Development and Validation of the Cognitive Behavioral Therapy Skills Scale Among Japanese College Students

Abstract

Background: There are many different skill components used in cognitive-behavioral therapy (CBT). However, there is currently no comprehensive way of measuring these skills in patients. Assessing pretreatment CBT skills will contribute to prediction of treatment responses in the context of CBT for depression.Methods: We developed the CBT Skills Scale from five pre-existing instruments measuring major CBT components: self-monitoring, behavioral activation, cognitive restructuring, assertiveness training, and problem-solving. University students (N = 847) who participated in a fully factorial randomized controlled trial of smartphone CBT were assessed with the CBT Skills Scale, the Patient Health Questionnaire-9 (PHQ-9), the Generalized 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.Results: 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. Trial registration: UMIN, CTR-000031307. Retrospectively registered on February 14, 2018.