Components of Cognitive Behavioral Therapy: The Factor Structure of the Cognitive Coding Scale for Bulimia Nervosa
Existing rating scales measuring therapist execution of the components of cognitive behavior therapy (CBT) have been criticized as too narrow to assess the theorized multidimensional structure of CBT. The current study sought to evaluate the factor structure of the combination of existing CBT therapist rating scales. A second goal of the study was to test a newly developed patient rating scale for use in CBT for bulimia nervosa. Therapy sessions from patients receiving a standardized CBT protocol for bulimia nervosa were coded and analyzed using both confirmatory (CFA) and exploratory factor analysis (EFA). The factor structures obtained were consistent across the CFA and EFA and were also consistent across raters and sessions. The therapist factors obtained were: therapist interpersonal effectiveness, cognitive interventions, structure, behavioral interventions and assumptions. These five factors corresponded well with theory about the major components of CBT. The obtained patient factors were also highly consistent with CBT treatment principles. Uses of the comprehensive rating scale for CBT for clinical and research purposes are discussed.