Culturally Adapted Cognitive-Behavioral Therapy for Insomnia in Adults From the Arab World: A Three-Arm Randomized Pilot Study

INTRODUCTION: Suboptimal response to CBTi is common in non-Western populations (e.g. Arabs). Aligning CBTi with culturally shaped beliefs and practices may improve outcomes. OBJECTIVES: A single-blind, three-arm randomized controlled trial was conducted to compare the efficacy of two-levels of cultural adaptations of CBTi against a wait-list condition for adults with insomnia disorder. METHODS: Fifty-four Arabs with insomnia were randomized to one of three conditions: (1) CBTi with surface-level adaptations (i.e. integration of socio-behavioral characteristics to foster treatment engagement and delivery); (2) CBTi with surface and deep-level adaptations (i.e. targeting sociocultural factors that may modulate perceptions of causes, prognosis and treatment); or (3) wait-list (WL). Cultural adaptations of CBTi were informed by findings from our previous qualitative study. Primary outcome was the Insomnia Severity Index (ISI), measured at four time points. Secondary outcomes included: sleep diaries, beliefs and attitudes about sleep (DBAS), anxiety, depression and fatigue scales (HADS and MFI). Compared to controls, both treatment conditions demonstrated improvements in sleep parameters, HADS and DBAS. No statistically significant differences were observed between active conditions. Improvements were maintained at three-month follow-up. CONCLUSION: Findings support the potential efficacy of culturally adapted CBTi compared to controls for Arabs. Future research comparing culturally adapted and standard CBTi is needed to determine the incremental benefit of cultural adaptations.