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

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.