Overview of Cognitive Behavior Therapy Tracks

The overarching aim of these tracks (as with the IOL internship as a whole) is the practical integration of psychological science and practice. Within this general framework, the CBT tracks will emphasize the use of critical thinking skills, the application of basic and applied research to complex cases, and the thoughtful and systematic evaluation of clinical work using evidence-based practices.

Two full-time positions will be offered by the Clinical Psychology Department; one focusing on Adult patients and one focusing on the treatment of children and adolescents. The training year is composed of three primary four-month rotations and several minor rotations. The primary training objective is to assist the intern in acquiring the necessary skill base to achieve a high level of competence in the evaluation, assessment, and treatment of acute and chronic psychiatric illness, including acute exacerbations of chronic mental illness. The Psychology Department believes that intensive training experience within an acute inpatient and outpatient hospital service provides exposure to the broadest range of psychiatric disorders and aids in the development of confidence in the interns’ diagnostic and treatment skills. Interns will be expected to integrate the use of cognitive-behavioral interventions, skills-training methodologies (e.g. Dialectical Behavior Therapy), and become familiar with psychodynamically-informed treatment planning when appropriate. The training faculty wants to assist the intern in deepening their ability to conceptualize on multiple levels and recognizing the interactions between intrapersonal, interpersonal, and systemic forces influencing the patients with whom they work.

This track will include the following training experiences and objectives:

  • To prepare psychologists who can consume new research findings and integrate them into practice. Using individual and group mentorship programs, interns will read, discuss, and evaluate practice-relevant research articles; develop treatment plans that consider the best available empirical evidence; and discuss the therapeutic, ethical, and legal aspects of evidence-based practice.

  • Interns will participate in research projects using evidence-based strategies of measurement and analysis in order to evaluate the efficacy of their treatments, to develop and refine programs, and to inform best practices for the institution.

  • To prepare psychologists who can produce new scientific findings that will contribute to the literature. All interns will have the opportunity to participate in the broad range of basic and applied research conducted at the Institute of Living, including psychotherapy research, pharmacotherapy clinical trials, neuroimaging research, and more.

The CBT track intern will spend at least 10 hours per week providing outpatient services at the Anxiety Disorders Center/Center for CBT for the entire internship year. This will allow them to treat patients over a longer period of time, become involved in longer-term projects at the ADC/CCBT, and provide a "home base" that will include meeting with a primary internship preceptor.

Core Training Rotations

The intern will complete 3 rotations, each lasting 4 months. They are:

(A) Anxiety Disorders Center/Center for Cognitive Behavioral Therapy
The CBT intern will spend the majority of their time at the Anxiety Disorders Center/Center for Cognitive Behavioral Therapy during one of their 4 month rotations. The Anxiety Disorders Center/Center for CBT (ADC/CCBT) is an outpatient clinic specializing in the cognitive-behavioral treatment of anxiety, mood, and obsessive compulsive spectrum disorders. Interns will provide outpatient CBT to the clinic’s patients, including accelerated (daily) exposure therapy sessions to patients with moderate to severe anxiety disorders and OCD. Interns will also complete assessments of new patients utilizing structured diagnostic interviews and well-validated self-report measures. The ADC/CCBT employs state of the art technology and assessment tools, including virtual reality technology, evidence based computerized assessment of treatment progress, which the interns will use in their patient care. In addition, interns will have the opportunity to contribute to research, gain experience in program development, and provide specialized consultation services to other departments of the Institute of Living. The ADC/CCBT provides services across the lifespan, although each of the two CBT interns will be assigned predominantly to either adult of children/adolescent cases.

(B) Connecticut Children’s
The CBT intern will spend four months providing consultation and brief therapy intervention to pediatric patients hospitalized at Connecticut Children’s. Connecticut Children’s is one of three hospitals in the state of Connecticut that provide comprehensive medical services to children, and along with Hartford Hospital and The Institute of Living, has a long tradition of training psychologists.
This rotation is designed to introduce the CBT intern to several roles that the psychologist can hold when interfacing with medically complex patients. During this rotation, the CBT intern will work in several specialty clinics. Primary outpatient work will involve patients in the gastrointestinal disorders clinic, and will involve individual and group based treatment as well as consultation. The CBT intern will work with patients from this clinic at times of symptom exacerbation that leads to hospitalization, and will gain exposure to the inpatient CL Psychiatry/Psychology service through following these patients. On the inpatient level, CL services may involve consultative and/or treatment roles. The intern can expect to spend roughly 10 hours with the GI population weekly, and will have 1 hour of supervision weekly with a psychologist who specializes in CBT treatment for GI disorders.

The CBT intern will also interface with the Developmental Pediatrics team, where the emphasis will be on providing behavioral consultation and planning for cases that require enhanced behavioral management. Opportunities to round with the developmental and behavioral pediatricians will be available to the interested intern.

Other specialty outpatient clinic exposure may include the sleep medicine clinic and the headache clinic. Trainees will also have opportunities to be involved in neuropsychological assessment for medically hospitalized patients as well as for outpatients who are followed by hematology/oncology.

Consultation to oncology, cardiology, rehabilitation, pulmonary, pain, and other departments are typical. The intern will be trained in a variety of empirically based treatments that utilize cognitive-behavioral methodologies targeting psychological response to medical conditions as well as functional disorders. Outpatient CBT based interventions will also be provided in specialty clinics, such as pain, feeding, oncology, gastrointestinal, and obesity. Exposure to hospital based neuropsychological assessment will also be available.
Finally, the CBT intern will attend pediatric journal club and relevant medical didactics during their time on rotation.

(C) Child and Adolescent Intensive Outpatient Service
IOL programming includes child and adolescent intensive outpatient programs. The CBT intern will be able to choose between the programs for this four month rotation. They will be exposed to a broad spectrum of both acute and chronic psychopathology. Patients present with severe mood, psychotic, personality, behavioral and developmental disorders. . The CBT intern will function as a group therapist in this setting. Program development during this rotation will involve creating, running and managing behavioral and skills-based groups that will ideally be self-sustaining by the rotation/training year’s end. Such groups may involve DBT skills, unified protocol, behavioral activation, parent-management training, et cetera, contingent on program needs and trainee experience. They will also carry an individual caseload for targeted interventions and offer consultation for behavioral interventions throughout the program.

Year Long Training Experiences:

Psychiatric Inpatient:
The Child CBT intern will consult to our psychiatric inpatient unit across all three rotations. Consultative role includes collaboration with inpatient providers on behavioral management strategies for selected patients as well as diagnostic consultation when OCD or anxiety disorders may play a significant role in the hospitalization. The CBT intern will also run inpatient therapy groups on both the child and adolescent units. Trans-diagnostic treatment targets may include social skills, coping skills, affect regulation, distress tolerance, et cetera; the novel experience will be in tailoring provision of these services to the capacity of the acute inpatients.

Anxiety Disorders Center/Center for CBT:
The CBT track intern will spend at least 10 hours per week providing outpatient services at the Anxiety Disorders Center/Center for CBT for the entire internship year. This will allow them to treat patients over a longer period of time, become involved in longer-term projects at the ADC/CCBT, and provide a "home base" that will include meeting with a primary internship preceptor.

Other Core Experiences

In addition, the CBT track intern may complete 3 electives, running concurrently with the Major Rotations, each lasting 4 months (although an elective could be extended to two periods by mutual agreement). The intern’s interests will be identified at the beginning of the training year so that a sequence of training can be established that takes into account any elective interests identified by the intern.

Electives offered will include:

• Young Adult Services
• Adolescent Inpatient Services
• Neuropsychology
• Health Psychology
• Schizophrenia Rehabilitation Program
• Anxiety Disorders Center/Center for Cognitive Behavioral Therapy
• Research (collaboration with faculty)

Seminar Program

Trainees attend a variety of seminars, offered by both the Psychology Department and the psychiatry residency training program. We anticipate that the following seminars will be available this year:

• Diagnosis and Assessment (Required)
• Modern Readings in Personality and Psychotherapy (Required)
• Family and Group Therapies (Required)
• Weekly Grand Rounds (Required)
• Child Psychotherapy Seminar and Case Conference (Required for Child Track)
• Connecticut Children’s Grand Rounds
• Psychosis Seminar
• Focal Therapy and Case Conference (Required)
• Diversity Seminar (Required)
• Psychiatry Journal club (monthly)