Process-Based Cognitive Behavioral Therapies

Interns attend a weekly two-hour DBT consultation team meeting and may provide individual therapy and/or co-lead a weekly DBT group for patients struggling with emotional dysregulation. Co-leading a DBT group provides additional training in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills.

Supervisors

• Colleen Cowperthwait, PhD
• Jeremy Grove, PhD
• Stephanie Hargrove, PhD
• Zachary Rosenthal, PhD

The ACT at Duke Clinic offers in-depth training on Acceptance and Commitment Therapy (ACT). Interns are trained to a high level of competency in functional assessment / case formulation, and engagement of the six core ACT processes (acceptance, defusion, self-as-context, present moment awareness, values and committed action).

Interns refine skills in the application of ACT to an array of presenting problems, including anxiety and mood disorders, eating disorders and psychological issues in the context of chronic illness (e.g., type 1 diabetes) or other medical issues (e.g., infertility, cancer). Most patients seen in the ACT at Duke Clinic are adults, although there may be opportunities to treat adolescents.  

Interns complete an ACT core competency assessment and participate in collaborative goal setting to achieve individual training goals. Interns are assigned to an individual supervisor and supervision is facilitated by live observation and audio tape review. Interns also attend a weekly didactic and group supervision with psychiatry residents, clinical psychology graduate students, and postdoctoral fellows, which includes didactic learning methods, and experiential exercises and skills demonstration and practice.

ACT at Duke Clinic faculty are leading ACT-based research. Faculty are highly supportive of Interns involvement in ongoing studies, which includes ACT clinical trials, digital and mobile health delivery and process of change research. Interns may also have the opportunity to be trained in clinical trial protocols or fidelity review, which deepens understanding of the model.

Supervisors

• Rhonda M. Merwin, PhD
• Ashley A. Moskovich, PhD

Interns will learn contemporary cognitive behavioral therapies focused on emotion regulation and reward processes in major depressive and other mood disorders. Interns will participate in team meetings and supervision to learn how to translate knowledge from cognitive neuroscience research including functional neuro-imaging to better understand and improve psychosocial interventions, including cognitive behavioral and mindfulness interventions.

Supervisor: Moria Smoski, 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

The Duke Consultation & Brief Psychotherapy Clinic (C&BP) provides empirically-based services to individuals primarily affiliated with the Duke community (current employees/faculty/students) across the adult lifespan. The clinical focus of the C&BP clinic is to increase access to brief, efficacious psychotherapy by offering a combination of targeted functional assessment and brief integrative psychotherapy.  
 
This rotation includes extensive training in integrative case formulation, which intends to identify behavioral, interpersonal, and cultural factors that contribute to the ongoing maintenance of problematic issues. This rotation will also emphasize intentional assessment of strengths and individual differences that impact the client’s personal growth and engagement in mental health services.
 
Learners will gain experience in how to quickly establish and maintain therapeutic alliance, clarify SMART goals, and provide brief empirically-based psychotherapy approaches (i.e., up to 10 sessions). Learners will achieve improved skills in client motivation enhancement, routine outcome monitoring, and use of modular care pathways that best target the patient’s specific proximal needs. Due to the brief format, learners will also have the frequent experience of taking ownership of the full treatment-arc that includes assessment, implementing targeted brief care, case management, and empowering patients to continue their individual work after leaving the C&BP clinic.  

Supervisors

• Tyson Pankey, PhD
• Jeffrey Sapyta, PhD

Interns attend a weekly two-hour DBT consultation team meeting and may provide individual therapy and/or co-lead a weekly DBT group for patients struggling with emotional dysregulation. Co-leading a DBT group provides additional training in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills.

Supervisors

• Colleen Cowperthwait, PhD
• Jeremy Grove, PhD
• Stephanie Hargrove, PhD
• Zachary Rosenthal, PhD

Duke Counseling and Psychological Services (CAPS) provides a comprehensive range of psychological and psychiatric services to support students in managing psychological and social difficulties, with an immediate goal of strengthening their abilities to succeed in the University’s undergraduate, graduate, professional, and allied programs. Duke University is a privately supported institution with an enrollment of 17,499 students who come from 50 states and 124 foreign countries. 

The University provides a stimulating learning environment in its ten colleges and schools: Trinity College of Arts and Sciences, School of Law, Divinity School, Graduate School, School of Medicine, School of Nursing, Nicholas School of the Environment and Earth Sciences, Pratt School of Engineering, Sanford School of Public Policy, and Fuqua School of Business.

Training emphasizes experiential clinical learning and incorporates evidence-based intervention approaches, including solution-focused brief therapy, CBT, DBT, and ACT. Training experiences include brief assessment, crisis intervention, individual and group psychotherapy, outreach, workshops, advocacy, and mental health consultation.

Service activities are balanced with individual and group supervision, seminars, clinical consultation teams, and professional development activities. Seminars will cover topics relevant to the clinical population, including identity and development, cultural considerations, mood and anxiety disorders, eating and body image concerns, executive functioning challenges, among others.

CAPS affirms and provides opportunities to increase awareness and knowledge of human diversity at the micro and macro levels of intervention. Training activities are designed to promote the acquisition of critical thinking skills related to individuals, environments, cultures, and systems and to develop culturally responsive psychological interventions.

Supervisors

• Leigh Spivey-Rita, PhD (CAPS Site Training Director)
• Chantal Gil, PsyD
• John Mitchell, PhD