Experiential Interventions for Externalizing Behavior: A Multilevel Meta-Analysis of Adolescents and Adults

Abstract

This meta-analysis examined the effectiveness of experiential interventions in reducing persistent externalizing behavior among adolescents and adults, and whether integrating cognitive-behavioral therapy (CBT) components enhances outcomes. Following PRISMA guidelines, a systematic search of ERIC, MEDLINE, PsycINFO, and Ovid identified 39 studies, yielding 123 effect sizes (N = 2,323). A three-level meta-analytic model with moderator analyses was conducted. Experiential interventions showed a significant medium effect in favor of the interventions compared to control conditions (g = 0.66). Interventions integrating CBT produced larger effects (g = 0.83) than those without CBT (g = 0.43), with the strongest effects for responsive CBT (g = 1.04 vs. g = 0.59). Treatment fidelity and active system involvement significantly moderated outcomes. Findings support integrating CBT within experiential approaches while ensuring high treatment fidelity and system involvement. Clinicians should combine CBT with experiential techniques and engage others to enhance responsiveness and therapeutic safety.

Plain Language Summary

How Effective Are Experiential Treatments For Reducing Aggressive and Antisocial Behavior?

Some adolescents and adults show persistent problem behavior, such as aggression, breaking rules, criminal behavior, or inappropriate sexual behavior. These behaviors often continue over time and can cause harm to others. They are therefore a major focus in forensic mental health care (treatment for people who have come into contact with the justice system). This study examined whether experiential interventions help reduce this type of behavior. These are treatments in which people learn by doing and experiencing, for example through role-play, mindfulness exercises, imagery, or body-focused activities. The goal is to help them better understand their emotions, thoughts, and behavior, and to respond in more helpful ways. We also examined whether combining these approaches with cognitive behavioral therapy (CBT)—a therapy that focuses on changing thoughts and behavior—leads to better results. We analyzed 39 studies with a total of 2,323 participants. Overall, these interventions led to moderate reductions in problem behavior, such as aggression and rule-breaking. Treatments that combined experiential methods with CBT were more effective than experiential methods alone. The strongest effects were found for CBT approaches that are adapted to the needs and characteristics of the individual (often referred to as “responsive CBT”). Results were also better when the treatment was carried out as intended and when people from the individual’s environment, such as family members or professionals, were involved. In sum, combining experiential techniques with CBT, tailoring treatment to the individual, and involving the social environment may improve treatment outcomes and help reduce reoffending.