Skip to main content
SpringerLink
Log in

Assessing Patients’ Cognitive Therapy Skills: Initial Evaluation of the Competencies of Cognitive Therapy Scale

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

In cognitive therapy (CT), therapists work to help patients develop skills to cope with negative affect. Most current methods of assessing patients’ skills are cumbersome and impractical for clinical use. To address this issue, we developed and conducted an initial psychometric evaluation of self- and therapist-reported versions of a new measure of CT skills: the Competencies of Cognitive Therapy Scale (CCTS). We evaluated the CCTS at intake and post-treatment in a sample of 67 patients participating in CT. The CCTS correlated with a preexisting measure of CT skills (the Ways of Responding Questionnaire) and was also related to concurrent depressive symptoms. Across CT, self-reported improvements in CT competencies were associated with greater changes in depressive symptoms. These findings offer initial evidence for the validity of the CCTS. We discuss the CCTS in comparison with other measures of CT skills and suggest future research directions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. The papers reporting on these measures were published after data collection for this study was underway.

  2. In a parallel analysis, one compares the eigenvalues obtained from an EFA to the corresponding values obtained from a randomly generated dataset with the same number of observations and variables. The number of factors to retain is indicated by the number of eigenvalues from the observed data that exceed the corresponding values from the random dataset. For the parallel analysis of CCTS-SR at intake, the first two eigenvalues from the observed data were 10.38 and 2.08; the values generated by the parallel analysis were 2.73 and 2.41. For the parallel analysis of CCTS-SR at the post-treatment assessment, the first two eigenvalues from the observed data were 15.66 and 1.70; the values generated by the parallel analysis were 3.09 and 2.69. Finally, for the parallel analysis of CCTS-TR, the first two eigenvalues from the observed data were 6.86 and .73; the values generated by the parallel analysis were 1.96 and 1.61. Thus, each analysis suggested a one factor solution.

  3. Because the comparison of patients at intake with control participants was limited to those patients who went on to complete treatment, the difference we detected could have been due in part to differences in CCTS-SR scores among patients who did and did not complete treatment. However, when we compared the control sample to all patients at intake, we still found a comparably large, significant difference in CCTS-SR scores (d = 1.14, t (118) = 6.19, p < .0001). Moreover, treatment completers and dropouts did not differ in initial skill level (d = .34, t(75) = 1.47, p = .14).

  4. For each of the relations of the CCTS-SR at intake reported in Table 1, we also examined whether these same relations were evident when we limited the sample to those patients who went on to complete treatment. All significant effects in Table 1 remained significant, with the sole exception of the relation of the CCTS-SR and WOR quality scores, which was a non-significant trend.

  5. One might be concerned that our matched control sample was limited to the 44 patients who completed treatment. We reran these analyses in a combined, intake sample of the 44 controls and the 44 patients who eventually completed treatment. All significant relationships remained when examining the Spearman correlations between WOR quality and the CCTS-SR after partialling out depressive symptoms.

References

  • Adler, A. D., Conklin, L., & Strunk, D. R. (2013). Quality of coping skills predicts depressive symptom reactivity over repeated stressors. Journal of Clinical Psychology, 69, 1228–1238.

    Article  PubMed  PubMed Central  Google Scholar 

  • Adler, A. D., Strunk, D. R., & Fazio, R. H. (2014). What changes in cognitive therapy for depression? An examination of cognitive therapy skills and maladaptive beliefs (submitted).

  • Barber, J. P., & DeRubeis, R. J. (1992). The ways of responding: A scale to assess compensatory skills taught in cognitive therapy. Behavioral Assessment, 14, 93–115.

    Google Scholar 

  • Barber, J. P., & DeRubeis, R. J. (2001). Change in compensatory skills in cognitive therapy for depression. Journal of Psychotherapy Practice and Research, 10, 8–13.

    PubMed  CAS  PubMed Central  Google Scholar 

  • Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Hoeber. Republished as Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.

  • Beck, A. T. (1976). Cognitive therapy and emotional disorders. New York: International Universities Press.

    Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, B. K. (1996). Beck depression inventory manual (2nd ed.). San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Connolly Gibbons, M. B., Crits-Christoph, P., Barber, J. P., Stirman, S. W., Gallop, R., Goldstein, L. A., et al. (2009). Unique and common mechanisms of change across cognitive and dynamic psychotherapies. Journal of Consulting and Clinical Psychology, 77, 801–813.

    Article  PubMed Central  Google Scholar 

  • DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., et al. (2005). Cognitive therapy vs. medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–416.

    Article  PubMed  Google Scholar 

  • Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., et al. (1989). National Institute of Mental Health treatment of depression collaborative research program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971–982.

    Article  PubMed  CAS  Google Scholar 

  • First, M. B., Spitzer, R. L., Miriam, G., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition. (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.

  • Gotlib, I. H. (1984). Depression and general psychopathology in university students. Journal of Abnormal Psychology, 93, 19–30.

    Article  PubMed  CAS  Google Scholar 

  • Hamilton, M. (1960). A rating scale for depression. Journal of Neurological Neurosurgical Psychiatry, 23, 56–62.

    Article  CAS  Google Scholar 

  • Hundt, N. E., Mignogna, J., Underhill, C., & Cully, J. A. (2013). The relationship between use of CBT skills and depression treatment outcome: A theoretical and methodological review of the literature. Behavior Therapy, 44, 12–26.

    Article  PubMed  Google Scholar 

  • Jacob, K. L., Christopher, M. S., & Neuhaus, E. C. (2011). Development and validation of the Cognitive-Behavioral Therapy Skills Questionnaire. Behavior Modification, 35, 595–618.

    Article  PubMed  Google Scholar 

  • Jarrett, R. B., Minhajuddin, A., Kangas, J. L., Friedman, E. S., Callan, J. A., & Thase, M. E. (2013). Acute phase cognitive therapy for recurrent major depressive disorder: Who drops out and how much do patients influence response? Behaviour Research and Therapy, 51, 221–230.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jarrett, R. B., Vittengl, J. R., Clark, L. A., & Thase, M. E. (2011). Skills of Cognitive Therapy (SoCT): A new measure of patients’ comprehension and use. Psychological Assessment, 23, 578–586.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kapson, H. S., Leddy, M. A., & Haaga, D. F. (2012). Specificity of effects of cognitive behavior therapy on coping, acceptance, and distress tolerance in a randomized controlled trial for smoking cessation. Journal of Clinical Psychology, 68, 1231–1240.

    Article  PubMed  Google Scholar 

  • Strunk, D. R. (2009). Competencies of Cognitive Therapy Scale. Unpublished instrument, The Ohio State University.

  • Strunk, D. R., & DeRubeis, R. J. (2001). Cognitive therapy for depression: A review of its efficacy. Journal of Cognitive Psychotherapy, 15, 289–297.

    Google Scholar 

  • Strunk, D. R., DeRubeis, R. J., Chiu, A. W., & Alvarez, J. (2007). Patients’ competence in and performance of cognitive therapy skills: Relation to the reduction of relapse risk following treatment for depression. Journal of Consulting and Clinical Psychology, 75, 523–530.

    Article  PubMed  Google Scholar 

  • Webb, C. A., DeRubeis, R. J., Dimidjian, S., Hollon, S. D., Amsterdam, J. D., & Shelton, R. C. (2012). Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: The role of therapist adherence and the therapeutic alliance. Journal of Consulting and Clinical Psychology, 80, 373–381.

    Article  PubMed  Google Scholar 

  • Weissman, A. N. (1979). The Dysfunctional Attitude Scale: A validation study. Dissertation Abstracts International, 40, 1389B–1390B.

    Google Scholar 

  • Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 742–747.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank those who helped make this research possible. Abby D. Adler, Andrew A. Cooper, Laren R. Conklin, Lizabeth A. Goldstein, and Elizabeth T. Ryan served as cognitive therapists and clinical interviewers. Abby D. Adler served as study coordinator. Daniel R. Strunk provided training in and supervision of clinical assessments and cognitive therapy.

Conflict of Interest

This project was supported by the National Center for Research Resources (Award number TL1RR025753). The project was also supported in part by a grant to Abby D. Adler from the American Psychological Association. Daniel R. Strunk, Shannon N. Hollars, Abby D. Adler, Lizabeth A. Goldstein, and Justin D. Braun declare that they have no conflict of interest.

Informed Consent

The study was approved by The Ohio State University Institutional Review Board. Informed consent was obtained from all study participants.

Animal Rights

No animal studies were carried out by the authors for this article.

Author information

Authors and Affiliations

  1. Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, 43210, USA

    Daniel R. Strunk, Shannon N. Hollars, Abby D. Adler, Lizabeth A. Goldstein & Justin D. Braun

  2. Aaron T. Beck Psychopathology Research Center, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA

    Abby D. Adler

Authors
  1. Daniel R. Strunk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shannon N. Hollars
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abby D. Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lizabeth A. Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Justin D. Braun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel R. Strunk.

Additional information

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources, the National Institutes of Health, or the American Psychological Association.

Portions of the results reported in this manuscript were reported at the annual convention of the Association for Behavioral and Cognitive Therapies in November, 2013.

Appendices

Appendices

Appendix 1 Factor loadings of a single factor solution of CCTS-SR items among depressed patients at intake and post-treatment
Full size table
Appendix 2 Factor loadings of a single factor solution of CCTS-TR among depressed patients at post-treatment
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Strunk, D.R., Hollars, S.N., Adler, A.D. et al. Assessing Patients’ Cognitive Therapy Skills: Initial Evaluation of the Competencies of Cognitive Therapy Scale. Cogn Ther Res 38, 559–569 (2014). https://doi.org/10.1007/s10608-014-9617-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-014-9617-9

Keywords

Search

Navigation