Training in Cognitive-Behavioral and Dialectical Behavior Therapy is provided within the context of the Cognitive Behavioral Treatment (CBT) Rotation. Interns in the CBT rotation conduct assessments and provide consultation and treatment in both inpatient and outpatient settings. Outpatient work is conducted at two physical locations within DUMC – the Civitan Building and the Rutherford Building. Inpatient work is conducted on Williams Unit, a 20-bed general psychiatric ward located in Duke South Hospital. Interns on the CBT rotation 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. 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 may co-lead a weekly DBT group for patients with borderline personality disorder or other appropriate diagnostic categories. 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.

There also is an opportunity for interns to conduct brief therapy and consultation in an inpatient setting and to collaborate with a multi-disciplinary team in this setting. Interns with inpatient responsibilities are members of a multi-disciplinary team, and take primary responsibility for the cognitive-behavioral assessment and therapy aspects of the patient’s care. Interns learn to provide brief, focused individualized interventions such as activity scheduling, cognitive restructuring, behavioral exposure and response prevention, contingency management, and training in distress tolerance skills. 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. 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, co-leading groups with supervisors, and assigned readings. 

There are two primary ways that we help nurture interns during the transition from graduate school to life as 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, throughout the year professional development meetings with CBT faculty occur.

Although CBT interns receive training in DBT, the caseload is a mix of multi-diagnostic patients (e.g., BPD) and those with less complicated presentations. Additionally, individual faculty members provide opportunities for interns to work with other populations. For example, Dr. Robins work includes access to inpatient populations; Dr. Compton’s work includes treatment of adolescents, couples, and families; Dr. Rosenthal’s work includes the integration of novel computer-based interventions into treatments. 

Research opportunities are not a requirement of the rotation but interested interns are encouraged to discuss various research options with faculty members. Dr. Rosenthal is currently running NIH sponsored research investigating DBT for substance use disorders and the use of virtual reality and cell phones in treatment for crack cocaine dependence. Additionally, he has various research projects investigating emotional sensitivity and regulation,,with a special emphasis on the use of novel technologies in the assessment and treatment (e.g., immersive virtual environments, cell phones, etc.) of psychopathology. Dr. Robins’ research currently focuses on the psychopathology and treatment of borderline personality disorder and on emotion regulation. Dr. Compton’s current research is funded by NIH and is focused on couples/marital treatments for older adults. 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.

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 or psychiatry residents early in their CBT training, and progress as a new supervisor is supervised during this time by CBT faculty.

Overall, the program’s 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.

Supervisors:  Jill S. Compton, Ph.D., Clive J. Robins, Ph.D., ABPP, BP, and M. Zachary Rosenthal, Ph.D.

 A. Eating Disorders Program 

The Outpatient Eating Disorders Program (OEDP) is a comprehensive multidisciplinary treatment program for individuals with anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders. Interns doing a rotation in the 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. If interns would like to be involved in research while on their rotation in the OEDP, there is the opportunity to participate in a weekly research meeting. Interns also receive one hour of weekly individual supervision.   

Supervisors:  Nancy Zucker, Ph.D. and Laura Weisberg, Ph.D.

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II. Health Psychology Concentration (Health Interns have a primary rotation and several minor rotations among items A-G listed below, based on the track or program they match with--program information is provided to those applicants who interview with us.)

The Health Psychology 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 Health Psychology concentration, interns rotate through the following rotational placements:

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A. Pain/Biofeedback  Program

This rotation is composed of a clinical and research program devoted to developing better methods to evaluate and treat pain and psychophysiological-based illnesses. Current research examines the influence of emotions, gender and race on pain coping in populations with chronic illness such as Sickle Cell Disease and osteoarthritis. In addition, other studies explore the relationship between depression and glucose control in patients with diabetes.

Specific Assessment Training:  Interns are instructed in techniques for the behavioral and psychological assessment of patients with medical disorders, and medical disorders with psychiatric features.  Assessment experience includes the use of behavioral observation, semi-structured interviews, the Minnesota Multiphasic Personality Inventory, 2^nd edition (MMPI-2), the Neuroticism, Extroversion, Openness, Personality Inventory Revised (NEO-PI-R), the State Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), The Symptoms Checklist, 90-Revised (SCL-90-R), Letter Memory Test (LMT), Multidimensional Pain Inventory, 2^nd Edition (MPI-2), the Headache Scale for Locus of Control (HSLC) and other assessment tools.

The rotation’s clinical activities are centered on an outpatient clinic that serves patients referred by medical and surgical specialists.  In the course of conducting assessments, interns learn to consult with specialists from a number of other disciplines including internal medicine, anesthesiology, psychiatry, hematology, nursing, physical therapy, and occupational therapy.  Interns also learn to integrate behavioral data with data gathered by other disciplines, and to create a comprehensive behavioral treatment program.

The major treatment focus for interns is in the area of Cognitive-Behavioral Therapy (CBT), including Rational Emotive Therapy (RET).  Interns follow several patients for individual therapy and are responsible for implementing such skills as cognitive restructuring, goal setting, problem solving, and training in imagery, distraction, biofeedback, and relapse prevention when needed.  In addition, interns have several opportunities for work with patients in group settings.

Supervisors:  Christopher Edwards, Ph.D., Miriam Feliu, Psy.D.

Research Supervisors:  Richard Surwit, Ph.D.

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B.      Pain Prevention and Treatment

The Pain Prevention and Treatment Rotation is based on a scientist-practitioner model of training that emphasizes the use of empirically-based treatment protocols.  The rotation is specifically designed to teach interns how to deliver protocol-based psychosocial pain management interventions to persons suffering  from disease-related pain (e.g. cancer pain, arthritis pain).  Interns are trained in one or more specific, psychosocial protocols (e.g. pain coping skills training, emotional disclosure interventions, meditation-based methods, and partner-assisted coping skills training) and then deliver these protocols to patients using both face to face and telephone formats.  Treatment sessions are audio taped and reviewed in weekly supervision sessions.  Interns also receive training in methods of supervising non-psychologists (e.g. nurses, physician assistants) in delivery of these interventions.  A major emphasis of the rotation will be on conducting intervention in the context of randomized clinical trials.  Thus, in addition to their clinical training, interns will be exposed to issues of research design, quality control, and data analysis inherent in the testing of standardized treatment protocols.

Supervisors:  Frank Keefe, Ph.D., Daphne McKee, Ph.D.

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C.      Behavioral Medicine Program

This rotation offers opportunities to provide psychological services to patients with a variety of medical disorders, with particular emphasis on cardiovascular disease, pulmonary disease, liver disease, and renal failure.  A major emphasis in this rotation will be in transplantation-related activities.  We offer a full range of psychological services for transplantation patients, including pre-transplant psychological assessment, inpatient and outpatient psychotherapy, and behavioral treatments including stress and weight management for both pre and post-transplant patients.  The intern plays a prominent role in assessment of pre-transplant patients and participates in weekly interdisciplinary meetings for the lung, heart, and liver transplant programs.  The intern may also provide psychotherapy services for transplant patients.  Finally, the intern also participates in ongoing research activities, which currently include studies of stress and heart disease, neuropsychological outcomes and cardiac surgery, exercise training for depression, stress management for heart and lung patients, and examination of bio behavioral aspects of hypertension and women's health.

Clinical Supervisors:  James A. Blumenthal, Ph.D., and Virginia Fenwick, Ph.D.
Research Supervisor:  James A. Blumenthal, Ph.D.
 

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D. Weight Loss Surgery Program (Bariatrics)

The interdisciplinary Weight Loss Surgery Program at DUMC involves medical psychology interns in the pre- and post-operative care of bariatric surgery patients.  Interns work closely with the rotation supervisors to learn how to conduct comprehensive psychometric and clinical pre-operative psychological assessments.  Interns will also receive training in leading and co-leading small cognitive-behavioral psychotherapy groups with pre- and post-operative WLS patients and their families.  Interns will have opportunities to develop an increased knowledge of the eating disorders and obesity literature relevant to the rotation, to lead support groups, and to conduct research projects with our existing data base.  Interns will work closely with the behavioral, medical, and surgical providers to gain a broad understanding of the clinical management of morbid obesity. 

Supervisors:  Katherine L. Applegate, Ph.D. and Kelli E. Friedman, Ph.D.

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E.  Behavioral Sleep Medicine Program

A rotation in the Duke Insomnia and Sleep Research Program (DISRP) is designed to provide training in the treatment and assessment of sleep disorders.   We have an active Cognitive Behavior Therapy 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.  We have several ongoing NIH-funded studies that focus on insomnia assessment/diagnosis and behavioral treatment of primary and comorbid insomnias.  Many of the patients we see for both clinic and research studies have multiple comorbidities, most notably those with comorbid depression, anxiety disorders and/or medical conditions.   Interns will learn about the complex interactions between insomnia and other comorbidities, 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 on the unit include: the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Duke Structured Interview for Sleep Disorders, daily sleep logs, the Epworth Sleepiness scale, Sleep Self-Efficacy Scale, Beck Depression Inventory, the Beck Anxiety Inventory, Dysfunctional Beliefs and Attitudes about Sleep Scale, Penn State Worry Questionnaire, Pre-Sleep Arousal Scale, Fatigue Severity Scale, and the State-Trait Anger Expression Inventory.  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 eventually conduct therapy and assessments under supervision. Training experiences also include attending regular didactic meetings on issues relating to sleep disorders and participating in multidisciplinary clinical rounds. Those interested in participating in research in addition to their clinical rotation may work with a supervisor on existing DISRP data.

SUPERVISORS: Jack D. Edinger, PhD, Margaret K. Lineberger, PhD

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F.  Duke Diet & Fitness Center 

The Duke Diet and Fitness Center (DFC) provides individuals with an interest in obtaining training in obesity treatment and research with an intensive educational and clinical experience. The DFC provides an evidence-based, multidisciplinary, immersion-style, lifestyle change program and follow-up intervention that is intended to engender meaningful weight loss and lasting improvements in health behavior. We treat individuals ranging from those in the early stages of obesity through individuals with severe obesity who are suffering the medical consequences of excess weight. Due to the balanced representation among program subspecialties (Medical, Nutrition, Fitness, Behavioral Health) and the strong medical focus of the program, the rotation provides one of the most complete obesity training experiences available. The internship position offers training and direct experience in the behavioral assessment of the obese patient, behavioral intervention in support of healthier lifestyle, psychotherapy, and healthcare coaching. Opportunities for research are also available in our rapidly expanding research program. Treatment modalities include group education, group therapy, individual therapy and behavioral services, telephonic intervention and internet-based programs for weight loss. Multidisciplinary treatment planning meetings take place twice weekly with ample opportunity to interact with faculty and staff across all represented specialties. In addition, a wide range of supplemental educational opportunities through Duke-sponsored seminars and symposia are available. The Diet & Fitness Center is also a member of a larger collaborative that includes other wellness focused programs at Duke making the rotation a true multidisciplinary and interdisciplinary experience. 

Internship duties include: Leading/co-leading lectures, CBT skills groups, therapy groups, discussion groups, and mind-body/stress management sessions. Provision of individual behavioral intervention and individual psychotherapy for related psychosocial issues is also required. Multidisciplinary treatment planning and curriculum development and general patient care-related responsibilities are also required.  

SUPERVISORS:  Staff and faculty at the Diet & Fitness Center is representative of the various specialties.  Rotation Preceptor: Martin Binks PhD

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III. Clinical Neuropsychology Concentration (Neuropsych interns rotate in several Neuropsych servivces and have a minor rotation in Cognitive-Behavioral Treatment (CBT) (see Section I, Cognitive-Behavioral Treatment Concentration above).

The clinical neuropsychology concentration focuses on providing comprehensive training in clinical neuropsychological assessment and intervention. In addition to consistent and extensive clinical experience, didactics and exposure to research applications of neuropsychology within a competitive academic medicine setting are offered.

Interns selecting a major concentration in clinical neuropsychology will have two principal rotations through the Clinical Neuropsychology Service: a six-month rotation working with outpatients and a six-month rotation working with inpatients. The primary focus of the outpatient rotation involves adult neuropsychological assessment in neurological and psychiatric populations (e.g., Alzheimer’s disease and other dementias, stroke, Parkinson’s disease, seizure disorders, multiple sclerosis, pain, depression), along with limited exposure to neuropsychological intervention services designed to maximize compensation and coping. The primary focus of the inpatient rotation involves the assessment and treatment of patients in acute care and therapeutic settings. While on this rotation, interns will be guided through a mentored research project ½ day per week.  Simultaneously, these interns will select two six-month minor rotations (1 day per week) in a psychotherapeutic setting, with at least one rotation occurring in CBT and the other in Pain Management, biofeedback, or some combination to ensure adequate exposure to training opportunities involving psychotherapy.

Interns selecting a minor concentration in clinical neuropsychology will have two six-month rotations (one day per week) in a structured clinical setting (e.g., Adult Brain Tumor Clinic, inpatient psychiatric unit), to become familiar with test administration, scoring, interpretation, and report writing. These interns will stay focused within a consistent clinical setting, allowing for integration in to specific teams and assessment and evaluation approaches.    

Mandatory and optional didactics and training opportunities include the following: neurology rounds, speech pathology rehabilitation management rounds, rehabilitation rounds, neuropathology rounds (brain cuttings), neurology in-services and lectures, and observation of psychosurgery. Didactic opportunities include a monthly neurobehavior case conference as well as weekly conferences (e.g. neurology grand rounds, psychiatry grand rounds, Center for Cognitive Neurosciences) and periodic (monthly, annual) conferences for the Center for Aging and Human Development and the Bryan Alzheimer’s Disease Research Center. Team affiliations will be encouraged as appropriate (e.g., Adult Brain Tumor Clinic, Neurological Disorders Clinic, Psychiatry inpatient and outpatient programs.

Goals for the concentration include mastery of test administration, scoring, interpretation, and neuropsychological report writing. In addition, oral communication skills to a variety of physicians and allied health professionals are fostered, thereby enhancing effective interaction as members of a multidisciplinary team. Multifaceted treatments, such as working with other disciplines to provide comprehensive patient care, as well as traditional diagnostic skills are also emphasized. Feedback and therapy with patients and families is also routine. In addition, interns develop an understanding of neurological symptoms, neurobehavioral disorders, and psychiatric conditions that span across adulthood. Participation in an ongoing research projects is an important focus and is fostered by the matching of the intern to a faculty mentor who will guide the intern in the development and implementation of a research study and its eventual presentation in an intern seminar at years end. 

Supervisor(s):  Kathleen A. Welsh-Bohmer, Ph.D., ABPP/CN (Director, Clinical Neuropsychology Training), Deborah Koltai Attix, Ph.D. (Director, Clinical Neuropsychology Service), Jeffrey Browndyke, Ph.D., Renee Raynor, Ph.D., Bart Brigidi, Ph.D., Guy Potter, Ph.D., and Larry Tupler, Ph.D.,  Tyler Story, PhD.

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