Adapting CBT-E for the Middle East: addressing regional gaps in eating-disorder treatment

Abstract

Eating disorders were regarded as Western conditions, yet recent evidence shows that they do occur across the Middle East and North Africa. Despite this, the region remains underserved: specialized services are scarce, awareness is limited, and mental health stigma persists. For many years, patients were misdiagnosed, treated only after medical crises, or managed with non-specialized, eclectic psychotherapeutic approaches not designed for eating disorders. Moreover, established treatments, developed and validated largely in Western contexts, were neither available in Arabic nor culturally adapted to local realities. This Perspective paper outlines the rationale and process of adapting and implementing enhanced cognitive behavioral therapy (CBT-E), the gold-standard treatment for adults with eating disorders, within the first specialized eating-disorders program established in the United Arab Emirates in 2017. Adaptation was shaped by systemic barriers, linguistic challenges, and sociocultural and religious considerations: Ramadan fasting, modesty norms, and family involvement. Therapists supported patients in maintaining regular eating patterns during Ramadan by integrating Islamic exemptions and spiritually meaningful alternatives, and modified body-image procedures, particularly exposure and clothing-related tasks, to respect modesty while preserving CBT-E’s mechanisms of change. Family participation was sometimes broadened beyond standard CBT-E to reflect norms of interdependence, and extended caregiving roles. Cultural tailoring may support more equitable implementation by improving acceptability and sustaining engagement, as observed in routine clinical practice and informed by internal service-level monitoring used to guide iterative refinement of care. The present paper offers a foundation for future adaptation efforts and underscores the need to expand evidence-based eating-disorder care across underserved regions.