Practice of Cognitive Processing Therapy in Arab Countries and Its Challenges: A Narrative Review

Cognitive Processing Therapy (CPT) aims to change maladaptive trauma-related beliefs through cognitive restructuring and structured review of trauma-related meanings. Although CPT has accumulated substantial empirical support and has been adapted in several international settings, evidence regarding its implementation and effectiveness in Arab countries remains limited and underexplored. This narrative review examined CPT-specific publications involving Arab populations. PubMed, PsycINFO, Scopus, and Google Scholar were searched for publications available from 2012 through January 2026 using terms related to CPT, posttraumatic stress disorder (PTSD), and trauma, and Arab or Arabic-speaking populations. Eligible publications evaluated CPT as the principal intervention among individuals residing in Arab-majority countries or Arab refugees and forcibly displaced populations. Findings were synthesized narratively according to study characteristics, methodological quality, clinical outcomes, feasibility and acceptability, reported cultural and linguistic adaptations, and convergent and divergent findings. Four CPT-specific publications met the eligibility criteria: one adaptation and early implementation report from Iraqi Kurdistan and three clinical studies conducted in Egypt. Methodological quality varied, with the randomized comparative trial providing stronger evidence than the two uncontrolled clinical studies and the descriptive adaptation report. The Egyptian studies reported reductions in PTSD and related symptoms, including depression, anxiety, and difficulties in emotion regulation, with improvements maintained at follow-up. Reported CPT-specific implementation considerations primarily involved linguistic and contextual adaptation, understandable treatment materials, greater reliance on oral discussion, and therapist preparation. However, direct evidence concerning acceptability, retention, and implementation barriers was limited. The evidence was geographically concentrated and methodologically heterogeneous and included only one randomized comparative trial. The limited evidence provides preliminary support for the feasibility and potential clinical benefits of culturally and linguistically adapted CPT in selected Arab and refugee populations. However, the small, geographically concentrated, and methodologically heterogeneous evidence base does not support conclusions regarding effectiveness across diverse Arab populations or readiness for widespread implementation. Independent, adequately powered, multi-site effectiveness and implementation trials are required before sustainable scale-up or major infrastructure changes can be recommended. Future studies should evaluate clinical outcomes, treatment fidelity, acceptability, retention, cultural adaptation, therapist training and supervision, and context-specific implementation barriers.