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Culturally Adapted Cognitive-Behavioral Therapy for Insomnia in Adults From the Arab World: A Three-Arm Randomized
M El Gewely1,2, N Attia2, Y Leanza1
1School of Psychology, Université Laval, Quebec City, Quebec, Canada.
Behavioral Sleep Medicine
|June 16, 2026
Summary
Culturally adapted Cognitive Behavioral Therapy for Insomnia (CBTi) significantly improved insomnia severity in Arab adults compared to a wait-list. Adaptations may enhance treatment effectiveness for diverse populations.
Area of Science:
- Psychiatry
- Sleep Medicine
- Cultural Psychiatry
Background:
- Suboptimal response to Cognitive Behavioral Therapy for Insomnia (CBTi) is prevalent in non-Western populations.
- Cultural adaptations of CBTi may enhance treatment engagement and outcomes for Arab adults with insomnia disorder.
Purpose of the Study:
- To compare the efficacy of two levels of culturally adapted CBTi against a wait-list for adults with insomnia disorder.
- To evaluate the impact of cultural adaptations on insomnia severity, sleep parameters, and psychological well-being.
Main Methods:
- A single-blind, three-arm randomized controlled trial involving 54 Arab adults with insomnia.
- Participants were randomized to: CBTi with surface-level adaptations, CBTi with surface and deep-level adaptations, or a wait-list control.
- Primary outcome: Insomnia Severity Index (ISI); Secondary outcomes: sleep diaries, Beliefs and Attitudes about Sleep (DBAS), HADS, MFI.
Main Results:
- Both culturally adapted CBTi groups showed significant improvements in insomnia severity compared to the wait-list (p < .001).
- Improvements in sleep parameters, anxiety, depression, and fatigue were observed in treatment groups versus controls.
- Treatment benefits were maintained at three-month follow-up, with no significant differences between the two adaptation levels.
Conclusions:
- Culturally adapted CBTi demonstrates potential efficacy in improving insomnia among Arab adults.
- Further research is warranted to compare culturally adapted CBTi with standard CBTi to ascertain the incremental benefits of adaptation.
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