cognitive, emotional, and behavioral variables in adolescents (Doctoral dissertation). University of Kansas, Lawrence, KS.

  23. *Clark, J. P., Marmol, L. M., Cooley, R., & Gathercoal, K. (2004). The effects of wilderness therapy on the clinical concerns (on axes I, II, and IV) of troubled adolescents. Journal of Experiential Education, 27, 213–232.

    Article  Google Scholar 

  24. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  25. Crisp, S. (1996). International models of best practice in wilderness and adventure therapy: Implications for Australia (final report). Melbourne: Winston Churchill Fellowship.

  26. *Davis-Berman, J., & Berman, D. S. (1989). The wilderness therapy program: An empirical study of its effects with adolescents in an outpatient setting. Journal of Contemporary Psychotherapy, 19, 270–281.

    Google Scholar 

  27. Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.

    Article  PubMed  Google Scholar 

  28. *Eikenœs, I., Gude, T., & Hofart, A. (2006). Integrated wilderness therapy for avoidant personality disorder. Nordic Journal of Psychiatry, 60, 275–281.

    Article  Google Scholar 

  29. Ellis, P. D. (2010). The essential guide to effect sizes: An introduction to statistical power, meta-analysis and the interpretation of research results. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  30. *Ganapol, D. S. (2008). The transformative effects of a three-week adventure therapy program with adolescents: An exploration of trauma and resiliency (Master’s thesis). Smith College School for Social Work, Northampton, MA.

  31. Gass, M. A., Gillis, H. L., & Russell, K. E. (2012). Adventure therapy: Theory, research, & practice. New York, NY: Routledge.

    Google Scholar 

  32. Gerstein, D. R., & Harwood, H. J. (Eds.). (1990). Treating drug problems: A study of the evolution, effectiveness, and financing of public and private drug treatment systems. Washington, D.C.: National Academy Press.

    Google Scholar 

  33. *Hagan, J. D. (2002). An alternative therapy for the behaviorally challenged youth: The efficacy of wilderness therapy programs (Doctoral dissertation). The University of Toledo, OH.

  34. Hair, H. J. (2005). Outcomes for children and adolescents after residential treatment: A review of research from 1993 to 2003. Journal of Child and Family Studies, 14, 551–575.

    Article  Google Scholar 

  35. *Harper, N. J. (2009). The relationship of therapeutic alliance to outcome in wilderness treatment. Journal of Adventure Education and Outdoor Learning, 9, 45–59.

    Article  Google Scholar 

  36. *Harper, N. J., & Russell, K. C. (2008). Family involvement and outcome in adolescent wilderness treatment: A mixed-methods evaluation. International Journal of Child & Family Welfare, 1, 19–36.

    Google Scholar 

  37. *Harper, N. J., Russell, K. C., Cooley, R., & Cupples, J. (2007). Catherine Freer wilderness therapy expeditions: An exploratory case study of adolescent wilderness therapy, family functioning, and the maintenance of change. Child & Youth Care Forum, 36, 111–129.

    Article  Google Scholar 

  38. *Harrison, M. M. (1999). Predictors of self-concept growth in youth at risk in wilderness therapy programs (Master’s thesis). Southern Illinois University at Corbondale, IL.

  39. Hattie, J., Marsh, H. W., Neill, J. T., & Richards, G. E. (1997). Adventure education and outward bound: Out-of-class experiences that make a lasting difference. Review of Educational Research, 67, 43–87.

    Article  Google Scholar 

  40. *Haywood, M. M. (2001). The effect of wilderness therapy on the self-concept of adolescents (Master’s thesis). California State University Hayward, CA.

  41. *Herrity, G. C. (2009). A follow-up study exploring the transformative effects of wilderness therapy on adolescents with histories of trauma (Master’s thesis). Smith College of Social Work, Northampton, MA.

  42. Higgins, J. P., & Green, S. (Eds.). (2008). Cochrane handbook for systematic reviews of interventions (Vol. 5). Chichester: Wiley-Blackwell.

    Google Scholar 

  43. *Hoag, M. J., Massey, K. E., Roberts, S. D., & Logan, P. (2013). Efficacy of wilderness therapy for young adults: A first look. Residential Treatment for Children & Youth, 30, 294–305. doi:10.1080/0886571X.2013.852452.

    Article  Google Scholar 

  44. Hooper, S. R., Murphy, J., Devaney, A., & Hultman, T. (2000). Ecological outcomes of adolescents in a psychoeducational residential treatment facility. American Journal of Orthopsychiatry, 70, 491–500.

    Article  PubMed  Google Scholar 

  45. Jeppson, M. (2008). Characterization and comparative analysis of adolescents admitted to therapeutic wilderness programs and more traditional treatment settings (Doctoral dissertation). Retrieved from Proquest dissertations and theses database (AAT 3318622).

  46. Kanas, N. (1988). Therapy groups for schizophrenic patients on acute care units. Hospital & Community Psychiatry, 39, 546–549.

    Google Scholar 

  47. Kimball, R. O., & Bacon, S. B. (1993). The wilderness challenge model. In M. Gass (Ed.), Adventure therapy: Therapeutic applications of adventure programming (pp. 11–41). Dubuque, IA: Kendall-Hunt Publishing.

    Google Scholar 

  48. Knorth, E. J., Harder, A. T., Zandberg, T., & Kendrick, A. J. (2008). Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care. Children & Youth Services Review, 30, 123–140. doi:10.1016/j.childyouth.2007.09.001.

    Article  Google Scholar 

  49. *Kraus, I. W. (1982). The effectiveness of wilderness therapy with emotionally disturbed adolescents (Doctoral dissertation). Georgia State University, Atlanta, GA.

  50. *Larson, B. A. (2007). Adventure camp programs, self-concept and their effects on behavioral problem adolescents. Journal of Experiential Education, 29, 313–330.

    Article  Google Scholar 

  51. *Lewis, B. A. (1994). The use of art and wilderness experience to increase hope in adolescents: An exploration of an intervention (Master’s thesis). College of Notre Dame, Belmont, CA.

  52. *Lewis, S. F. (2013). Examining changes in substance use and conduct problems among treatment-seeking adolescents. Child and Adolescent Mental Health, 18, 33–38. doi:10.1111/j.1475-3588.2012.00657.x.

    Article  Google Scholar 

  53. Lorentzen, S., Høglend, P., & Ruud, T. (2008, June). The efficacy of short‐ and long‐term psychodynamic group psychotherapy. A Norwegian multi‐center study. Panel presentation at the annual meeting of the Society for Psychotherapy Research, Barcelona, Spain.

  54. *Lowe, T. A. (2005). The effectiveness of Anasazi: A wilderness treatment program (Doctoral dissertation). Brigham Young University, Provo, UT.

  55. Magle-Haberek, N., Tucker, A. R., & Gass, M. A. (2012). Effects of program differences with wilderness therapy and residential treatment center (RTC) programs. Residential Treatment for Children & Youth, 29, 202–218.

    Article  Google Scholar 

  56. *Martinez, M. C. (2002). A wilderness therapy program for a diverse group of at risk adolescent boys: Changes in self-esteem and locus of control and there relationship to group affiliation (Doctoral dissertation). The California School of Professional Psychology, San Francisco Bay Campus, San Francisco, CA.

  57. Millon, T., Millon, C., & Davis, R. (1993). The Millon Adolescent Clinical Inventory. Minneapolis, MN: NGS Assessments.

    Google Scholar 

  58. Moses, T. (2000). Attachment theory and residential treatment: A study of staff–client relationships. American Journal of Orthopsychiatry, 70, 474–490.

    Article  PubMed  Google Scholar 

  59. *Mulvaney, T. R. (2011). Efficacy of outdoor therapy interventions: Meeting life skills and well-being objectives for at-risk young people? A mixed methods evaluation. Bachelor of Science in Psychology (Honours), University of Canberra, Bruce, Australia.

  60. Neill, J. T., Marsh, H. W., & Richards, G. E. (1997). Development and psychometrics of the Life Effectiveness Questionnaire. Sydney: University of Western Sydney.

    Google Scholar 

  61. Newes, S. L., & Doherty, T. J. (2007). Evaluating wilderness therapy as an option for treatment resistant adolescents. Paper presented at 2007 American Psychological Association Convention, San Francisco, CA.

  62. Norcross, J. C. (2002). Empirically supported therapy relationships. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 3–16). New York: Oxford University Press.

    Google Scholar 

  63. *Norton, C. L. (2007). Understanding the impact of wilderness therapy on adolescent depression and psychosocial development (Doctoral dissertation). Loyola University Chicago, Chicago, IL.

  64. Norton, C., Tucker, A., Russell, K., Bettmann, J. E., Gass, M., Gillis, H. L., & Behrens, E. (2014). Adventure therapy with youth: A state of knowledge paper. Journal of Experiential Education, 37, 46–59. doi:10.1177/1053825913518895.

    Article  Google Scholar 

  65. Nowicki, S., & Strickland, B. (1973). A locus of control scale for children. Journal of Consulting and Clinical Psychology, 40, 148–154.

    Article  Google Scholar 

  66. *Nurenberg, S. J. G. (1985). Psychological development of borderline adolescents in wilderness therapy (Doctoral dissertation). Smith College, Northampton, MA.

  67. *Pawlowski, M., Holme, G., & Hafner, R. J. (1993). Wilderness therapy for psychiatric disorder. Mental Health in Australia, 1, 8–14.

    Google Scholar 

  68. *Price, R., & DeBever, M. (1998). The windana therapeutic community’s action adventure program. In Exploring the boundaries of adventure therapy: International perspectives. Proceedings of the international adventure therapy conference (1st, Perth, Australia, July, 1997).

  69. *Rice, S. (1988). A study of the impact of long-term therapeutic camping on self-concept development among troubled youth (Doctoral dissertation). University of South Florida, Tampa, FL.

  70. Rodgers, J. H., & Barnett, P. G. (2000). Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs. American Journal of Drug and Alcohol Abuse, 26, 429–442.

    Article  PubMed  Google Scholar 

  71. *Romi, S., & Kohan, E. (2004). Wilderness programs: Principles, possibilities and opportunities for intervention with dropout adolescents. Child & Youth Care Forum, 33, 115–136.

    Article  Google Scholar 

  72. *Ronalds, L., & Allen-Craig, S. (2008). Preventing family and educational disconnection through wilderness-based therapy targeting youth at risk. ACHPER Healthy Lifestyles Journal, 55, 7–16.

    Google Scholar 

  73. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

    Book  Google Scholar 

  74. Russell, K. C. (1999). Theoretical basis, process, and reported outcomes of wilderness therapy as an intervention and treatment for problem behavior in adolescents (Doctoral dissertation). Retrieved from Proquest dissertations and theses database (AAT 9954110).

  75. Russell, K. C. (2000). Exploring how the wilderness therapy process relates to outcomes. Journal of Experiential Education, 23, 170–176.

    Article  Google Scholar 

  76. Russell, K. C. (2001). What is wilderness therapy? Journal of Experiential Education, 24, 70–79.

    Article  Google Scholar 

  77. *Russell, K. C. (2003). An assessment of outcomes in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 32, 355–381.

    Article  Google Scholar 

  78. Russell, K. C. (2005). Two years later: A qualitative assessment of youth well-being and the role of aftercare in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 34, 209–239. doi:10.1007/s10566-005-3470-7.

    Article  Google Scholar 

  79. Russell, K. C. (2007). Adolescent substance-use treatment: Service delivery, research on effectiveness, and emerging treatment alternatives. Journal of Groups in Addiction & Recovery, 2, 68–96.

    Article  Google Scholar 

  80. Russell, K. C., Gillis, H. L., & Lewis, T. G. (2008). A five-year follow-up of a survey of north American outdoor behavioral healthcare programs. Journal of Experiential Education, 31, 55–77.

    Article  Google Scholar 

  81. Russell, K. C., & Hendee, J. C. (2000). Outdoor behavioral healthcare: Definitions, common practice, expected outcomes, and a nationwide survey of programs (technical report no. 26). Retrieved from Idaho University at Moscow Wilderness Research Center website. http://www.its.uidaho.edu/wrc/pdf/obhpublication.pdf.

  82. Russell, K. C., Hendee, J. C., & Phillips-Miller, D. (1999). How wilderness therapy works: An evaluation of the wilderness therapy process to treat adolescents with behavioral problems and addictions. In D. N. Cole & S. F. McCool (Eds.), Proceedings: Wilderness science in a time of change (pp. 207–217). Ogden, UT: U.S. Department of Agriculture, Forrest Services, Rocky Mountain Research Station.

    Google Scholar 

  83. Russell, K. C., & Phillips-Miller, D. (2002). Perspectives on the wilderness therapy process and its relation to outcome. Child & Youth Care Forum, 31, 415–437.

    Article  Google Scholar 

  84. *Shin, W. S., Shin, C. S., & Yeoun, P. S. (2012). The influence of forest therapy camp on depression in alcoholics. Environmental Health and Preventative Medicine, 17, 73–76. doi:10.1007/s12199-011-0215-0.

    Article  Google Scholar 

  85. Steenbarger, B. N. (1994). Duration and outcome in psychotherapy: An integrative review. Professional Psychology: Research and Practice, 25, 111–119.

    Article  Google Scholar 

  86. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2008). Mental health service use among youths aged 12 to 17: 2005 and 2006. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

    Google Scholar 

  87. Tourigny, M., & Hebert, M. (2007). Comparison of open versus closed group interventions for sexually abused adolescent girls. Violence and Victims, 22, 334–349.

    Article  PubMed  Google Scholar 

  88. *Tucker, A., Bettmann, J. E., Norton, C., & Comart, C. (2015). The role of transport use in adolescent wilderness treatment: Its relationship to readiness to change and outcomes. Child & Youth Care Forum, 44, 671–686. doi:10.1007/s10566-015-9301-6.

    Article  Google Scholar 

  89. U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: Author.

    Google Scholar 

  90. *Vissell, R. (2004). Effects of wilderness therapy on youth at risk’s concept of self and other: A deeper understanding of the journey (Doctoral dissertation). Institute of Transpersonal Psychology, Palo Alto, CA.

  91. West, M., Rose, M. S., Spreng, S., Sheldon-Keller, A., & Adam, K. (1998). Adolescent attachment questionnaire: A brief assessment of attachment in adolescence. Journal of Youth and Adolescence, 27, 661–673.

    Article  Google Scholar 

  92. Wilson, S. J., & Lipsey, M. W. (2000). Wilderness challenge programs for delinquent youth: A meta-analysis of outcome evaluations. Evaluation and Program Planning, 23, 1–12.

    Article  Google Scholar 

  93. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York: Basic Books.

    Google Scholar 

  94. Young, M. C., & Gass, M. (2010). Preliminary data from the NATSAP research and evaluation network: Client characteristics at admission. Journal of Therapeutic Schools and Programs, 4, 80–105.

    Google Scholar 

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Bettmann, J.E., Gillis, H.L., Speelman, E.A. et al. A Meta-analysis of Wilderness Therapy Outcomes for Private Pay Clients. J Child Fam Stud 25, 2659–2673 (2016). https://doi.org/10.1007/s10826-016-0439-0

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Keywords

  • Wilderness therapy
  • Therapeutic outcomes
  • Meta-analysis
  • Adolescents
  • Private-pay
  • Outdoor behavioral healthcare