mediate treatment effects on abstinence from drugs, satisfying all criteria in the causal chain (Kiluk, Nich, Babuscio, & Carroll, 2010b). Also, increased self-efficacy has been found to mediate the relationship between drink refusal training (a specific ingredient of CBT) and drinking outcomes (Witkiewitz, Donovan, & Hartzler, 2012). Despite these findings, many trials have not found CBT to enhance coping or self-efficacy to a greater degree than comparison conditions, raining questions about the uniqueness of these mechanisms (Litt et al., 2008). Thus, consistent support for CBTs putative mechanisms of action remain elusive, as it does for many interventions (Emmelkamp et al., 2014).
