Behavioral Medicine

APPIC Program Code: 141312

One intern will be selected for this concentration, which provides an emphasis in behavioral medicine health psychology.

Rotations

  • Primary rotations:
    • Transplant Medical Psychology Program
    • Pain Psychology Program
  • Inpatient Psychology (Behavioral Health) (1 day)

Rotation Descriptions

This rotation offers psychological services to solid organ transplant recipients as well as to patients being considered for solid organ transplantation at Duke, including patients with chronic heart failure, end-stage pulmonary disease, chronic liver disease, and renal failure.  

We offer a full range of psychological services for organ transplant patients, including pre- and post-transplant psychological evaluations, inpatient and outpatient psychotherapy, peri-operative neurobehavioral screening assessments for delirium and psychosocial functioning, and psychoeducational/support groups for lung transplant candidates. Evaluations with transplant candidates assess:

  • Patient adherence
  • Substance use
  • Cognitive functioning
  • Psychological functioning/coping
  • Transplant-related motivation/knowledge
  • Social support

The intern also can play a prominent role in the assessment of living kidney donors, and can participate in weekly interdisciplinary team meetings for the lung, heart, liver and renal transplant programs. Services are provided both in- and outpatient and at times, urgent evaluations are requested (e.g., Tylenol overdose). Donor evaluations assess:

  • Readiness/motivation to donate
  • Psychological functioning/coping
  • Social support
  • Cognitive functioning
  • Ability to adhere to post-surgical recommendations
  • Substance use

If interested, there are opportunities to participate in educational lectures provided to transplant coordinators and staff and to participate in morbidity and mortality (M&M) conferences and quality improvement projects. 

Supervisors

The rotation in pain psychology is located at the Duke Spine Center, which encompasses an interdisciplinary outpatient clinic focusing on the treatment of back and spine disorders. This training opportunity is heavily focused on the psychological assessment and treatment of medical and surgical patients who are being considered for chronic opioid management, implantation of medical devices for pain management (e.g., SCS, TDDS), and cognitive-behavioral psychotherapy with an emphasis on behavioral pain management. Patients at the Spine Center reflect a diverse racial and ethnic heritage, age ranges, socio-economic backgrounds, sexual orientations, and gender identities. 

Interns on the pain psychology rotation will receive didactics and training in the psychology of chronic pain, performing semi-structured diagnostic clinical interviews in this setting, and communicating behavioral treatment plans to both patients and their referring interdisciplinary teams. Common diagnostic categories represented in this patient population include mood disorders, anxiety, PTSD, adjustment disorders, somatic symptom disorders, substance abuse, personality disorders, traumatic brain injury, mild cognitive impairment and psychosis.

Interns also receive training on:

  • Cognitive-behavioral psychotherapy for chronic pain
  • The application of mindfulness meditation for patients with chronic pain
  • Crisis management
  • Interdisciplinary case consultation
  • Psychometric assessments (If on-site services are active)

Interns receive individualized supervision adjusted to their developmental level based on familiarity with chronic pain populations and diagnostic evaluations. A comprehensive training manual aids in providing interns an evidence-based approach to the clinical assessment and interventions on the rotation. 

Trainees are also invited to participate in the Pain Lecture Series to learn more about the multidisciplinary treatment of chronic pain with surgeons, anesthesiologists, physical therapists, pain psychologists, and rehabilitation specialists, as well as to participate as an intern co-facilitator with the monthly clinical health psychology symposium.

Supervisor: Katherine Applegate, PhD

The Inpatient Psychology (Behavioral Health) service at Duke Regional Hospital’s psychiatric inpatient unit provides brief evidence-based treatment for adults hospitalized for an acute mental health crisis. Interns on this rotation serve as the psychology consultant to various multidisciplinary treatment teams on the unit. As the psychology consultant, interns operate independently of the treatment teams, utilized by request to address specific needs of the patient/or the team itself.

The most common consultation request made by teams is for the psychology consultant to provide patients a brief, single-session intervention targeting a specific problem (typically the very problem that contributed to their hospitalization in the first place). Interventions are process-based, drawn from contemporary CBTs with heavy emphasis on DBT skills and strategies.

Because of the brief nature of the contact and intervention with patients, interns serving as psychology consultants will learn to rapidly assess for and prioritize treatment targets most relevant to the chief complaint put forth by the patient’s treatment team, and select and flexibly apply CBT (e.g., DBT) strategies accordingly. In addition to brief interventions, treatment teams often utilize the Psychology Consultation Service to receive assistance with differential diagnosis for patients with complex presentations. As a result, interns will hone skills in rapid informal assessment strategies (e.g., behavioral chain analyses) to generate a clinical impression of the patient that will inform the course of the patient’s inpatient treatment. 

The intern will be exposed to a wide range of clinical presentations and presenting concerns on the unit, most commonly: 

  • Suicidal thoughts and behaviors, and non-suicidal self-injury
  • Personality pathology
  • Traumatic stress
  • Psychosis
  • Mood and anxiety disorders
  • Substance use disorders
  • Treatment-interfering behaviors (e.g., medication non-compliance, disruptive behavior).

At the heart of this rotation is the consultation process prior to meeting with patients, whereby the intern meets with the treatment teams to shape consultation requests so that the requests are behaviorally-based, targeted, and linked to an actionable intervention or assessment plan.

Treatment teams typically include psychiatrists, social workers, nurses, behavioral technicians, and pharmacists. As a result, interns will emerge from the training experience with a unique skill that is crucial to inpatient psychology: the ability to “translate” the ways other disciplines in the field describe patient behaviors/concerns into the language of clinical psychology.

There are additional training opportunities for interns, depending on the intern’s interest and needs of the inpatient unit. For instance, interns can lead DBT skills straining groups on the unit. Interns will also have the opportunity to provide clinician education, including informal supervision and didactic training of learners from other fields, such as psychiatry residents, medical and physician assistant students, nursing, and social work students. 

At the outset of the rotation, interns will receive 1:1 didactic training on core CBT (especially DBT) skills and strategies, and observe Dr. Grove conduct consultation meetings and 1:1 sessions with patients on the unit. Once foundational knowledge is acquired, for a short time the intern will take the reins on cases while Dr. Grove observes. This onboarding process typically unfolds over the course of three to four weeks until competence is demonstrated, at which point the intern will begin practicing independently on the unit (though will meet with Dr. Grove for supervision weekly).

Given the heavy emphasis on DBT strategies, prior experience in the direct (i.e., face to face) application of the four modules of DBT skills through practicum or other experiential learning is helpful but certainly not a requirement. Regardless of previous training, Dr. Grove will meet the intern where they are developmentally to provide supervision in skills implementation to build upon foundational training and gain competence in the rapid application of person-centered DBT and other CBT-based skills in an inpatient context. Learn more

Supervisor: Jeremy Grove, PhD

Mohammed Alsubaie, Jeremy Grove, and Julia Chafkin walking in the hallway of the inpatient unit at Duke Behavioral Health North Durham

Duke Psychiatry's Jeremy Grove, PhD, directs the psychology consult service on Duke Regional Hospital’s inpatient unit. He and clinical psychology doctoral interns provide one-on-one consults with patients and facilitate group sessions to help patients build skills to cope with challenges in their lives.

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