Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder: A Systematic Review

Area of Science:

• Mental Health
• Psychotherapy Implementation
• Trauma Treatment

Background:

• Trauma-focused therapies, including cognitive processing therapy (CPT) and prolonged exposure (PE), are recommended for posttraumatic stress disorder (PTSD).
• Implementation efforts in the Veterans Health Administration (VHA) and other settings began in 2006.
• A systematic review was conducted to identify facilitators and challenges in implementing CPT and PE.

Approach:

• A systematic literature search was performed across major databases (MEDLINE, Embase, PsycINFO, CINAHL) until March 2021.
• Eligibility and quality assessment were conducted by two independent reviewers.
• Findings were synthesized using the RE-AIM and CFIR frameworks.

Key Points:

• Training and audit/feedback improved provider perceptions and self-efficacy but did not ensure widespread CPT/PE use.
• In VHA settings, facilitators included strong training support and perceived patient/clinic benefits, while barriers involved protocol inflexibility and patient complexity.
• Non-VHA settings reported fewer perceived barriers but limited CPT/PE training; patient-level factors were under-addressed across settings.

Conclusions:

• While training and feedback enhance CPT/PE availability and provider attitudes, consistent utilization remains a challenge.
• Future research should focus on implementation strategies addressing post-training barriers, particularly patient-level factors.
• Further investigation into actual versus perceived barriers in non-VHA settings is necessary.