the war in Iraq, and Hurricane Katrina have focused attention on posttraumatic stress disorder (PTSD), an anxiety disorder that can result from exposure to traumatic events like combat, rape, assault, and disaster. Posttraumatic stress disorder is characterized by symptoms of reexperiencing the traumatic event, avoiding reminders of the event or feeling emotionally numb, and hyperarousal. 1 The disorder is associated with psychiatric and physical comorbidity, reduced quality of life, 2-4 and substantial economic costs to society. 5 Lifetime prevalence in US adults is higher in women (9.7%) than in men (3.6%) 6 and is especially high among women who have served in the military. 3,7 Thus, research aimed at testing treatments for PTSD in this population is important.

This study did not find a treatment effect for trauma-focused group therapy. The difference between the effectiveness and adequate dose findings suggests the possible value of methods to enhance the delivery of cognitive-behavioral treatments in clinical practice settings.

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4-23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322-1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.

Posttraumatic stress disorder (PTSD) is a highly prevalent disorder in both clinical and community populations. This article reviews current knowledge about PTSD in order to assist clinicians in the diagnosis and treatment of reactions to traumatic life events. First, research findings are presented, followed by guidelines for the assessment of trauma and PTSD. Topics discussed include epidemiology, course, and comorbidity, as well as information processing and psychobiology. The review is limited to information about PTSD in adults, although some of the material may generalize to child and adolescent populations.