# Effects of six months of weekly supervision on using Prolonged Exposure Therapy for PTSD treatment in Ukraine

## TL;DR

Weekly remote supervision for six months significantly boosted Ukrainian clinicians' confidence in using Prolonged Exposure Therapy for PTSD, even during wartime.

## Contribution

Demonstrates the effectiveness of remote supervision in improving trauma-focused therapy implementation in crisis settings.

## Key findings

- Confidence in Prolonged Exposure Therapy implementation increased significantly after six months of supervision.
- Supervision attendance and PE case initiation predicted over 30% of the variance in post-supervision confidence.
- Perceived barriers shifted from structural to client-centered challenges after supervised practice.

## Abstract

Brief training can introduce clinicians to evidence-based psychotherapies, but ongoing supervision is often critical for successful implementation. This need is amplified in global mental health, where linguistic, cultural, and systemic barriers complicate the delivery of trauma-focused treatments such as Prolonged Exposure (PE) therapy for Post Traumatic Stress Disorder (PTSD). Following the onset of the full-scale war in Ukraine, we implemented a PE training and remote supervision initiative for Ukrainian psychiatrists and psychologists.

This study evaluated the effects of six months of weekly remote supervision on clinicians’ confidence in implementing PE and examined whether supervision attendance and PE case initiation predicted post-supervision confidence. We also assessed changes in perceived barriers to implementation.

Ukrainian clinicians (n=41) were trained in PE during a five-day in-country workshop. Assessments included 29 clinicians who joined six months of weekly online supervision with U.S.-based PE trainers. Confidence in delivering PE, was measured pre- and post-supervision using a Likert-scale self-report item. Linear regressions tested the predictive value of supervision attendance and PE case initiation on post-training confidence. Qualitative thematic analysis was applied to open-ended responses describing perceived implementation barriers before and after supervision.

Confidence in PE implementation significantly increased from pre- to post-supervision (p < .05). Both the number of supervision sessions attended and the number of PE cases initiated were significant independent predictors of post-supervision confidence (p < .05) and together explained over 30% of the variance. Thematic analysis revealed a shift in perceived barriers from structural and educational limitations to client-centered and logistical challenges following supervised practice.

Remote supervision, despite language, time zone, and wartime obstacles, effectively enhanced clinicians’ confidence and understanding of implementation barriers. These findings demonstrate the feasibility and value of structured, fidelity-focused supervision in crisis settings and support its role in scaling trauma-focused care globally.