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Completed

NCT Number: NCT07109973

"Culturally Adapted CBT for Depression in Arab and Asian Adolescents in the UAE (CA-CBT)"

This study evaluated the effectiveness of a culturally adapted form of Cognitive Behavioural Therapy (CA-CBT) for reducing depression among Arab and Asian adolescents in the United Arab Emirates (UAE). Depression is a major concern for adolescents in the region, where cultural differences and stigma can make standard mental health treatments less effective.

A total of 175 adolescents aged 13-18, from Filipino, Arab, and other Asian backgrounds, were recruited from schools and communities across the UAE. Participants were randomly assigned to one of two groups: (1) an 8-week CA-CBT program delivered in weekly sessions, or (2) a treatment-as-usual (TAU) group who received available community support.

The CA-CBT program was carefully adapted to reflect the cultural and religious values of participants, including family involvement, use of familiar metaphors, and respect for beliefs about mental illness. The goal was to make therapy more relatable, acceptable, and effective.

The main outcome measured was the severity of depression symptoms before and after the 8-week period. Other outcomes included anxiety, stress levels, and dropout rates. The results showed that CA-CBT significantly reduced depression symptoms more than standard care. The program also had fewer dropouts, meaning more students stayed in therapy.

These findings suggest that adapting evidence-based therapy to reflect cultural values can improve mental health outcomes in diverse communities. The research supports the use of culturally sensitive treatments in school and community mental health programs across multicultural societies like the UAE.

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Key information

Conditions

Depression Adolescent Depression Anxiety Disorder Anxiety Disorders Behavior Behavioral Symptoms Mental Disorders Mental Health Personal Satisfaction Psychological Stress Psychological Well-Being Stress, Psychological

Age range

13 year–18 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Bath Spa University Academic Centre - Ras Al Khaimah

Ras al-Khaimah, United Arab Emirates, 00000

About this study

This study was a two-arm, parallel-group, single-blind randomized controlled trial (RCT) conducted to assess the efficacy of a newly developed Culturally Adapted Cognitive Behavioural Therapy (CA-CBT) for adolescent depression in the multicultural context of the UAE. The trial involved 175 adolescents aged 13-18 from Arab, Filipino, and other Asian backgrounds who met the inclusion criteria of scoring ≥10 on the PHQ-A (Patient Health Questionnaire for Adolescents). Participants were randomized to either the CA-CBT intervention group or a treatment-as-usual (TAU) control group.

The CA-CBT group received an 8-week manualized intervention tailored to the cultural values of Arab and Asian adolescents, including content adaptations (e.g., academic and family stress in Filipinos, spiritual concerns in Arabs), process modifications (e.g., family involvement, religious framing), and therapist training. The Southampton Adaptation Framework (SAF-CaCBT) and PEN-3 model guided the cultural adaptation. Sessions were delivered by trained facilitators fluent in English, with support in Arabic and Tagalog.

The TAU group received standard mental health resources as available in the community, including school counselors and primary care services. All participants were assessed at baseline (T0) and after the intervention (T1) using validated tools including PHQ-A for depression and DASS-21 for anxiety and stress.

Primary analysis used a 2 (Group) x 2 (Time) repeated measures ANOVA. Results showed a significant time-by-group interaction, with CA-CBT participants experiencing a greater reduction in depressive symptoms (mean difference = -6.8, p < .001, ηp² = .095) compared to the TAU group. Dropout rates were significantly lower in the CA-CBT group (10.2%) than in the TAU group (19.5%), supporting higher engagement and cultural congruence.

The study protocol received ethical approval from the Bath Spa University Academic Centre RAK IRB (Ref # BSU-RAK-PSYCH-2025-0011) and was registered prospectively (ISRCTN14751844).

The findings demonstrate that CA-CBT is a culturally valid and effective intervention for adolescent depression in diverse populations and support the integration of culturally tailored therapies in school and community-based mental health care systems.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adolescents aged 13 to 18 years old
  • Screening positive for mild to moderate depressive symptoms based on the PHQ-9
  • Able to understand and communicate in English, Arabic, or Tagalog
  • Parental/guardian consent and participant assent provided
  • Willing to attend all 8 weekly therapy sessions

Exclusion criteria

  • Currently undergoing structured psychotherapy or psychiatric treatment
  • Diagnosed with severe mental disorders (e.g., psychosis, bipolar disorder)
  • Active suicidal ideation requiring emergency intervention
  • Significant cognitive or developmental delays that impede participation
  • Unwilling or unable to commit to full program attendance

Exclusion criteria

-

Treatment and study plan

Culturally Adapted Cognitive Behavioural Therapy (CA-CBT)

Behavioral

CA-CBT is an 8-week manualized therapy program based on core CBT principles, adapted for Arab and Asian adolescents in the UAE. Adaptations followed the Southampton Adaptation Framework (SAF-CaCBT) and the PEN-3 model, including culturally relevant metaphors, integration of religious/spiritual beliefs, family involvement, and emphasis on academic and familial stressors. Sessions were delivered weekly for 60 minutes by trained therapists, with support in English, Arabic, and Tagalog.

Treatment-as-Usual (TAU)

Other

Participants in the TAU group received standard care available within their community. This included optional access to school counselors, general practitioners, or local mental health clinics. No structured psychotherapy or manualized intervention was provided by the research team. This arm served as a pragmatic comparator to evaluate the added value of the Culturally Adapted Cognitive Behavioural Therapy (CA-CBT) intervention.

Primary outcomes

  1. Change in depressive symptoms measured by the PHQ-9 scale

    Time frame: Baseline and post-intervention (8 weeks)

    The Patient Health Questionnaire-9 (PHQ-9) will be used to assess the severity of depressive symptoms. Scores range from 0 to 27, with higher scores indicating greater depressive symptom severity. The PHQ-9 is a validated and widely used self-report tool.

Sponsors and collaborators

Lead sponsor

Bath Spa University Academic Centre RAK

Other

Registry information

Official study title

"Efficacy of a Culturally Adapted Cognitive Behavioral Therapy (CA-CBT) for Depression Among Arab and Asian Adolescents in the United Arab Emirates: A Randomized Controlled Trial"

Acronym: CA-CBT

Important dates

Study start
2024
Primary completion
2025
Study completion
2025
First posted
Aug 7, 2025
Registry last updated
Aug 7, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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