post treatment gains
Therapeutic efficacy — the demonstrable power of a treatment to produce meaningful and lasting improvement in those who receive it — occupies a contested and richly debated space within the depth-psychology and allied clinical literatures. The corpus reveals at least three major fault lines. First, an epistemological tension persists between efficacy studies (tightly controlled RCTs establishing causal warrant) and effectiveness studies (naturalistic field research capturing real-world complexity), with Chambless and Hollon arguing forcefully that independent replication within controlled experimentation is the sine qua non of established efficacy, while Avery’s therapeutic-community literature cautions that such standards can unjustly marginalise treatment-resistant populations excluded from trials by design. Second, there is the question of what outcomes best index efficacy: sustained abstinence, symptom reduction, social adjustment, self-efficacy gains, occupational functioning, and cost-benefit profiles all appear as candidate benchmarks across the corpus, reflecting deep disagreement about what therapy is for. Third, the temporal dimension complicates appraisal: Abbass documents that psychodynamic therapies show gains that increase rather than decay at follow-up, Bowen’s adventure-therapy meta-analysis confirms maintenance of short-term gains over time, and Chambless insists that durability of change is itself a dimension of efficacy. Together these voices establish therapeutic efficacy not as a fixed property of a method but as a multi-dimensional, population-sensitive, and temporally extended judgment.
A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious.
Chambless and Hollon establish the foundational criteria — centred on controlled replication — by which psychological treatments are formally designated as efficacious, creating the field’s dominant evaluative framework.
, Defining Empirically Supported Therapies, 1998thesis
the utility of effectiveness (as opposed to efficacy) studies in treatment-resistant clinical populations and interventions whose complexity rivals that of a university education should not be discounted
Avery argues that the efficacy/effectiveness distinction is consequential for treatment-resistant populations, and that privileging RCT-based efficacy evidence alone risks excluding the most clinically relevant data.
, The Opioid Epidemic and the Therapeutic Community Model: An Essential Guide, 2019thesis
in each of somatic symptoms, depressive symptoms, anxiety, general symptoms, social adjustment and interpersonal problems, the treatment effect sizes were greater in long-term follow-up
Abbass’s meta-analysis demonstrates that short-term psychodynamic psychotherapy produces post-treatment gains that amplify over time, challenging assumptions that therapeutic efficacy is captured adequately at discharge.
, Short-term psychodynamic psychotherapies for common mental disorders, 2014thesis
only when a treatment has been found efficacious in at least two studies by independent research teams do we consider its efficacy to have been established and label it an efficacious treatment.
The criterion of independent replication is identified as the essential safeguard against investigator bias and idiosyncratic findings in claims of therapeutic efficacy.
, Defining Empirically Supported Therapies, 1998thesis
the largest published psychodynamic psychotherapy meta-analysis to date likewise found significantly increased gains in follow-up compared with immediately post treatment in a group of 46 studies
Converging meta-analytic evidence confirms that psychodynamic post-treatment gains are durable and increase at follow-up, substantiating a distinctive temporal profile of efficacy for this modality.
, Short-term psychodynamic psychotherapies for common mental disorders, 2014thesis
adventure therapy offers a moderately effective treatment modality for improving psychological and/or behavioural functioning, and can be a beneficial counterpart to already established treatments.
Bowen’s comprehensive meta-analysis establishes that adventure therapy yields moderate, statistically significant short-term efficacy with maintenance of gains over time, positioning it as an empirically supportable complement to established treatments.
, A Meta-Analysis of Adventure Therapy Outcomes and Moderators, 2013thesis
Three studies have reported not merely null but adverse outcomes of MI with clients who were ready for change prior to the intervention
Miller documents that the therapeutic efficacy of Motivational Interviewing is population-specific, with client readiness-to-change constituting a critical moderator that can reverse expected benefit into harm.
, Motivational Interviewing: Helping People Change, Third Edition, 2013thesis
Psychological treatments have long been presumed to have more stable effects than pharmacotherapy, either because they redress underlying propensities that contribute to risk or because patients acquire stable skills
Chambless identifies durability as a theoretically grounded dimension of therapeutic efficacy, distinguishing psychological treatments from pharmacotherapy on the basis of stable skill acquisition.
, Defining Empirically Supported Therapies, 1998supporting
even if they were, the important point is that meta-analyses do not eliminate the need to make informed judgments about the quality of the studies reviewed
Chambless cautions that quantitative aggregation in meta-analyses cannot substitute for substantive expert judgment when evaluating the evidential basis of therapeutic efficacy claims.
, Defining Empirically Supported Therapies, 1998supporting
the current work was aimed at investigating the effect of a manualized bouldering psychotherapy (BPT) on perceived self-efficacy in people with depression, compared with a home-based physical exercise program (EP) and state-of-the-art cognitive behavioral group therapy (CBT).
Kratzer frames the RCT as a rigorous test of whether bouldering psychotherapy can match established treatments in producing self-efficacy gains, operationalising therapeutic efficacy through manualized, comparative design.
, Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial, 2021supporting
no differences were found between BPT and CBT with respect to positive effects on self-efficacy, which suggests that BPT should be used in health care besides state-of-the-art CBT.
Equivalent self-efficacy gains in BPT and CBT provide evidence that therapeutic efficacy is not exclusive to established verbal therapies and can be achieved through embodied, activity-based modalities.
, Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial, 2021supporting
MI is intended to influence client factors that are associated with positive outcomes such as hope, self-efficacy, and active engagement
Miller situates MI’s therapeutic efficacy within a common-factors framework, arguing that its mechanisms operate through potentiating client-side variables including self-efficacy and hope.
, Motivational Interviewing: Helping People Change, Third Edition, 2013supporting
it is useful to consider the extent to which evidence from efficacy trials is relevant to the kinds of patients actually seen in clinical practice
Chambless foregrounds external validity as a bridge problem between laboratory-derived efficacy evidence and clinical utility, arguing that the generalisability of RCT findings must be explicitly examined.
, Defining Empirically Supported Therapies, 1998supporting
those disorders that tend to follow a more variable course require longer follow-ups than those that tend to be more stable over time.
Chambless argues that optimal follow-up duration for post-treatment assessment is disorder-specific, reflecting the insight that therapeutic efficacy must be evaluated against the natural course of the presenting condition.
, Defining Empirically Supported Therapies, 1998supporting
youth who participated in OBH had 36 points of change greater than youth. In addition, this regression model accounted for 29.4% of the variances in Time 2 Y-OQ 2.01 total scores
DeMille quantifies the efficacy advantage of outdoor behavioural healthcare over a comparison condition, demonstrating clinically meaningful differential change that persists to one-year post-treatment.
, The effectiveness of outdoor behavioral healthcare with struggling adolescents: A comparison group study, 2018supporting
indicating retention of short-term gains, and ranging in size from very small negative (Social Development, -.06) to small positive (Physical, .23)
Bowen’s outcome-category analysis reveals that adventure therapy’s post-treatment gains are retained rather than reversed at follow-up, though effect magnitudes vary considerably by domain.
, A Meta-Analysis of Adventure Therapy Outcomes and Moderators, 2013supporting
Treatment approaches that focus on gradual development of self competence in relation to real-life problems and settings have been shown to have optimal treatment effects
Russell identifies incremental, real-world self-competence development as the mechanism underlying optimal treatment efficacy in outdoor behavioural healthcare.
, An Assessment of Outcomes in Outdoor Behavioral Healthcare Treatment, 2003supporting
the time is rapidly approaching when unsystematic clinical impressions will no longer suffice to document a treatment’s value, particularly when alternative treatments
Chambless argues that the evidential bar for therapeutic efficacy is rising, and that reliance on uncontrolled clinical experience is no longer defensible when systematic alternatives exist.
, Defining Empirically Supported Therapies, 1998supporting
For a designation of efficacious and specific, the EST must have been shown to be statistically significantly superior to pill or psychological placebo or to an alternative bona fide treatment in at least two independent research settings.
Chambless specifies the most demanding level of efficacy designation, requiring superiority over credible active comparators across independent sites to establish specificity of therapeutic action.
, Defining Empirically Supported Therapies, 1998supporting
Major patient attributes include motivation for change, readiness for treatment, and problem severity at intake — the types of measures believed to be important for deciding treatment program placement
Simpson’s process model situates pre-treatment patient attributes as determinants of differential therapeutic efficacy, arguing that intake characteristics shape which patients benefit from which programmes.
, A conceptual framework for drug treatment process and outcomes, 2004supporting
Enhanced perceived self-efficacy is also regarded as an important protective factor that promotes psychological resilience.
Kratzer positions self-efficacy enhancement as both a proximal outcome and a mechanism of therapeutic benefit, linking it to resilience, reduced depression, and improved coping.
, Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial, 2021supporting
post hoc pairwise comparisons showed significant differences between pre- and posttreatment for all three subscales for males and females
Russell documents significant pre-to-post symptom reduction across gender on all measured subscales, with partial maintenance at six-month follow-up, providing outcome evidence for wilderness treatment efficacy.
, Adolescent Substance-use Treatment: Service Delivery, Research on Effectiveness, and Emerging Treatment Alternatives, 2008supporting
Eight studies were included in the meta-analysis for interpersonal outcome measures… These studies yielded an overall Hedge’s g of 0.54
Bettmann’s meta-analysis quantifies a medium effect size for interpersonal outcomes in private-pay wilderness therapy, contributing domain-specific efficacy evidence within a residential treatment population.
, A Meta-analysis of Wilderness Therapy Outcomes for Private Pay Clients, 2016supporting
research has used a broader array of outcomes to measure the effectiveness of treatment, which can be subsumed under the concept of tertiary prevention
McPheeters documents a paradigm shift in how AUD treatment efficacy is operationalised, moving beyond abstinence to include harm-reduction outcomes that better reflect patient-relevant goals.
, Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings: Systematic Review, 2023supporting
de Jonghe 2001 specifically compared dropout rates between STPP added to treatment with medications versus medications alone. They found a 10% dropout rate using STPP plus medication versus 40% for medication alone.
Abbass presents dropout rates as an index of therapeutic viability, with markedly lower attrition in STPP conditions suggesting superior treatment engagement and implicitly supporting real-world efficacy.
, Short-term psychodynamic psychotherapies for common mental disorders, 2014supporting
marital and family problems, accompanied with successful problem resolution, have also been reported to increase the alcoholic family member’s chances of resuming abstinence following relapse
Benda notes that relational factors can amplify long-term therapeutic gains following relapse, indicating that efficacy in alcohol treatment is partly mediated by systemic interpersonal dynamics.
, Spirituality and Religiousness and Alcohol/Other Drug Problems: Treatment and Recovery Perspectives, 2006aside
Therapeutic alliance Self-efficacy
Brower enumerates therapeutic alliance and self-efficacy among the factors moderating treatment adherence and relapse risk, implicitly situating these as determinants of sustained therapeutic efficacy.
, Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances, 2010aside
The pre-readiness to change score depicted the client’s willingness to engage in treatment at the onset of the wilderness therapy experience, while the change in pre-readiness score indicated how motivation had shifted during the experience.
Bettmann operationalises motivational change as a predictor of symptom reduction, treating readiness-to-change as a mediating mechanism through which wilderness therapy achieves its efficacy.
, How Substance Abuse Recovery Skills, Readiness to Change and Symptom Reduction Impact Change Processes in Wilderness Therapy Participants, 2013aside
the relationship between depression at baseline and postintervention was partially mediated (23%) by perceived self-efficacy only in the CBT group
Mediation analysis localises self-efficacy as a treatment-specific mechanism of efficacy within CBT but not BPT, introducing important mechanistic nuance into interpretation of overall outcome equivalence.
, Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial, 2021aside