ADULT PSYCHOLOGY TRACK
Introduction to the Adult Psychology Track
I. Cognitive Behavioral Concentration (Program code: 141314)
Primary CBT rotations:
-General Outpatient CBT/DBT,
-Inpatients (Williams Unit),
-Implementation of CBT in Community Substance Abuse Treatment Programs,
-Behavioral Activation across the Adult Lifespan,
-Motivational Interviewing and CBT for Substance Use Disorders,
-Outpatient Eating Disorders Program (1 intern)
Minor CBT rotation (Health Psychology rotation):
-Pain/Biofeedback Clinic (2-3 interns)
II. Health Psychology Concentration (Program codes: 141316 (Biofeedback) and 141326 (Cancer Management)
Primary Health rotations:
-Cancer Behavioral Symptom Management and Support,
Minor Health rotation:
-Behavioral Sleep Medicine Program (this rotation does not have a program code associated with it as it is a rotation that rotates between Biofeedback and Cancer Management major tracks)
The adult psychology program provides interns with supervised assessment, treatment and consultative experience with the broad range of adult patients treated at Duke University Medical Center. Interns work in an apprenticeship-collaborator relationship with senior staff psychologists, becoming functional members of the treatment team and contributing as professionals to the successful operation of the adult psychology service.
The program provides training in the following concentration areas:
- Cognitive-Behavioral Psychology
- Health Psychology
Applicants elect only one of the two concentrations.
Interns who choose to concentrate in the Cognitive-Behavioral Psychology area spend 75% time in this concentration, and 25% time in one or two other areas. Interns who choose the Health Psychology concentration rotate across three or four different rotations that expose them to a variety of populations and skill areas
I. Cognitive-Behavioral Treatment Concentration (CBT)
(Program code: 141314)
(CBT interns will rotate in several CBT clinics with a minor rotation in the Eating Disorders Program and a minor rotation in the Health Psychology-Biofeedback Clinic)
Overview: Training in cognitive behavioral therapies (with an emphasis on Dialectical Behavior Therapy; DBT) is provided within the context of the Cognitive Behavioral Treatment (CBT) Track. Interns in the CBT track conduct assessments and provide consultation and treatment in both inpatient and outpatient settings. Outpatient work is conducted at two physical locations within DUMC – the Civitan Building and the Duke Child & Family Study Center located at the Lakeview at Pavilion East Building. Inpatient work is conducted on Williams Unit, a 20-bed general psychiatric ward located in Duke South Hospital. Interns on the CBT rotation will be trained over the course of the internship year to conduct individualized assessments and provide CBT and DBT for individuals with mood, anxiety, substance use, and personality disorders. Interns train in several CBT clinics to obtain a diversity of experiences. As such, CBT interns have at least two CBT faculty supervisors for their outpatient caseload, in order to increase diversity of training throughout the year. In addition, interns may co-lead a weekly DBT group for patients with borderline personality disorder or other appropriate diagnostic categories. Co-leading a DBT group provides additional training in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. Furthermore, all interns participating in the CBT rotation attend a weekly DBT consultation team meeting. Rotations are year-long, allowing treatment-resistant patients to be seen throughout the year for longer-term care.
Overall, the program’s primary goals for interns include increased understanding of the cognitive, behavioral, biological and emotional aspects of mood, anxiety, and personality disorders; development of skills in cognitive-behavioral assessment and treatment of these disorders; and successful oral and written communication with other health professionals.
Diversity of Training: Although CBT interns receive training in DBT, the caseload is a mix of multi-diagnostic patients (e.g., BPD) and those with less complicated presentations. The most common diagnoses treated include mood, anxiety, and personality disorders. All interns will receive training in providing CBT and DBT in a general outpatient setting (the Civitan Building). In addition, interns receive specialized training with one or more of the specific and diverse settings and patients listed below.
- Inpatients. Dr. Robins provides training to interns in brief therapy, consultation, and multi-disciplinary collaboration in an inpatient setting. Interns with inpatient responsibilities are members of a multi-disciplinary team, and take primary responsibility for the cognitive-behavioral assessment and therapy aspects of the patient’s care. Interns learn to provide brief, focused individualized interventions such as activity scheduling, cognitive restructuring, behavioral exposure and response prevention, contingency management, and training in distress tolerance skills.
- Implementation of CBT in Community Substance Abuse Treatment Programs. Dr. Rosenthal provides training in implementation of DBT and CBT for dually diagnosed outpatients in a “real world” substance abuse treatment program (SouthLight, Inc.). This work includes group and individual DBT/CBT and an emphasis on dissemination of empirically supported treatments in a largely poor, ethnically diverse community treatment program.
- Behavioral Activation across the Adult Lifespan. Dr. Smoski provides training in behavioral activation interventions for mood disorders in adults. Interns will learn a values-informed approach to brief interventions focused on goals attainment and avoidance reduction. Special attention and training is given to implementation of interventions with individuals ages 65 and older.
- Motivational Interviewing and CBT for substance use disorders co-morbid with anxiety or mood disorders. Dr. Seel provides training for those interested in assessing and treating disorders such as PTSD, social anxiety, phobias, bipolar, depression and substance use. Dr. Seel uses empirically supported treatments to include prolonged exposure, cognitive processing therapy, cognitive restructuring, acceptance commitment therapy, and behavioral activation. In addition, Dr. Seel is a member of the international Motivational Interviewing Network of Trainers and incorporates motivational interviewing into her training model. Interns supervised by Dr. Seel will have the opportunity to join live “bug-in-the-eye” supervision with 4th year psychiatric residents who are also learning cognitive behavioral therapy and motivational interviewing.
- Outpatient Eating Disorders Program (OEPD). The OEDP is a comprehensive multidisciplinary treatment program for individuals with anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders. Interns who receive training in this program will be involved in a variety of clinical activities including assessments and evaluations, individual, group, and family psychotherapy, and parent training groups. They also participate in a weekly interdisciplinary team meeting, clinical case consultation meeting, and didactic training seminar that introduces them to a variety of therapeutic approaches and issues in the treatment of eating disorders.
- In addition to the above, several CBT interns will have a minor rotation in the Health Psychology– Pain/Biofeedback Clinic. Please see the description for this rotation provided below in II. Health Psychology.
One CBT intern each will receive training in the eating disorders program, implementation of DBT/CBT in a community substance abuse treatment program, motivational interviewing and CBT for substance use. Several interns will receive training in the Inpatient and behavioral activation rotations. After interns are matched to Duke, we then select interns for the different diversity clinical experiences based in large part on their ranking and ratings of preferences for each rotation.
Didactics: The CBT rotation provides didactics and educational opportunities to interns through several different activities. First, the DBT consultation team meeting serves as an educational opportunity through interactions with faculty and post-doctoral level DBT therapists. One hour of each weekly two-hour meeting is devoted to didactic training. Second, during the first month of training, interns will participate in intensive seminars on issues related to starting the clinical internship, including assessing and managing suicidal behavior, assessing and intervening on substance use in the treatment setting, and DBT skills/theoretical principles. Third, all CBT interns will have individual supervision that may include reviewing therapy tapes, live supervision (e.g., “bug-in-the-eye”), co-leading groups with supervisors, and assigned readings. Fourth, interns will participate in several half-day workshops in empirically validated treatments for specific populations, such as interventions for adult ADHD and Motivational Interviewing, provided by Duke faculty members.
Interns have multiple supervisors who will work with them continuously throughout the year, allowing for more- in-depth supervisory relationships and the development of longer-term goals for clinical development.
Professional Development: There are two primary ways that we help nurture interns during the transition from graduate school to life as a clinical psychologist. Early in the internship year, CBT interns choose a CBT faculty mentor for ongoing mentoring throughout the year about issues relevant to their professional growth (e.g., getting a post-doc or faculty position, balancing one's life with career aspirations, etc.). Throughout the year there are monthly scheduled professional development meetings for all CBT interns with CBT faculty and other colleagues. Over the past 10 years we have continually focused on cultivating and enhancing a supportive atmosphere that equally blends service with learning and professional growth. We care about professional development and work carefully to tailor personalized goals that are attainable.
Research Opportunities: CBT interns have 4 hours of weekly protected research time, during which they can choose to work on their dissertation or any other research projects, including studies and manuscripts with CBT faculty. Although research is not a requirement of the rotation, interested interns are encouraged early in the year to explore research options with faculty members. There are many ways to be involved with CBT faculty research projects while on internship. Dr. Rosenthal is currently running treatment studies and lab-based experiments. He is the PI on NIDA and NIMH sponsored grants investigating the use of portable reminders of learning (using mobile phones) as adjunctive interventions, and DoD sponsored research on the use of computer-based interventions for veterans with PTSD and addiction. Additionally, he has various research projects investigating emotional sensitivity and regulation in borderline personality disorder, with a special emphasis on the use of novel technologies (e.g., immersive virtual environments) in laboratory studies of emotion and psychopathology. Dr. Robins’ research currently focuses on mindfulness and emotion regulation and on the psychopathology and treatment of borderline personality disorder. Dr. Smoski conducts NIH-funded studies of emotion regulation and reward processing in depression, including studies of depression in late life. Via collaborations with Duke Integrative Medicine, Dr. Smoski is involved in ongoing studies of mindfulness. If interns would like to be involved in research on eating disorders, there is the opportunity to participate in a weekly research meeting to explore ways to collaborate with Dr. Zucker’s research projects.
Supervision Training: To enhance capabilities as a supervisor, in the first half of the year CBT interns receive didactic training in supervision. During the second half of the year CBT interns supervise Duke graduate students or psychiatry residents early in their CBT training, and progress as a new supervisor is supervised during this time by CBT faculty.
Supervisors: Clive J. Robins, Ph.D., ABPP, BP, M. Zachary Rosenthal, Ph.D., Julie Seel, Ph.D., Moria Smoski, Ph.D., Laura Weisberg, Ph.D., Nancy Zucker, Ph.D.
II. Health Psychology Concentration
(Health Interns have a primary rotation and several minor rotations among the rotational descriptions listed below, based on the track or program they match with--program information is provided to those applicants who interview with us.)
The Health Psychology concentration involves didactic training, patient care and research experiences. Interns are exposed to empirical and theoretical readings from a number of disciplines, and are expected to use that information while working in both inpatient and outpatient settings. In the Health Psychology concentration, interns rotate through the following rotational placements:
A. Pain/Biofeedback Program (Program code: 141316)
This rotation is composed of a clinical and research program devoted to developing better methods to evaluate and treat chronic pain and psychophysiologically-based illnesses. Current research examines the psychosocial influences on reports of pain, distress, and disability among patients with a range of illnesses and among an ethically, gender, and age-based diverse sample. Medical disorders included in the current research and clinical interventions include but are not limited to Sickle Cell Disease, Raynaud’s Disease, Complex Regional Pain Syndrome (CRPS)/ Reflex Sympathetic Dystrophy (RSD), phantom limb pain, and chronic headaches. Psychiatric disorders include but are not limited to depression and anxiety disorders, somatoform disorders, personality disorders, and dissociative disorders. Interns are exposed to evaluation and treatment of common (Tourette’s Disorder, etc.) and unique presentations of psychopathology (Foreign Accent Syndrome, etc.).
This clinical rotation provides in-depth training in the psychometric evaluation of patients with medical disorders as well as patients with primary psychiatric disorders with particular attention to diversity and effective evaluation and treatment of historically disenfranchised populations. Intern get exposure to personality testing (MMPI-2, NEO-PI-R), brief cognitive tests (Letter Memory Test, MMSE), pain specific questionnaires (Short-form McGill Pain Questionnaire, Multidimensional Pain Inventory), and the use of a range of other validated psychometric instruments (State-Trait Anxiety Inventory, Beck Depression Inventory, Symptom Checklist 90-item Revised, Headache Scale for Locus of Control, etc.).
Interns are also instructed in techniques for diagnostic interviewing using semi-structure interviews, the use of the DSM-IV-TR, clinical observation, and consult liaison. Interns work directly with medical and psychiatric professionals to include clinical psychologists, neuropsychologists, psychiatrists, neurosurgeons, hematologists, anesthesiologists, neurologists, nursing staff, primary care physicians, physical and occupational therapists, and physician assistants in outpatient (Pain Clinic, Back and Spine Clinic, Sickle Cell Clinic, etc.) and inpatient settings.
Interns learn to provide clinical interventions in a high volume setting with treatments focused in 3 primary areas: (1) brief psychotherapy and coping skills training; (2) long-term psychotherapy; and, (3) biofeedback. A vast majority of patients with receive short-term psychotherapies or coping skills training (less than 12 weeks). These include crisis and suicide management, stress management, anger management, systematic desensitization techniques as well as problem-focused coping skills training. Interns are also encouraged to identify patients for long-term psychotherapy that they will treat across the duration of their internship experience. Patients include those with primary personality disorders or who require long-term supportive psychotherapy. Interventional approaches include cognitive behavioral interventions, dialectical behavioral therapy, systematic desensitization administered in individual and group settings. Approximately 1 in every 5 patients will be candidates for biofeedback and psychophysiological interventions to include relaxation training, mental imagery, distraction techniques, breathing retraining, relapse prevention, sleep efficacy, and psycho-education.
Interns are trained in supervision via organized didactics provided by faculty members on the internship. Interns are provided opportunities to apply and refine their supervision skills on the rotation. Intern duties include supervising and assisting to manage the clinical activities of practicum students.
Clinical Supervisors: Christopher L. Edwards, Ph.D., Miriam Feliu, PsyD, Katherine Applegate, Ph.D.
Research Supervisor: Christopher L. Edwards, Ph.D.
B. Cancer Behavioral Symptom Management and Support (Program code: 141326)
The rotation in Cancer Behavioral Symptom Management and Support is based on a scientist-practitioner model of training, and is comprised of clinical and research activities that address the psychological, social, behavioral, and symptom management needs of cancer patients including patients undergoing bone marrow transplant. This rotation’s clinical activities are conducted as part of the Duke Cancer Patient Support Program and the Duke Adult Blood and Marrow Transplant Program. The Duke Cancer Patient Support Program provides psychological services to cancer patients and their families in the outpatient and inpatient clinics of the Duke Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. The Duke Adult Blood and Marrow Transplant Program, which is closely associated with the Duke Cancer Institute, is internationally recognized for its novel approaches to treating leukemia, lymphoma, and myeloma through bone marrow and stem cell transplantation. The Duke Cancer Institute and the Duke Blood and Marrow Transplant Program treat patients from a range of ages, ethnic and racial backgrounds, socioeconomic statuses, and from rural and urban settings in North Carolina and the larger region.
Experiences on this rotation aim to increase interns’ knowledge and skills for treating psychological, social, behavioral, and symptom management issues which occur during the cancer experience. Interns in this rotation work closely with the multidisciplinary Cancer Patient Support and Bone Marrow Transplant Teams. These teams include psychologists, psychiatrists, marriage and family therapists, social workers, physicians, nurse practitioners, pharmacists, nutritionists, physical therapists, and patient financial advisors. Interns gain experience in the role of a psychologist on a medical team and learn how to collaborate within and contribute to a multidisciplinary team.
Interns are trained to conduct and interpret psychological assessments and health behavior evaluations for patients, their families, and caregivers. Assessment techniques include behavioral observation, standardized psychological measures, semi-structured interviews, and diagnostic interviews. Interns also perform regular follow-up assessments of post-treatment quality of life for patients undergoing bone marrow transplant. Through training and clinical experiences, interns become skilled at assessing the psychological, relationship, and behavioral health issues that impact individuals and families affected by cancer.
Interns provide psychological services for patients, their families, and caregivers. Clinical experiences include inpatient and outpatient CBT based psychotherapy, manualized behavioral interventions for symptom management, and health behavior interventions. Psychological services are provided in individual, couples, and group settings through face-to-face meetings, phone, and web-based technologies. Interns gain competence in developing treatment plans and choosing appropriate, evidence-based interventions for the range of issues and problems that arise for patients and their families when faced with a serious, life-threatening illness.
Interns participate in weekly individual supervision sessions for psychological assessment and psychotherapy cases. Interns also participate in weekly multidisciplinary team meetings that include all members of the Cancer Patient Support Team. Through this weekly multidisciplinary meeting, interns gain a sophisticated conceptualization of patients. During the rotation, interns attend educational seminars on psychopharmacology and psycho-oncology. A developmental approach is used. Initially interns are given educational materials about cancer and the bone marrow transplant process, and will work closely with a psychologist or other team member to promote understanding of the treatment process and the clinic environment. Then, the intern will be assigned his/her own patients and groups.
Finally, interns have the opportunity to participate in ongoing research activities. Interns are exposed to issues of research design, quality control, and data analysis inherent in the testing of standardized treatment protocols and program evaluation.
Supervisors: Rebecca Shelby, PhD; Tamara Somers, PhD
C. Minor Health rotation: Behavioral Sleep Medicine Program (No program code as this rotation will rotate between Biofeedback and Cancer Management major tracks, both of which have a program code)
A rotation in the Duke Insomnia and Sleep Research Program (DISRP) is designed to provide training in the treatment and assessment of sleep disorders. We have an active Behavioral Sleep Medicine clinic wherein we primarily see patients with insomnia, circadian rhythm disorders and/or sleep apnea treatment adherence issues. We also provide full assessments for sleep disorders. We have several ongoing NIH-funded studies that focus on insomnia assessment/diagnosis and behavioral treatment of primary and co-morbid insomnias. Many of the patients we see for both clinic and research studies have multiple co-morbidities, most notably those with co-morbid depression, anxiety disorders and/or medical conditions. Interns will learn about the complex interactions between insomnia and other co-morbidities, and learn to develop case formulations and appropriate treatment plans.
Rotational activities will include training in psychological assessment of sleep disorders and Cognitive Behavior Therapy for insomnia. Some of the assessment tools we use on the unit include: the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Duke Structured Interview for Sleep Disorders, daily sleep logs, the Epworth Sleepiness scale, Sleep Self-Efficacy Scale, Beck Depression Inventory, the Beck Anxiety Inventory, Dysfunctional Beliefs and Attitudes about Sleep Scale, Penn State Worry Questionnaire, Pre-Sleep Arousal Scale, Fatigue Severity Scale, and the State-Trait Anger Expression Inventory. Assessment training will include training in interpreting the results of overnight sleep studies and actigraphy. Interns will have the opportunity to observe experienced psychologists conduct CBT for insomnia, and will eventually conduct therapy and assessments under supervision. Training experiences also include attending regular didactic meetings on issues relating to sleep disorders and participating in multidisciplinary clinical rounds.
Supervisor: Margaret D. Lineberger, PhD