Adult CBT Concentration

The Adult CBT concentration provides an emphasis in full model Dialectical Behavior Therapy (DBT) approximately 40% time or two days per week. 

After matching to Duke, interns will rank their preferences for two or three other elective rotations to diversify their clinical experiences based on their interests. At least one will focus on assessment.  

Interns on the CBT concentration will be trained over the course of the internship year to conduct individualized assessments and provide evidence-based CBT and DBT for individuals with mood, anxiety, trauma, substance use and personality disorders. 

Interns will train in several clinics to obtain a diversity of experiences. Rotations are year-long, allowing more challenging patients to be seen throughout the year for longer-term care.

All CBT interns receive training in DBT; however, the caseload is a mix of multi-diagnostic patients (e.g., borderline personality disorder) and those with less complicated presentations. The most common diagnoses treated include mood, anxiety, trauma and personality disorders. All interns will receive training in providing CBT and DBT in Duke’s outpatient setting.

Interns may 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. Interns attend a weekly two-hour DBT consultation team meeting in addition to one hour of weekly individual DBT supervision.

Overall, the 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
  • Successful oral and written communication with other health professionals

Supervisors for DBT rotation:

The CBT rotation provides didactics and educational opportunities to interns through several different activities.
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. During the first quarter of training, interns participate in intensive seminars on issues related to starting the clinical internship, including “DBT: Model, Principles and Strategies.”

Other seminars have included:

  • Cognitive behavioral therapy for insomnia
  • Unified Protocol
  • Psychopharmacology basics for therapists 
  • Multicultural competence in psychotherapy for diverse populations

All CBT interns 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.

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.

Early in the internship year, all interns choose a faculty member 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, all interns attend weekly meetings that focus on professional development, including a biweekly meeting with the training director, Chris Mauro, PhD, as well as a monthly supervision series and seminars on anti-racism, ethics and professionalism.

Adult CBT interns who have completed their dissertation may choose to have elective 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 interns can get involved with CBT faculty research projects. CBT faculty strongly encourage and are ready to support interns pursuing research activities. Examples include: 

  • Zach Rosenthal, PhD, directs the Center for Misophonia & Emotion Regulation, the Cognitive Behavioral Research & Treatment Program and the Clinical Psychology Post-Doctoral Training Program. His currently funded research examines the role of emotional processes in misophonia, borderline personality disorder and psychopathology more generally.
  • Moria Smoski, PhD, 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.
  • Interns interested in research on eating disorders may participate in a weekly research meeting to explore ways to collaborate on research projects led by Nancy Zucker, PhD.

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:

After matching to Duke, interns will rank their preferences for two or three other elective rotations. 

See Elective Rotations