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Military veterans and active-duty service members face high rates of posttraumatic stress disorder (PTSD), a chronic and debilitating condition that is comorbid with other negative psychological and social outcomes. PTSD symptomology in military careers is attributed to unique organizational factors and risks both during and post-deployment. Delivering modern, effective PTSD treatments derived from evidence-based research to the military population is a multi-faceted effort. Among these interventions, prolonged exposure therapy (PE) is a safe and effective trauma-focused treatment for veterans. To yield higher rates of PE success, common challenges faced by both military clients and their clinicians that may be impairing adoption were examined in this systematic review of 136 articles. While military clients face challenges related to treatment access and retention, clinicians entrusted to administer PTSD treatment report limited training and skepticism towards PE as barriers. When these complex barriers converge, PE, while shown successful at reducing PTSD symptomology in randomized controlled trials, may fail to achieve positive outcomes. To aid current understanding of this multi-level issue, a systematic review of existing client and clinician studies was conducted to synthesize common problems and facilitators to PE implementation. Findings suggest that low treatment readiness, complex symptom presentations, and time conflicts remain significant barriers. Providers could benefit from increased organizational support and training while clients experience better treatment retention and outcomes when a strong therapeutic alliance and social support is present.

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