The following information is subject to change throughout the internship year.
ADULT PSYCHOLOGY TRACK
Introduction to the Adult Psychology Track and descriptions of the rotations offered
The Adult Psychology Track 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 Adult Program provides training in the following Concentrations within the Adult Psychology Track:
Interns who choose to concentrate in the Cognitive Behavioral Therapy Concentration spend 75% time in this Concentration, and 25% time in a minor rotation.
Interns who choose the Health Concentration will rotate across three different rotations that expose them to a variety of populations and skill areas for a total of 100% time.
1. ADULT COGNITIVE BEHAVIORAL THERAPY CONCENTRATION (CBT)
(APPIC Program code: 141314 - Adult-CBT Concentration)
CBT interns will rotate in several CBT clinics with a minor rotation in the Health Psychology-Biofeedback Clinic, and a minor rotation in the ADHD 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 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.
- Outpatient CBT/DBT. Supervision of all CBT interns in the outpatient CBT/DBT setting provided by: Zach Rosenthal, PhD, Melissa L. Miller, PhD, Andrada Neacsiu, PhD and Noga Zerubavel, PhD.
- Inpatients (Zach Rosenthal, PhD). Dr. Rosenthal 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 (Zach Rosenthal, PhD). Dr. Rosenthal provides training in implementation of DBT and CBT for dually diagnosed outpatients in a “real world” substance abuse treatment program (South Light, 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 (Moria Smoski, PhD). 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.
- Outpatient Eating Disorders Program (OEPD) (Nancy Zucker, PhD). 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.
- Minor Rotation(s) – In addition to the above, one CBT intern will have a minor rotation in the ADHD Clinic (see rotataion description in the Child Psychology Track section).
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, and computer-based interventions. Several interns will receive training in the 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. 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 for primary CBT rotations: Melissa L. Miller, PhD, Andrada Neacsiu, PhD, M. Zachary Rosenthal, Ph.D., Moria Smoski, Ph.D., Laura Weisberg, PhD, Noga Zerubavel, PhD, Nancy Zucker, Ph.D)
2. ADULT HEALTH CONCENTRATION
(APPIC Program code: 141316 - Adult-Health Concentration)
In the Adult Health Concentration, two interns willl rotate through the Duke Fertility Center, the Cancer Behavioral Management and Support Clinic, and the Behavioral Sleep Medicine Clinic:
A. Duke Fertility Center
This Clinic in the Department of Obstetrics and Gynecology provides a Psychological Services Program within the Department of Psychiatry and Behavioral Sciences.
A rotation at the Duke Fertility Center provides training in:
1. Experience in conducting individual, couples, and group therapy with patients facing fertility treatment, recurrent pregnancy loss, perinatal mood disorders, diagnosis of fetal anomaly, medically-necessary or elective fertility preservation, embryo disposition concerns after conclusion of fertility treatment.
2. Exposure to crisis management interventions (e.g., ultrasound reveals no fetal heartbeat; panic attack prior to egg retrieval procedure, etc.).
3. Training in CBT and ACT theory and interventions.
4. Experience in conducting psychological evaluations with testing and integrated report writing.
5. Training in the use of the Personality Assessment Inventory (PAI).
6. Experience in providing psychosocial consultation in complex medical decision-making.
7. Participation in weekly, multidisciplinary Third Party Reproductive team meeting (with physician, fellows, nurses).
Diagnoses commonly seen:
Mood Disorders (particularly MDD, Anxiety Disorders (particularly Panic Disorder, Specific Phobia & GAD), Adjustment Disorders, Personality Disorders, Eating Disorders (among both obese and underweight patients), patients with a trauma history.
Issues commonly addressed:
Grief and loss, marital conflict, existential concerns ("Why do bad things happen to good people?"; "Am I being punished?"), stress and coping, parenting concerns (especially with multiples), alternate family-building strategies (third-party reproduction, adoption).
Duke Fertility Center Clinical Supervisor: Julia T. Woodward, PhD
B. Cancer Behavioral Management and Support Clinic
The rotation in the Cancer Behavioral Management and Support Clinic 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 for Cancer Behavioral Management and Support: Rebecca Shelby, PhD; Tamara Somers, PhD
C. Behavioral Sleep Medicine Clinic
A rotation in the Duke Insomnia and Sleep Research Program (DISRP) is designed to provide training in the assessment and treatment 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. Many of the patients we see 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 in clinic include: the Duke Structured Interview for Sleep Disorders, the Consensus Sleep Diary-M, the Insomnia Severity Index, Epworth Sleepiness scale, Fatigue Severity Scale, and Dysfunctional Beliefs and Attitudes about Sleep Scale. 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 conduct therapy and assessments under supervision. Training opportunities also include attending regular didactic meetings on issues relating to sleep disorders and participating in multidisciplinary clinical rounds.
Supervisor for the Behavioral Sleep Medicine: Meg D. Lineberger, PhD, CBSM