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Original research
Development and validation of the Cognitive Behavioural Therapy Skills Scale among college students
  1. Masatsugu Sakata1,
  2. Rie Toyomoto1,
  3. Kazufumi Yoshida1,
  4. Yan Luo1,
  5. Yukako Nakagami2,
  6. Shuntaro Aoki3,
  7. Tomonari Irie4,
  8. Yuji Sakano5,
  9. Hidemichi Suga6,
  10. Michihisa Sumi7,
  11. Takashi Muto8,
  12. Nao Shiraishi9,
  13. Ethan Sahker1,10,
  14. Teruhisa Uwatoko11,
  15. Toshi A Furukawa1
  1. 1Departments of Health Promotion and Human Behavior and Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
  2. 2Kyoto University Health Service, Kyoto, Japan
  3. 3Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
  4. 4Department of Psychology and Counseling, School of Education and Culture, Hokusho University, Ebetsu, Japan
  5. 5Department of Clinical Psychology, Goryokai Medical Corporation, Sapporo, Japan
  6. 6Junior College, Ryukoku University, Kyoto, Japan
  7. 7Ritsumeikan Medical Service Center, Kyoto, Japan
  8. 8Faculty of Psychology, Doshisha University, Kyoto, Japan
  9. 9Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
  10. 10Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
  11. 11Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
  1. Correspondence to Mr Masatsugu Sakata, Kyoto University, Kyoto, Japan; masatzg.sakata{at}


Background There are many different skill components used in cognitive behavioural therapy (CBT). However, there is currently no comprehensive way of measuring these skills in patients.

Objective To develop a comprehensive and brief measure of five main CBT skills: self-monitoring, behavioural activation, cognitive restructuring, assertiveness training and problem-solving.

Methods University students (N=847) who participated in a fully factorial randomised controlled trial of smartphone CBT were assessed with the CBT Skills Scale, the Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 (GAD-7) and the short form of the Japanese Big Five Scale. Structural validity was estimated with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency evaluated with Cronbach’s α coefficients. Construct validity was evaluated with the correlations between each factor of the CBT Skills Scale, the PHQ-9, the GAD-7 and the Big Five Scale.

Findings The EFA supported a five-factor solution based on the original instruments assessing each CBT skill component. The CFA showed sufficient goodness-of-fit indices for the five-factor structure. The Cronbach’s α of each factor was 0.75–0.81. Each CBT skills factor was specifically correlated to the PHQ-9, GAD-7, and the Big Five Scale.

Conclusions The CBT Skills Scale has a stable structural validity and internal consistency with a five-factor solution and appropriate content validity concerning the relationship with depression, anxiety and personality.

Clinical implications The CBT Skills Scale will be potential predictor and effect modifier in studying the optimisation of CBT interventions.

Trial registration CTR-000031307.

  • depression & mood disorders

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  • Contributors TU and TAF conceived of the study. MS, YL, TU and TAF designed the study. SA, TI and YS critically contributed to the study design. MS, RT, KY, YN, HS, MS, NS, TM, TU and ES acquired the data. MS analysed the data. MS, RT, KY and YL administered the data. MS and TAF wrote the first draft of the manuscript. YL, TI, NS and ES revised the manuscript. All authors read and approved the final manuscript.

  • Funding This study was supported in part by a grant-in-aid from Japan Agency for Medical Research and Development (AMED) to TAF (grant number 20dk0307085), Suzuken Memorial Foundation, KDDI Foundation and Pfizer Health Research Foundation to TU.

  • Competing interests TAF reports personal fees from Mitsubishi-Tanabe, MSD and Shionogi, a grant from Mitsubishi-Tanabe, and, outside the submitted work; TAF has a patent 2018-177688 pending and intellectual properties for Kokoro-app licensed. NS received lecture fees from Dainippon-Sumitomo and Meiji-seika Pharma for work that was not associated with this article.

  • Patient consent for publication Not required.

  • Ethics approval The Ethics Committee of Kyoto University School of Medicine have approved this study (Protocol # C1357). All participants provided written informed consent.

  • Data availability statement No data are available. Data sharing is not applicable as the scope of data use is limited to informed consent to participants.

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