A Systematic Review of the Cultural Adaptation of Third-wave Psychotherapies for Youth in Saudi Arabia with Common Mental Health Problems

Abstract

This systematic review examined the cultural adaptation and reported effectiveness of third-wave psychotherapies for youth in Saudi Arabia with common mental health problems. The review followed PRISMA guidance and included studies in which at least 75% of participants were aged 15-24 years and had diagnosed mental health disorders or clinically relevant subclinical symptoms. Searches of eight international, regional and Arabic-language databases were conducted from inception to 30 April 2025. After removal of duplicates and screening, six studies met the inclusion criteria. Cultural adaptation was assessed using Bernal et al.'s framework across dimensions including language, person, metaphors, content, concept, context, goals and methods. Methodological quality was assessed using the Standard Quality Assessment Criteria for quantitative studies, and findings were synthesised narratively. The included studies evaluated mindfulness-based interventions, mindfulness-based cognitive therapy and dialectical behaviour therapy. Reported outcomes suggested reductions in stress, anxiety, depression and social anxiety, although interpretation was limited by small sample sizes, incomplete reporting, variable study quality and high dropout rates in two studies. Cultural adaptation was limited, with most studies focusing on language or minor unstructured modifications. None reported using a structured cultural adaptation model. The findings indicate a need for more systematic, transparent and culturally grounded adaptation of third-wave psychotherapies for Saudi youth.