An investigation into the factor structure of the Cognitive Therapy Scale - Revised (CTS-R) in a CBT training sample

• Published in: Behavioural and cognitive psychotherapy 2021-11, Vol.49 (6), p.721-731
• Main Authors: Beale, Sarah, Vitoratou, Silia, Liness, Sheena
• Format: Article
• Language: English
• ISSN: 1352-4658; 1469-1833
• DOI: 10.1017/S1352465820000983

Effective monitoring of cognitive behaviour therapy (CBT) competence depends on psychometrically robust assessment methods. While the UK Cognitive Therapy Scale - Revised (CTS-R; Blackburn ., ) has become a widely used competence measure in CBT training, practice and research, its underlying factor structure has never been investigated. This study aimed to present the first investigation into the factor structure of the CTS-R based on a large sample of postgraduate CBT trainee recordings. Trainees ( = 382) provided 746 mid-treatment audio recordings for depression ( = 373) and anxiety ( = 373) cases scored on the CTS-R by expert markers. Tapes were split into two equal samples counterbalanced by diagnosis and with one tape per trainee. Exploratory factor analysis was conducted. The suggested factor structure and a widely used theoretical two-factor model were tested with confirmatory factor analysis. Measurement invariance was assessed by diagnostic group (depression versus anxiety). Exploratory factor analysis suggested a single-factor solution (98.68% explained variance), which was supported by confirmatory factor analysis. All 12 CTS-R items were found to contribute to this single factor. The univariate model demonstrated full metric invariance and partial scalar invariance by diagnosis, with one item (item 10 - Conceptual Integration) demonstrating scalar non-invariance. Findings indicate that the CTS-R is a robust homogenous measure and do not support division into the widely used theoretical generic versus CBT-specific competency subscales. Investigation into the CTS-R factor structure in other populations is warranted.