Background: Adolescents participate in decision-making processes involving risky behaviors. Management of these important decisions may be promoted by enhancing adolescents' self-efficacy beliefs and cognitive autonomy. Objective: In order to elucidate the value of wilderness therapy to the successful management of decision making processes among adolescents at risk, this study aims to examine the effect of wilderness therapy participation on cognitive autonomy and self-efficacy. Methods: The sample consisted of 93 male adolescents at-risk aged 14-16 who study at boarding schools in Israel. Participants took part in a full wilderness therapy intervention, a partial one, or a control condition. Allocation was not randomized. Assessments included the cognitive autonomy and self evaluation inventory and the potency scale and were administered in 3 waves: pre-intervention, post-intervention, and at 5-month follow-up. Results: The intervention group showed a significant increase in cognitive autonomy following wilderness therapy participation when compared to controls in wave 2 and wave 3. Partial wilderness therapy participation engendered a significant increase in cognitive autonomy when compared to no participation. An identical pattern of findings was found for self-efficacy. Conclusion: This is the first report of significant cognitive autonomy benefits among male adolescents following wilderness therapy participation. Findings suggest that wilderness therapy may provide adolescents with the capacity to tackle decision-making dilemmas in a successful, constructive manner.