Work

Narrowing the research to practice gap for trauma-focused psychotherapies in the Veterans Health Administration: A narrative review

Year: 2026

Type: review

Abstract: BACKGROUND: The US Veterans Health Administration (VHA) has almost twenty years of experience implementing trauma-focused psychotherapies (TFPs) for posttraumatic stress disorder (PTSD). Yet, the potential of TFPs to alleviate the burden of PTSD has not been fully realized. Previous reviews focused primarily on clinician uptake and patient perceptions of TFPs with limited examination of service delivery challenges. METHODS: This narrative review summarizes the evidence describing practice gaps specific to TFPs within VHA, factors that contribute to these evidence gaps, and recommends strategies and research to address modifiable contributing factors. RESULTS: TFP practice gaps include limited or variable reach to patients, high dropout, and reduced effectiveness compared to randomized clinical trials. Contributing factors span patient, clinician, and healthcare organizational levels. To bridge these practice gaps, we recommend: (1) Taking patient preference and heuristic approaches to treatment decisions into account; (2) Testing novel strategies to augment patient sustained engagement through treatment completion; (3) Developing empirically adapted clinician training and consultation programs; (4) Designing clinics to facilitate delivery of these proven interventions; (5) Developing scheduling and other organizational strategies to facilitate an adequately intensive treatment course; (6) Enhancing local leadership support and the implementation climate for TFPs; and (7) Evaluating how clinician burnout symptoms impact treatment delivery and outcomes. CONCLUSIONS: Narrowing the research-to-practice gap for TFPs within VHA requires addressing multi-level determinants to maximize patient engagement and facilitate effective intervention delivery. Without optimizing the conditions for intervention delivery, TFPs will remain limited in their capacity to reduce the systemic burden of PTSD.

Source: Comprehensive Psychiatry

DOI: 10.1016/j.comppsych.2026.152751

Authors: Nina A. Sayer, Rebecca K. Sripada, Peter P. Grau