Remote clinical supervision and therapist confidence, case initiation, and perceived barriers in delivering prolonged exposure therapy in wartime Ukraine: a multimethod uncontrolled pre- and post-evaluation study

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. Clinicians were offered 24 weekly online supervision sessions over six months; attendance varied, with a mean of seven sessions attended (out of 29 clinicians assessed). 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-supervision 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 suggested a pattern of change 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, was associated with increased self-reported confidence and shifts in clinicians’ perceived implementation barriers. These findings suggest the feasibility of structured, fidelity-focused supervision in crisis settings and are consistent with existing literature suggesting a role for such models in scaling trauma-focused care globally.