The Effectiveness and Outcomes of Culturally Adapted Cognitive Behavioral Therapy Across Common Mental Health Conditions: A Meta-Analysis

Abstract

Culturally adapted cognitive behavioral therapy (CaCBT) is increasingly used to reduce disparities in mental health outcomes among ethnoculturally diverse populations. Although CBT is a well-established evidence-based intervention, little is known about CaCBT’s effectiveness across diagnostic groups and global contexts. This meta-analysis synthesizes CaCBT efficacy for common mental health conditions. Using PRISMA guidelines, five electronic databases were used to search for RCTs reporting mental health variables for CaCBT. Funnel plots, Egger’s test, and the trim-and-fill method were used to evaluate publication bias. Hedges’ g was used to compute effect sizes, and heterogeneity was assessed through DerSimonian and Laird I2 statistics. Variations in populations, settings, and adaptation strategies were accounted for through random-effects models. Sixteen articles (n = 4787) met the inclusion criteria. CaCBT was associated with significant reductions in anxiety (g = −0.86, 95% CI [−1.66, −0.07], p = 0.032), somatic symptoms (g = −0.89, 95% CI [−1.61, −0.16], p = 0.016), and improved emotion regulation (g = 1.50, 95% CI [0.72, 2.28], p = 0.0002), though adjusted models reduced effects. For depression, PTSD, stress, and quality of life, pooled estimates favored CaCBT but did not reach statistical significance and were characterized by substantial heterogeneity. Significant heterogeneity was noted across studies, demonstrating diverse cultural contexts and intervention methods. CaCBT demonstrated significant benefits for anxiety, somatic symptoms, and emotional regulation across diverse groups. While depression and PTSD had varying outcomes, overall trends support this culturally responsive intervention’s efficacy. Further research on CaCBT, including understudied populations and standardized adaptation methods, could improve global mental health equity.