Lessons learned regarding challenges and facilitators of implementing written exposure therapy across different...

This paper describes training models and lessons learned from four programs to implement written exposure therapy (WET) for the treatment of posttraumatic stress disorder (PTSD) in community practice settings across the United States. Four separate training endeavors with common training elements are briefly presented. Common implementation facilitators observed across efforts include organizational support for training, therapist interest, openness to learning a structured trauma-focused intervention, and flexible training plans responsive to therapists' needs. Common observed challenges include program schedules that did not allow ample time for consultation; a lack of weekly therapy appointment slots; and therapists' concerns that a brief, exposure-based treatment for PTSD may not be a good fit for patients. Many of the observed barriers were related to issues with implementing an evidence-based psychotherapy (EBP) in community clinics that have high patient demands, high therapist turnover, and limited therapist training time, rather than issues specific to WET. The results of these training and implementation endeavors underscore factors that may impact success and subsequent reach of an EBP for PTSD.