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:
1. Adult Cognitive Behavioral Therapy (CBT) Concentration (APPIC Program code: 141314)
2. 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 (4 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: Zach Rosenthal, PhD, Melissa L. Miller, PhD, Andrada Neacsiu, PhD, Moria Smoski, PhD, and 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 DBT (Kristin Wyatt, PhD). Dr. Wyatt will supervise one intern in providing therapy services on the Duke Psychiatry Inpatient Service, Williams Ward. The intern will serve as a consultant to the inpatient psychiatry team. In this role, the intern will interact regularly with the unit psychiatry teams to ascertain and shape consultation questions from psychiatry residents and will provide responsive brief, targeted interventions with inpatients. Consultation questions and patient clinical presentations vary widely, allowing for flexible use of contemporary CBT strategies (including frequent requests for DBT strategies specifically).
Population Health (M. Zach 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 Program Development (Melissa L. Miller, PhD). Dr. Miller will supervise one intern in contemporary CBTs. This rotation will also include an opportunity to create and provide psychoeducation classes and workshops for the family members of loved ones with emotion regulation difficulties, deliver didactics and trainings within the Duke community, and engage the larger community to promote mental health.
Translational Neuroscience Treatment Development (Andrada D. Neacsiu, PhD). Dr. Neacsiu is supported by received several lines of funding to develop a neurostimulation and CBT intervention for emotion dysregulation. Neuroscience-informed intervention development involves identifying the appropriate sample that could benefit, as well as identifying and remedying a skills deficit that is common in psychopathology and that has a clear neural underpinning. The intern partaking in this specialized rotation will learn principles of translational science, treatment development, and intervention assessment. In addition to these research oriented skills, the intern will accumulate substantial clinical experience conducting structured clinical assessments, and delivering the novel intervention. The rotation would involve doing 1-2 clinical assessments with the new SCID-5 and SCID 5 PD each week, as well as conducting the neurostimulation and CBT intervention when possible. The intervention targets a transdiagnostic sample, and therefore the intern will have the opportunity to work with a variety of clinical presentations. The clinical assessment will involve a thorough suicide risk assessment when necessary. The minor rotation also involves participating in the 2 day Duke Neurostimulation Fellowship program, participating in weekly lab meetings focused on treatment development, and becoming a certified transcranial magnetic stimulation (TMS) technician. (Research Opportunities: Dr. Neacsiu conducts funded studies of emotion regulation and treatment development in transdiagnostic samples. Currently, she is developing a novel intervention that combines transcranial magnetic stimulation with cognitive behavioral therapy. She is also connected with the Brain Stimulation and Neurophysiology group and can facilitate research.)
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. In addition, Drs. Wyatt and Cowperthwait provide developmentally-tailored DBT skills training for individuals 18-25 and their families. This skills group is based on the DBT for adolescents skills training model (Rathus & Miller, 2015), in that the group will be a multi-family group, in which parents or caregivers will participate weekly alongside their young adult. 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.
Palliative Care (Laura Porter, PhD and Jason Webb, MD). 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.
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 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.). 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: 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, 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: Melissa L. Miller, PhD, Andrada Neacsiu, PhD, Laura Porter, PhD, M. Zachary Rosenthal, PhD, Moria Smoski, Ph.D., Jason Webb, MD, Kristin Wyatt, PhD, Noga Zerubavel, PhD, Nancy Zucker, Ph.D.
Adult Health Concentration
(APPIC Program code: 141316 – Adult-Health Concentration)
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, interns rotate through the Cancer Behavioral Management and Support Clinic, the Duke Fertility Center, and the Behavioral Sleep Medicine Clinic.
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: Rebecca Shelby, PhD; Tamara Somers, PhD
Duke Fertility Center
This Clinic in the Department of Obstetrics and Gynecology provides a Psychological Services Program through the Department of Psychiatry and 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).
Duke Fertility Center Clinical Supervisor: Julia T. Woodward, PhD
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 Danforth, PhD, CBSM