Efficacy of a culturally adapted cognitive behavioural therapy (CA-CBT) for depression among Arab and Asian adolescents in the United Arab Emirates: a randomized controlled trial

Abstract Background Adolescent depression is a significant public health concern in multicultural settings like the United Arab Emirates (UAE), where diverse youth populations, including large Arab and Asian communities, coexist. Standard Cognitive Behavioural Therapy (CBT), predominantly developed in Western contexts, may lack efficacy due to cultural incongruence. This study aims to evaluate the efficacy of a newly developed Culturally Adapted CBT (CA-CBT) for Arab and Asian adolescents presenting with depressive symptoms in the UAE. Methods A two-arm, parallel-group randomized controlled trial was conducted with 175 adolescents (ages 13–18; of Filipino, other Asian, and Arab descent) residing in the UAE. Participants were recruited through schools, community centers, and social media. After screening, they were randomly assigned to either an 8-week, manualized CA-CBT intervention ( n = 88) or a treatment-as-usual (TAU) control group ( n = 87). The primary outcome, depression severity, was measured at baseline (T0) and post-intervention (T1) using the Patient Health Questionnaire for Adolescents (PHQ-A). Secondary outcomes included anxiety and stress levels (DASS-21) and treatment dropout rates. Results A 2 (Group) × 2 (Time) repeated measures ANOVA on the primary outcome revealed a significant time-by-group interaction effect for PHQ-A scores (F(1, 173) = 18.24, p < .001, ηp 2 = .095). The CA-CBT group demonstrated a significantly greater reduction in depressive symptoms (M_diff = -6.8, SD = 3.1) from baseline to post-intervention compared to the TAU group (M_diff = -2.1, SD = 2.5). Subgroup analysis indicated that while all ethnic groups benefited from CA-CBT, the adaptation was particularly effective for participants who reported high importance of family and religious values. The treatment dropout rate was significantly lower in the CA-CBT group (10.2%) compared to the TAU group (19.5%) (χ 2 (1) = 4.12, p = .042). Conclusions CA-CBT was more effective than treatment-as-usual in reducing depressive symptoms among adolescents in a multicultural UAE setting and showed greater acceptability as indicated by lower dropout. Given our initial convenience recruitment and other study constraints, findings should be interpreted with appropriate caution and require confirmation with representative sampling and longer follow-up.