Adult Psychology Track
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:
- Adult Cognitive Behavioral Therapy (CBT) Concentration (APPIC Program code: 141314)
- Adult Health Concentration (APPIC Program code: 141316)
Applicants may select only one of the above concentrations.
Adult Cognitive Behavioral Therapy (CBT) Concentration
APPIC Program code: 141314 - Adult-CBT Concentration (3 interns)
Overview: Training in cognitive behavioral therapies (with an emphasis on Dialectical Behavior Therapy; DBT) is provided within the context of the Cognitive Behavioral Research and Treatment Program at Duke University Medical Center. Interns on the CBT concentration 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 will co-lead a weekly DBT group for patients with borderline personality disorder or other appropriate diagnostic categories struggling with emotion dysregulation. 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. The program also includes a focus on trauma-informed care.
Diversity of Training: All CBT interns receive training in DBT, however 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). Supervision of CBT interns in the outpatient CBT/DBT setting provided by: M. Zachary Rosenthal, PhD; Andrada Neacsiu, PhD; Moria Smoski, PhD; Noga Zerubavel, PhD
In addition, after interns match to Duke, we then select interns for the following diverse clinical experiences based in large part on their ranking and ratings of preferences for each rotation. Interns receive specialized training with one or more of the specific and diverse settings and patients listed below.
Adult CBT Concentration Settings and Patients:
- Inpatient Consultation Service (Kristin Wyatt, PhD). Dr. Wyatt provides specialized training in the application of contemporary principle-driven CBTs in the inpatient setting, where one intern will serve as the psychology consultant to a multi-disciplinary team on the Duke Psychiatry Inpatient Service, Williams Ward. The intern will learn how to provide collaborative care through 1) working with the unit’s two psychiatry teams to formulate goals for one-session psychotherapeutic intervention and/or assessment, and 2) direct delivery of brief, targeted interventions with inpatients. Consultation requests and patient clinical presentations vary widely, allowing for extensive development of case conceptualization skills and responsive, flexible use of contemporary CBT interventions, with heavy emphasis on DBT skills and strategies.
- Population Health (M. Zachary Rosenthal, PhD). Dr. Rosenthal provides specialized training focusing on learning about value-based care, MACRA, and integrated care models. The service portion of the training would feature rapid access, evaluation, and brief therapy to help increase access to the many who are currently bottled up in our Access Center seeking care but waiting due to our tradition of longer-term psychotherapy. Dr. Rosenthal will be developing protocols to work with the Access Center, our social workers, and admin staff to create streamlined assessment, referrals into the community, and referrals to others within Duke Health alongside brief transdiagnostic interventions.
- Trauma-Informed Care (Noga Zerubavel, PhD). Dr. Zerubavel provides training in empirically supported treatments for survivors of trauma in the Stress, Trauma, and Recovery Treatment Clinic. Interns provide treatment for trauma-related disorders including PTSD, dissociative disorders, and other trauma-related sequelae using Cognitive Processing Therapy, Prolonged Exposure, Mindfulness-Based Cognitive Therapy, and compassion focused therapy. Along with providing individual psychotherapy, interns have opportunities to provide couple therapy and group psychotherapy. All interns are welcome to join the START Clinic weekly interdisciplinary trauma team meetings for specialized training and consultation.
- Outpatient Eating Disorders Program (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.
- CBT/DBT for Young Adults (Kristin Wyatt, PhD and Colleen Cowperthwait, PhD). Dr. Wyatt will supervise outpatient contemporary CBTs for emerging adults (approx. ages 18-25) and their families, with emphasis on developmentally-responsive DBT. Training on this rotation emphasizes integration of family-based adolescent (Miller, Rathus, & Linehan, 2006; Rathus & Miller, 2015) and adult DBT models (Linehan, 1993; Linehan, 2014) to be responsive to highly variable, rapidly changing developmental needs in emerging adulthood. The intern will receive training in family-inclusive DBT interventions, including parent phone coaching, as needed family sessions, and family-inclusive skills training. The intern will co-lead a developmentally-tailored multi-family DBT skills group for emerging adults and their caregivers, alongside Drs. Wyatt and Cowperthwait. All the standard DBT skills are taught (mindfulness, emotion regulation, interpersonal effectiveness, distress tolerance), as well as a module that specifically targets skills for problematic familial patterns seen in teens and young adults with emotional dysregulation.
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 quarter of training, interns will participate in intensive seminars on issues related to starting the clinical internship, including 1) assessing and managing suicidal behavior, 2) DBT: Model, Principles, and Strategies, and 3) Trauma and its Legacy: Fundamental Trauma Topics and Evidence-Based Principles for Treatment for PTSD and Core Trauma Symptoms. 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 provided by Duke faculty members. Topics vary each year, and may include examples such as: cognitive behavioral therapy for insomnia, Unified Protocol, psychopharmacology basics for therapists, and multicultural competence in psychotherapy for diverse populations.
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.). In addition, we provide weekly meetings that focus on personal self-care, which are intended to help us care for ourselves and to cultivate personal qualities and habits that can contribute to clinical work over the course your career. 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: Adult CBT interns who have completed their dissertation may choose to have elective, protected, and accountable research time dedicated to collaborative projects with Duke 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. CBT faculty strongly encourage and are ready to support pursuing research activities during internship. Dr. Rosenthal directs the Center for Misophonia & Emotion regulation (www.misophonia.duke.edu), the Cognitive Behavioral Research & Treatment Program, and the Clinical Psychology Fellowship Program. His currently funded research examines the role of emotional processes in Misophonia, borderline personality disorder and psychopathology more generally. Dr. Neacsiu conducts funded research on treatment development for emotional dysregulation and Misophonia using psychophysiology, neurostimulation, and neuroimaging. Dr. Smoski conducts NIH-funded studies of emotion regulation and reward processing in depression, including studies of depression in late life. Dr. Smoski is also involved in ongoing studies of mindfulness based interventions. 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, social work 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 CBT rotations: Andrada Neacsiu, PhD; M. Zachary Rosenthal, PhD; Moria Smoski, PhD; Kristin Wyatt, PhD; Noga Zerubavel, PhD; Nancy Zucker, PhD
Adult Health Concentration
APPIC Program code: 141316 – Adult-Health Concentration (3 interns)
The Adult Health 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 Adult Health Concentration, all three interns rotate through the Cancer Behavioral Management and Support Clinic. Behavioral Sleep Medicine Clinic, The Duke Fertility Center, Health Risk Behavior Management Clinic, Palliative Care Clinic, and Perinatal Mental Health Clinic are all minor rotations.
Adult Health Concentration Rotations:
Cancer Behavioral Symptom Management and Support Clinic
The rotation in the Cancer Behavioral Symptom 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 Symptom Management and Support Clinic: Rebecca Shelby, PhD; Tamara Somers, PhD
Minor Health Rotations:
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 Clinic: Meg Danforth, PhD, CBSM
Duke Fertility Center
This clinic in the Department of Obstetrics and Gynecology provides a Psychological Services Program through the Department of Psychiatry & Behavioral Sciences. Interns training in this rotation learn about the psychological aspects of reproductive medicine and provide psychological services on-site alongside healthcare providers. The Psychological Services Program serves individuals and couples with diverse ethnic and racial backgrounds, gender identities, and sexual orientations who are working to achieve parenthood. Interns gain assessment experience conducting structured diagnostic interviews and psychological testing with egg donor and gestational carrier candidates; they also provide consultation and counseling to future parents who need an egg donor, sperm donor, or gestational carrier to build their family.
Interns receive training in: (1) Conducting individual, couples, and group therapy with patients facing fertility treatment, recurrent pregnancy loss, perinatal mood disorders, fertility preservation, or embryo disposition concerns after conclusion of fertility treatment; (2) Crisis management interventions (e.g., ultrasound reveals no fetal heartbeat; panic attack prior to egg retrieval procedure, etc.); (3) CBT and ACT theory and interventions; (4) Use and interpretation of the Personality Assessment Inventory (PAI); and (5) Providing psychosocial consultation in complex medical decision-making. Interns attend and/or present in a weekly Third Party Reproductive team meeting (comprised of Reproductive Endocrinology physicians, fellows, and nurses) and thus gain experience in contributing as a Health Psychologist within a multidisciplinary medical team. Interns receive weekly, individualized supervision delivered in a combination of individual and small group formats. Interns also have the opportunity to gain experience in providing supervision to the Duke Clinical Psychology graduate students completing a yearlong clinical rotation in our program. Interns are supported in their learning about the psychological aspects of reproductive medicine through a combination of weekly educational seminars and weekly supervision of recorded therapy sessions.
Diagnoses commonly seen: Mood Disorders, 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, alternate family-building strategies (e.g., donor egg/sperm, adoption).
Supervisor for the Duke Fertility Center: Julia T. Woodward, PhD
Health Risk Behavior Management Program
A rotation in the Health Risk Behavior Management Program is an opportunity to develop important skills for assessing and treating individuals with a Substance Use Disorder or who have difficulty living in accordance with recommendations for overall healthy living. Services are provided in an outpatient clinic serving adults across the lifespan, and some young adult referrals are co-managed with the Duke Center for Adolescent and young adult Substance Use Treatment program.
Common problems addressed on this rotation include alcohol use disorder, cannabis use disorder, tobacco use disorder, patients stable on opiate replacement therapy (e.g., Suboxone), chronic pain with long-term prescription opiate use, or difficulty with effective management of chronic conditions. Many individuals treated in the program have comorbid mental health conditions including depression, PTSD, and anxiety.
Experiences on this rotation aim to increase interns’ knowledge and skills for understanding and treating individuals from a transdiagnostic, functional behavioral perspective. Interns are trained to utilize a range of assessment tools (e.g., standardized psychological assessments, semi-structured interviews, urine tox screens) to assist in diagnosis and establishing a coherent treatment plan that accounts for an understanding of health concerns, SUD, and mental health issues.
Evidence-based approaches to care employed in the clinic include cognitive-behavioral, Relapse Prevention, and mindfulness- and acceptance-based approaches such as Acceptance and Commitment Therapy (ACT). Interns will also develop and implement skills for collaborative management of suicidality when it arises in the context of SUD or other health risk behaviors. An abstinence-based approach to SUD care is provided for patients seeking this goal (most commonly in response to alcohol, cannabis, or tobacco use), but interns will also become familiar with and practice implementing the principles of Harm Reduction as a means to reduce overall health risk and improve overall wellbeing.
Interns provide individual counseling services, co-facilitate group (e.g., Relapse Prevention for alcohol use disorder), conduct co-therapy as appropriate, and have opportunities to work with partners, parents, and other family members to bolster an individuals’ progress toward healthier living. Interns participate in weekly individual supervision, and early on in the rotation supervision meetings incorporate didactic material to assist interns in learning the foundational skills for seeing patients independently. Interns on this rotation also have the opportunity to participate in ongoing activities to improve the quality of care offered through formal and informal quality improvement projects and to participate in ongoing efforts to expand services.
Supervisor for the Health Risk Behavior Management Program: Jennifer Plumb Vilardaga, PhD
Palliative Care Clinic
Dr. Porter provides training in empirically-based cognitive-behavioral, mindfulness, and couple-based strategies for psychological distress and symptom management among patients with serious medical illness and their family caregivers. Dr. Webb provides training in the role of mental health providers in palliative medicine. The rotation includes one half-day per week in the outpatient palliative care clinic under the supervision of Dr. Webb where interns will be members of a multi-disciplinary team. They will have the opportunity to conduct brief psychological assessments of patients and caregivers, and provide brief, focused interventions for distress and symptom management. Another half-day per week is in the outpatient psychiatry clinic under the supervision of Dr. Porter where interns will provide longer-term psychotherapy to patients and caregivers focused on helping them manage the symptoms and psychological challenges associated with serious illness.
Supervisors for the Palliative Care Clinic: Laura Porter, PhD; Jason Webb, MD
Perinatal Mental Health Program
A rotation in the Perinatal Mental Health Program involves assessment, individual psychotherapy, and partner-assisted psychotherapy for women with perinatal mood, anxiety, and trauma related disorders. Interns will be supervised in ACT and CBT treatments for mood and anxiety disorder during pregnancy and postpartum, as well as in CPT and PE to treat postpartum PTSD.
Interns will receive training in:
- The transition to parenthood, including pregnancy, labor and delivery, newborn development and care, and evidence-based approaches to parenting
- The etiology and treatment of mood, anxiety, and trauma-related disorders during pregnancy
- Pregnancy and infant loss
- Preventative measures to reduce rates of postpartum mood, anxiety, and trauma-related disorders
Interns will participate in a monthly interdisciplinary perinatal consult team, and will regularly collaborate with perinatal psychiatry residents and fellows.
Supervisor for the Perinatal Mental Health Program: Rachel Feuer, PhD