Cognitive Behavioural Sati Scale (CBSS)

1. Abstract

The Cognitive Behavioural Sati Scale (CBSS) is a specialized 17-item psychometric instrument designed to evaluate cognitive processes and overt behavioral manifestations of mindfulness (sati) within the Thai cultural milieu (Sangprasert et al., 2023). Developed to overcome the cultural and conceptual limitations of Western-derived mindfulness inventories when administered in Theravada Buddhist contexts, the CBSS operationalizes mindfulness not merely as a metacognitive attentional state, but as an integrated cognitive-behavioral practice that drives health-promoting conduct and self-regulation. The scale emerged from a systematic instrument development protocol that began with an initial pool of 21 items generated through expert panel consultations and qualitative focus group discussions, integrating 12 de novo items with 9 adapted items from the foundational Srithanya Sati Scale (Silpakit & Silpakit, 2014). Psychometric refinement yielded a 17-item self-report questionnaire calibrated across a 5-point authentic frequency response scale ranging from "never" to "every time." Structural evaluation via confirmatory factor analysis and structural equation modeling supported a second-order hierarchical model featuring three primary first-order latent dimensions: Acceptance, Awareness, and Self-Recollection, subsumed under an overarching higher-order mindfulness factor, while also mapping onto observable mindful health behaviors. Empirical testing in older adult and midlife community populations demonstrated strong reliability indices, including a total scale Cronbach’s alpha of 0.86 and a McDonald’s omega of 0.88, alongside robust subscale reliabilities ranging from 0.70 to 0.87. Construct validity was confirmed through substantial convergence with existing validated indices (Pearson’s r > 0.70). The CBSS provides a culturally grounded, structurally robust assessment tool for public health researchers, gerontologists, and clinical psychologists investigating contemplative health interventions in Southeast Asian settings.

2. Keywords

Cognitive Behavioural Sati Scale, CBSS, Sati, Mindfulness Assessment, Cognitive-Behavioral Mindfulness, Acceptance, Awareness, Self-Recollection, Mindful Behavior, Thai Psychometrics, Contemplative Science, Cultural Adaptation

3. Authors

• Pantip Sangprasert, Ph.D. — Department of Community Health Nursing, Faculty of Nursing, Thammasat University, Pathum Thani, Thailand. ORCID: 0003-4643-2901. Email: [email protected] (Corresponding Author).
• Junya Pattaraarchachai, Ph.D. — Tulane University, New Orleans, Louisiana, United States. ORCID: 0001-5838-7082.
• Srimuang Palungrit, M.D. — Division of Community and Family Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
• Sitthiphon Bunman — Independent Contemplative Health Researcher, Thailand.

4. Purpose

The primary purpose of the Cognitive Behavioural Sati Scale (CBSS) is to provide an epistemologically congruent and psychometrically sound instrument capable of assessing mindfulness-based cognitions and everyday health behaviors within the Thai sociocultural context. While contemporary Western clinical psychology has produced an array of prominent mindfulness inventories—such as the Mindful Attention Awareness Scale (MAAS) and the Five Facet Mindfulness Questionnaire (FFMQ)—these instruments frequently conceptualize mindfulness through a decontextualized, secular lens focused heavily on present-centered non-judgmental attention. In Theravada Buddhist societies like Thailand, however, the classical concept of sati inherently encompasses ethical discernment, deliberate recollective memory of wholesome actions, and the active translation of cognitive awareness into virtuous behavioral repertoires. Consequently, Western scales often exhibit construct underrepresentation or cultural misalignment when administered to native Thai populations, particularly older adults whose understanding of mindfulness is fundamentally woven into community traditions, meditative regimens, and moral self-regulation.

The CBSS was engineered to bridge this divide by harmonizing contemporary cognitive-behavioral paradigms with traditional Buddhist psychology. In doing so, it serves multiple practical and theoretical functions across research, clinical, and preventive community settings:

• Measurement of Health-Promoting Self-Regulation: The scale quantifies how intentional cognitive presence and self-recollection directly steer health-related behaviors, including medication adherence, dietary moderation, physical activity, stress mitigation, and emotional stabilization among mature and aging populations.
• Evaluation of Contemplative Interventions: It functions as a specialized outcome measure for randomized controlled trials and community-based health promotion programs that incorporate mindfulness-based cognitive therapy (MBCT), Buddhist walking/sitting meditation, or integrative wellness workshops in Thailand.
• Cross-Cultural Psychometric Benchmarking: By defining mindfulness across both internal cognitive mechanisms (awareness and non-reactive acceptance) and external behavioral execution (mindful action and self-recollection), the CBSS allows cross-cultural researchers to examine how linguistic nuances and indigenous Buddhist ethics reshape the psychometric properties of contemplative self-report instruments.
• Clinical Screening and Gerontological Assessment: In family medicine and community nursing, the CBSS enables clinicians to identify cognitive resources and deficits in daily self-monitoring among middle-aged and older adults (ages 35 and above), providing actionable baseline data for preventive behavioral medicine.

5. Psychological Construct

The construct measured by the CBSS is Cognitive-Behavioral Sati, defined as an integrative psychological state and behavioral habitus wherein an individual sustains lucid metacognitive monitoring of internal and external stimuli, holds current experience with non-reactive acceptance, continuously remembers wholesome intentional commitments (self-recollection), and actively enacts healthy, values-aligned behaviors. Rather than viewing mindfulness as a passive, non-evaluative cognitive state, the CBSS framework identifies sati as dynamic self-regulation. The scale captures this construct through four interrelated conceptual components organized within a hierarchical structure:

1. Awareness (Metacognitive Monitoring)

The Awareness dimension represents the receptive, continuous tracking of somatic sensations, cognitive appraisals, emotional shifts, and environmental changes as they unfold in real time. Within the CBSS, awareness is not simply an absence of absent-mindedness; it is the purposeful, conscious orientation toward one’s physiological needs and psychological states. For example, an individual scoring high on this dimension exhibits lucid perceptual sensitivity to early signs of physical tension, exhaustion, physiological hunger cues, or emerging affective distress, enabling rapid and adaptive self-adjustment before dysregulation cascades.

2. Acceptance (Non-Reactivity and Psychological Flexibility)

The Acceptance dimension reflects an attitude of psychological openness, non-resistance, and emotional equanimity toward unpleasant sensations, uncomfortable cognitive events, or unavoidable external stressors. Operating in close alignment with third-wave cognitive-behavioral principles such as psychological flexibility, acceptance in the CBSS indicates the cessation of maladaptive cognitive avoidance or impulsive behavioral reactivity. Individuals with elevated acceptance acknowledge unpleasant physical symptoms or emotional turmoil without exacerbating secondary suffering through rumination, catastrophizing, or experiential denial.

3. Self-Recollection (Sati / Sampajañña)

Rooted deeply in classical Theravada psychology, Self-Recollection reflects the deliberate retrieval and sustained retention of wholesome intentions, ethical principles, and health goals in working memory. In Pali terminology, sati is intrinsically linked with memory and lucid retrospection—remembering what is wholesome, what actions lead to well-being, and what commitments have been made. In the CBSS, this dimension captures the individual’s capacity to maintain focus on their core health intentions (e.g., remembering dietary restrictions, recalling stress-reduction commitments, staying anchored to medical advice) amidst daily distractions, stressors, or competing immediate impulses.

4. Mindful Behavior (Behavioral Expression of Sati)

The Mindful Behavior facet operationalizes the overt, pragmatic translation of cognitive awareness, acceptance, and self-recollection into everyday physical and psychosocial conduct. This involves intentional action taken during routine activities—such as eating slowly and attentively, speaking with deliberate consideration, avoiding sedentary patterns, and executing health-protective habits with sustained presence. By bridging cognitive capacity with observable lifestyle execution, this dimension ensures that mindfulness is quantified not merely as an abstract introspective state, but as an active behavioral lifestyle.

6. Theoretical Framework

The architecture of the Cognitive Behavioural Sati Scale is built upon an integrative theoretical synthesis joining classical Theravada Buddhist epistemology with contemporary Cognitive Behavioral Therapy (CBT) and Self-Regulation Theory (Carver & Scheier, 1981; Bandura, 1991).

In Buddhist psychological treatises such as the Abhidhamma Pitaka and the Satipatthana Sutta, sati is not conceptualized as passive, non-discriminating presence. Rather, it operates alongside sampajañña (clear comprehension or situational wisdom) and appamada (heedfulness or diligence). Sati carries the fundamental cognitive function of recollection, anchoring the mind to wholesome mental factors while preventing it from drifting into unwholesome states of heedlessness, sensory indulgence, or cognitive dispersion. Classic Buddhist theorists underscore that sati acts as an internal gatekeeper, maintaining continuous awareness of bodily posture, feeling tones, mental formations, and moral duties. In Thai cultural life, this framework has been disseminated across generations through community monastic teachings, where practicing sati is viewed as synonymous with leading an ethically upright, balanced, and healthy daily life.

Concurrently, contemporary cognitive-behavioral science frames self-regulation as a cyclical cybernetic feedback process consisting of self-monitoring, self-evaluation against an internal standard, and corrective behavioral self-reinforcement. Within this framework, modern mindfulness-based cognitive therapies (Teasdale et al., 2000; Hayes et al., 1999) emphasize that cultivating metacognitive awareness alters the individual’s functional relationship to their thoughts and sensations, decoupling automatic maladaptive behavioral scripts from cognitive triggers.

Sangprasert and colleagues synthesized these two traditions into the Cognitive-Behavioral Sati Model. According to this unified theory, Awareness provides the essential sensory and metacognitive data stream regarding internal and external homeostasis. Acceptance prevents affective resistance, emotional exhaustion, and impulsive avoidance, thereby preserving executive cognitive resources. Self-Recollection holds the overarching standard, health goal, or ethical guideline active in focal attention. Finally, Mindful Behavior serves as the downstream regulatory output, closing the cybernetic loop by executing concrete, adaptive lifestyle actions. This theoretical synergy ensures that the CBSS measures mindfulness as an applied psychological mechanism directly linked to health behaviors, rather than an isolated, passive meditation skill.

7. Validity

The psychometric validation of the Cognitive Behavioural Sati Scale followed rigorous methodological standards to establish content, construct, and convergent validity within the target population of Thai adults and older adults residing across urban and community settings.

Content Validity

Content validity was developed through a two-stage qualitative and expert consensus procedure. An initial candidate pool of 21 items was generated, comprising 12 newly developed items designed to tap health-related cognitive-behavioral mindfulness and 9 adapted items derived from the established Srithanya Sati Scale (SSS; Silpakit & Silpakit, 2014), a respected Thai mindfulness questionnaire. A multidisciplinary expert panel consisting of clinical psychiatrists, community health nursing scholars, and Buddhist psychology specialists evaluated the items for clarity, cultural appropriateness, linguistic precision, and conceptual congruence. In-depth focus group discussions with community-dwelling older adults (aged 35 years and older) further refined item wording to eliminate ambiguity, leading to the selection of 17 psychometrically robust items demonstrating high item-objective congruence (IOC).

Construct and Convergent Validity

Construct validity was established through both structural modeling and convergent testing against established criteria:

• Convergence with Established Mindfulness Measures: The newly developed items of the CBSS demonstrated substantial convergent validity when evaluated against the original Srithanya Sati Scale. Pearson’s correlation coefficients between the CBSS items and the established SSS dimensions exceeded r = 0.70 (p < 0.001), indicating strong construct coherence while capturing additional behavioral variance unique to health self-management.
• Discriminant and Structural Evidence: Confirmatory factor analysis confirmed that the multidimensional subscales of Acceptance, Awareness, and Self-Recollection capture distinct yet complementary facets of the broader sati construct. The latent factor intercorrelations fell within the moderate-to-high theoretical range, establishing both adequate differentiation among facets and unity beneath a higher-order mindfulness dimension.

8. Reliability

The internal consistency and precision of the Cognitive Behavioural Sati Scale were extensively evaluated across the total scale and its individual factor dimensions, utilizing both traditional parametric reliability coefficients and modern composite indices.

For the complete 17-item scale, the CBSS demonstrated high internal consistency:

• Cronbach’s Alpha (α): 0.86, substantially exceeding the conventional psychometric threshold of 0.70 for research and clinical inventory utility.
• McDonald’s Omega (ω): 0.88, confirming robust composite reliability without relying on the restrictive tau-equivalence assumptions inherent to Cronbach’s alpha.

The individual subscales exhibited satisfactory to excellent reliability estimates:

• Awareness Subscale: Cronbach’s α = 0.85; McDonald’s ω = 0.87, reflecting high precision in evaluating perceptual tracking and metacognitive presence.
• Acceptance Subscale: Cronbach’s α = 0.70; McDonald’s ω = 0.72, establishing acceptable consistency for a shorter affective/attitudinal subscale.
• Self-Recollection Subscale: Cronbach’s α = 0.80; McDonald’s ω = 0.81, showing solid internal coherence for items assessing intentional retention of wholesome health goals.
• Mindful Behavior Subscale: Cronbach’s α = 0.85; McDonald’s ω = 0.87, verifying robust measurement stability across overt daily health actions.

Item-total correlations remained consistently strong across all dimensions, confirming that each item contributes meaningful true-score variance to its respective subscale without introducing psychometric redundancy.

9. Factor Analysis

The latent structure of the CBSS was examined using Confirmatory Factor Analysis (CFA) executed via Structural Equation Modeling (SEM) to verify the underlying theoretical framework in a sample of Thai adults aged 35 years and older.

Researchers tested and compared competing conceptual models to determine the optimal factorial configuration:

• Two-Factor Hierarchical Model: An initial competing model evaluated a two-factor structure specifying Mindful Behavior and Acceptance under a higher-order mindfulness construct. This model yielded standardized factor loadings ranging from 0.52 to 0.79. However, the model exhibited suboptimal fit indices, indicating that collapsing perceptual awareness and intentional recollection into a single broad behavioral factor obscured important psychometric nuances.
• Three-Factor Hierarchical Model (Best-Fitting Solution): The hypothesized hierarchical model comprised three distinct primary factors—Acceptance, Awareness, and Self-Recollection—subsumed under an overarching, second-order general Mindfulness factor. This model demonstrated superior fit to the observed empirical data across multiple global fit criteria (e.g., Comparative Fit Index [CFI], Tucker-Lewis Index [TLI], Root Mean Square Error of Approximation [RMSEA], and Standardized Root Mean Square Residual [SRMR]).

Standardized factor loadings for the items onto their respective primary latent dimensions in the three-factor hierarchical model were strong and uniformly statistically significant (p < 0.001), ranging from 0.54 to 0.81. Furthermore, the first-order factors loaded robustly onto the overarching second-order mindfulness latent construct, confirming that while Acceptance, Awareness, and Self-Recollection represent structurally distinct cognitive-behavioral facets, they function synergistically as components of an integrated contemplative self-regulation system.

10. Instrument / Measurement Tool

• Instrument Name: Cognitive Behavioural Sati Scale (CBSS)
• Test Type: Original psychometric inventory / self-report questionnaire
• Item Count: 17 items
• Subscales / Dimensions:
  • Awareness (Metacognitive monitoring of somatic and emotional states)
  • Acceptance (Non-reactive openness and psychological flexibility)
  • Self-Recollection (Intentional cognitive retention of wholesome goals and health commitments)
  • Mindful Behavior (Overt behavioral translation of sati in daily living)
• Authentic Response Scale: 5-point frequency scale featuring the exact anchors:
  • Never
  • Rarely
  • Often
  • Very often
  • Every time
• Scoring Protocol: Items are scored on a numerical metric ranging from 1 ("never") to 5 ("every time"). Subscale scores are derived by calculating the mean or sum of the items corresponding to each respective dimension. An overall Cognitive Behavioural Sati composite score is obtained by summing or averaging all 17 items. Higher scores reflect higher levels of cognitive-behavioral mindfulness and greater execution of mindful health behaviors.
• Administration Time: Approximately 5 to 10 minutes to complete.
• Target Population: Thai adults and older adults (operationalized as individuals aged 35 years and older), suitable for community, clinical, and gerontological research.
• Original Language: Thai

11. Permissions & Fee and Test Year

• Test Year: 2023
• Original Publication: Mindfulness, Volume 14, Issue 9, pages 2137–2144.
• Copyright & Permissions: The Cognitive Behavioural Sati Scale is the intellectual property of the original authors and the publisher (Springer Nature). The scale is intended for academic, public health, and non-commercial clinical research. Prospective users wishing to administer, translate, or reproduce the instrument must contact the corresponding author to obtain written permission and the complete authorized instrument.
• Commercial Use: No commercial licensing is permitted without explicit formal agreement.
• User Fee: No fee is charged for non-profit academic and clinical research use upon obtaining author authorization.
• Corresponding Author Contact: Dr. Pantip Sangprasert, Department of Community Health Nursing, Faculty of Nursing, Thammasat University, Pathum Thani, Thailand. Email: [email protected].

12. References

• Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50(2), 248–287. https://doi.org/10.1016/0749-5978(91)90022-L
• Carver, C. S., & Scheier, M. F. (1981). Attention and self-regulation: A control-theory approach to human behavior. Springer-Verlag. https://doi.org/10.1007/978-1-4612-5887-2
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
• Sangprasert, P., Pattaraarchachai, J., Palungrit, S., & Bunman, S. (2023). Development and validation of the Cognitive Behavioural Sati Scale (CBSS). Mindfulness, 14(9), 2137–2144. https://doi.org/10.1007/s12671-023-02167-8
• Silpakit, O., & Silpakit, P. (2014). Development of the Srithanya Sati Scale. Journal of Mental Health of Thailand, 22(3), 143–154. https://he01.tci-thaijo.org/index.php/jdmh/article/view/29322
• Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–625. https://doi.org/10.1037/0022-006X.68.4.615

13. Items of the Scale