Internal validity refers to establishing a causal relationship between a treatment and outcome. Some threats to internal validity include history effects from outside events between pre- and post-testing, maturation effects from natural physical/intellectual changes, and testing effects from taking a pre-test influencing later tests. Other threats are instrumentation changes affecting measurements, regression toward the mean for extreme pre-test scores, mortality from participant dropout, diffusion of treatment between groups, and experimenter bias from expected outcomes influencing results.