The Cognitive Behaviorial Therapy (CBT) Track:

The CBT Track provides experiences in a clinical setting according to the Scientist-Practitioner model and encourages academic careers in psychology. Interns in this track will receive intensive training designed to provide

1. Up-to-date knowledge of clinical research methods and outcomes,
2. Knowledge of the nature of the Axis I and Axis II conditions and treatment interventions based on the current empirical literature, and
3. Experience in formulating and implementing treatments based on functional analyses of maladaptive behaviors in patients with a wide range of severity, comorbidity, and clinical presentations.
   

Treatment/Assessment/Evaluation:
The CBT track provides interns with experience evaluating and treating patients with conditions representing a full spectrum of DSM-IV disorders. To insure that experience with a variety of disorders and relative specialization with several disorders is achieved, interns track the number of patients seen within each diagnostic category. Patient assignments are adjusted to create diversity in each intern's case load. The clinical training requirement for CBT interns is 10 patient-contact hours per week. Typically, interns schedule approximately 12 patient/hours per week to insure a full 10 hours of contact. The CBT and Behavioral Medicine tracks are closely linked, and CBT interns will devote roughly 1/4 of the 12 patient hours per week to behavioral medicine cases.

Participation in a number of diagnostic programs will help enusre that, in addition to providing state-of-the-art CBT interventions, CBT interns become facile with the issues associated with pharmacologic and combined pharmacologic and cognitive-behavioral treatment. Outcome findings for pharmacotherapy, CBT, and their combination is an element of the CBT seminar. During the internship, interns will become aware of the common doses, side-effects, and actions of the agents most commonly applied in the pharmacotherapy of anxiety, mood, and somatoform disorders. In addition, the CBT track provides specialty training in issues of combined treatment and discontinuation of pharmacotherapy for patients with anxiety and affective disorders. Experience with and awareness of the effectiveness of CBT for different diagnostic categories helps prepare interns for interacting with managed care companies and other mental health professionals.

Consultation:
CBT interns provide consultations to medical and psychiatric patients hospitalized at MGH on an as-needed basis.

Research:
Typically, successful applicants to the CBT track have already demonstrated a commitment to clinical research as evidenced by an emerging history of completed research publications and/or presentations. To make the most of the clinical research training, an incoming intern would have their dissertation either nearly complete or complete before starting the internship. One of the main training objectives of the CBT track is to solidify the interns' background and skills necessary for a career in academic research. As part of our commitment to the Scientist-Practitioner model, clinical research is a regular and protected part of CBT interns' weekly activities. Faculty from the Anxiety (Panic Disorder, Social Phobia, PTSD, GAD), OCD, Bipolar, Depression, Psychotic Disorders, Adult ADD, and HIV programs offer a wealth of research opportunties to CBT interns, including multiple ongoing investigations of the nature and treatment of anxiety and affective disorders. In addition to these direct experiences, the CBT Seminar provides training in the use of structured clinical interviews and discusses the methods and findings in recent clinical research trials. The structure of these ongoing studies allows for the intern to add existing measures to ongoing projects or to design side studies of their own.

Below is a list of key faculty involved in research and clnical training in the CBT internship track:

• Lee Baer, Ph.D. - Obsessive-Compulsive disorder, anxiety disorders, computer applications in psychology and psychiatry neuroimaging
• Ann Chosak, Ph.D. - OCD and OC spectrum disorders (BDD, trichotillomania, etc,) and anxiety disorders in adults
• Aude Henin, Ph.D. - the treatment of childhood anxiety disorders and bipolar disorder. Longitudinal studies of risk factors for anxiety and mood disorders.
• Nancy Keuthen, Ph.D. - Clinical treatment of OCD and OC spectrum disorders (e.g. trichotillomania, BDD, etc.) Research on trichotillomania and other body-focused repetitive disorders (e.g. skin picking).
• Joel A. Pava, Ph.D. - Cognitive-behavioral treatment of depression
• Noreen Reilly-Halrrington, Ph.D. - Bipolar disorder, including cognitive-behavioral therapy for bipolar disorder, the managment of medication related weight gain, and research on the role of cognition and life stress.
• Susan J. Penava, Ph.D., - Cognitive behavioral therapy of anxiety disorders and depression; treatment development
• Diana M. Ronell, Ph.D., - Fear of flying, panic symptoms, and medical anxiety.
• Steven A. Safren, Ph.D., - Behavioral aspects of HIV, anxiety disorders, treatment development
• Susan Sprich, Ph.D. - Anxiety disorders and trichotillomania in children, adolescents and adults, DBT.
• Sabine Wilhelm, Ph.D. - Obsessive compulsive disorder and OC spectrum disorders, including information processing, treatment development and treatment outcome research. Body dysmorphic disorder.
  
  

Didactics:

• CBT seminar (weekly)
• Behavioral Medicine seminar (weekly)
• Group Supervision and Case Conferences
• Psychopharmacology Conference

• 2+ hours individual supervision
  
• 1 hour Anxiety Program group supervision
  
• 1 hour Depression Program group supervision
  
• Supervision provided in both group and individual formats is designed to offer a variety of perspectives on the careof patients. In all cases, supervision is designed to combine perspectives based on empirical research and enhanced with clinical experience.

PostDoctoral Training Opportunties:
The internship year is the first step toward specialization in a clinical research area related to Behavioral Medicine/Health Psychology. To provide CBT/BMED track interns with advanced training in clinical methods and clinical research, the research teams programs within Behavioral Medicine and the Division of Medical Psychiatry Outpatient Department at MGH may offer Postdoctoral Fellowships in Clinical Research. Currently, there are post-doctoral fellows who are completing clinical research projects as part of the Anxiety, Bipolar, OCD, and Psychotic Disorder research teams. These teams offer ongoing experiences in treatment outcome protocols as well as specialized investigations of the nature and correlates of these disorders. As the Behavioral Medicine Program grows, clinical fellowship positions may be available for new areas consistent with the mission of the program, department and hospital. Interested interns are encouraged to organize their research and clinical activities such that they can make a smooth transition to a fellowship year if positions are available.

Links:

Cognitive Behavioral Therapy
OCD Clinic and Related Disorders Program
Body Dysmorphic Disorder Clinical and Research Unit
Behavioral Medicine
Tic Disorders Clinic and Research Unit
Trichotillomania Clinic and Research Unit


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