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

Princess E. Ackland, Erin A. Koffel, Elizabeth S. Goldsmith, Kristen Ullman, Wendy A. Miller, Adrienne Landsteiner, Benjamin Stroebel, Jessica Hill, Timothy J. Wilt, Wei Duan-Porter

Research output: Contribution to journalArticlepeer-review


Guidelines strongly recommend trauma-focused therapies to treat posttraumatic stress disorder. Implementation of cognitive processing therapy (CPT) and prolonged exposure (PE) in Veterans Health Administration (VHA) and non-VHA settings began in 2006. We conducted a systematic review of implementation facilitators and challenges and strategies to address barriers. We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception until March 2021 for English-language articles. Two individuals reviewed eligibility and rated quality. Quantitative results were abstracted by one reviewer and verified by a second. Qualitative results were independently coded by two reviewers and finalized through consensus. We used RE-AIM and CFIR frameworks to synthesize findings. 29 eligible studies addressed CPT/PE, mostly conducted in VHA. Training/education with audit/feedback was the primary implementation strategy and was linked to improved provider CPT/PE perceptions and self-efficacy. Use was not widespread. Only six studies tested other implementation strategies with mixed impact. Following VHA implementation, strong support for training, perceived effectiveness for patients and benefits for clinics, and positive patient experiences and relationships with providers were reported. However, barriers persisted including perceived protocol inflexibility, complex referral processes and patient complexity and competing needs. In non-VHA settings, providers perceived fewer barriers, but few were CPT/PE trained. Across both settings, fewer studies targeted patient factors. Training/education with audit/feedback improved perceptions and the availability of CPT/PE, but not consistent use. Studies testing implementation strategies to address post-training challenges, including patient-level factors, are needed. A few studies are underway in VHA to test patient-focused and other implementation strategies. Research assessing actual vs perceived barriers in non-VHA settings is needed to elucidate unique challenges experienced.

Original languageEnglish (US)
Pages (from-to)792-812
Number of pages21
JournalAdministration and Policy in Mental Health and Mental Health Services Research
Issue number5
StatePublished - Sep 2023

Bibliographical note

Funding Information:
This work is funded by the Veterans Health Administration, Health Services Research and Development, Evidence Synthesis Program (#09-009). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Publisher Copyright:
© 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.


  • Evidence-based psychotherapy
  • Implementation
  • Posttraumatic stress disorder
  • Systematic review

PubMed: MeSH publication types

  • Systematic Review
  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.


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