This feature by Basma Kilani, M.A highlights how DBT was first introduced to the Arab region, the timeline of Basma’s journey with DBT and how that influenced the region, and what the future of DBT looks like in the Arab world.
Mental health in the Middle East remains a stigmatized and oft unspoken topic. In recent years, however, significant advances in the de-stigmatization of mental health in the Arab world have been made, with a majority of countries agreeing in principle to the integration of mental health into health care facilities.
However, the implementation of agreed-upon principles has seen limited progress. This is largely due to an underfunded and grossly insufficient mental health infrastructure in the region, inhibiting much of the progress possible as well as limiting the ability of mental health services to serve the large and ever-growing needs. The region is also lacking in appropriate mental health education, training, and research.
DBT training and research has allowed for advances to be made more significantly, and the goal of this blog is to highlight how DBT was first introduced to the Arab region, how its journey has progressed so far, and what the future of DBT may look like in the Arab world.
- Therapy approaches in the middle east
Within the Middle East, mental health professionals rely heavily on the use of psychoanalysis and CBT as a treatment method for virtually every disorder. This approach can be over-reliant and inflexible and is due in part to the Arab region’s lack of available training for local mental health professionals, as well as the lack of legal implementation of required professional development for mental health professionals. DBT remained a foreign and alien treatment to local practices and was not part of conversations around mental health amongst professionals, nor in educational settings and beyond. This had been the case until the early 2010’s.
With that being said, modern modes of Therapy such as DBT are now evolving and spreading through Middle Eastern roots and the MENA regions.
Here is a brief timeline of Clinical Psychologist Dr. Basma Al-Kilani, Founder of DBT MENA and affiliate of Behavioral Tech Institute and how it relates to the timeline of DBT in the MENA regions.
- 2012 – Basma attended the APS Conference in Australia and met Dr. Hadi Stamboulieh, The DBT Person in Sydney, Australia.
- 2013 – Maria Den Braven Center, which is a center founded and run by Basma, organized a DBT Conference in Amman, Jordan and invited Dr. Hadi Stamboulieh (who then connected her to Marsha Linehan.)
- 2014 – Basma set up a Skype call with Marsha Linehan to plan a training in Jordan. Marsha advised Basma’s team to train with the British Isles DBT (BIDBT).
- 2015 – The DBT team of Jordan had discussions with the British Isles DBT, who generously offered a bursary that enabled the team in Jordan to get intensively trained.
- November 2016 – The Maria Den Braven team attended the Intensive Training Part 1 followed by Part 2 in June 2017. The team consisted of solely 4 people.
- 2018 – Basma – alongside the whole DBT team – began the DBT Skills Class., now with a team of 10 people leading 6 DBT Skills Groups (3 Beginner’s Skills Classes – 2 in Arabic, 1 Advanced Skills Group, and 2 Adolescents Skills Group).
- February 2021 – After much hard work, Basma presented in the Online Skills Training with Donna Pattie for BTECH.
- November 2021 – Basma presented the Columbia University Intensive Training (Part 1) and became a certified Clinician in DBT in October 2021.
- February 2022 – Basma attended a 4-day Mindfulness Retreat with Randy Wolbert in Tuscon, Arizona, then presented the Foundational Training with Nick Salsman.
Among the significant achievements for the region in this journey, Basma and BTECH led two Intensive Trainings in the MENA region and were proud to see that specialists from 11 Arab counties participated.
II. Therapists in Jordan & Lack of research in the Arab Region – How can DBT help?
Religious and cultural beliefs are commonly utilized as a primary resort and scapegoat for the treatment of individuals suffering from mental health disorders. This approach lacked any evidence-based treatments, such as DBT. Part of this may be due to the scarcity of comprehensive trainings that qualify specialists to practice treatment as well as apprehension of evidence-based effective treatments.
This is reflected in the prevalent and noticeable shortage of licensed clinical psychologists in the Arab World. In Jordan, there are only 141 reported licensed clinical psychologists for a local population of 10 million, which would leave 1 therapist for every 7000 individuals.
The integration and introduction of evidence-based treatments, such as DBT, into the mental health field in the Arab world is needed, if not crucial, especially since the Arab world continues to be affected by a variety of conflicts, wars, precarity, terrorism, and fundamentalisms which plant the seeds for a variety of behavioral and mental disorders. This alone can and should act as a motivator for mental health professionals to pursue and foster DBT as an effective treatment with the hope of allowing those in need to live a life worth living.
Furthermore, the financial expenditure, or lack thereof, plays a significant role in the shortfall of cultural integration of mental health as a healthcare need for many individuals, one that is essential for a better quality of life. Data on mental health expenditure as a percentage of the total health expenditure is not available in most Arab countries and is not reported.
Finally, the region also suffers from a shortage in its contribution to research. Across the 22 Arab countries, only 4,506 eligible and peer-reviewed journal articles have been published in the past decade. In contrast to non-Arab countries, the Arab world has only contributed to approximately 1% of all mental health publications between the years of 2009-2018, a stark reminder of the pitfalls of local research contribution. In order to close the gap with the global and increasingly globalized mental health field, it is vital that the MENA region must invest more in mental health research and development. As the region’s populations continue to be traumatized by conflict, war and terrorism, there is a vast groundwork for essential research to build off of and gain prominence in the field of mental health care research. Further research in the mental health field must also be done in order to gain insights on the local cultural competence and suitability of mental health treatments in non-Western cultures.
Further research, interventions, training, and proactive efforts towards regional mental health policies are vital in order to move forward and advance in this field.
The need for effective treatments in the Arab world has been elucidated and is clearly evident. DBT MENA has aided in paving the way towards the implementation and dissemination of DBT in our region. We aim to increase training and implementation of DBT as an evidence-based treatment.
Basma Kilani, M.A., is a DBT-LBC Certified Clinician by the Linehan Institute from Amman, Jordan where she is Founder & Chief Specialist at the Maria Den Braven Mental Health Center. She is also the Managing Director of DBT-MENA, the BTECH affiliate in that region. Read her full bio here.
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