Behavioral Sleep/Circadian Medicine & Research Track

Goals

The Behavioral Sleep/Circadian Medicine & Research track is ideal for those with a career goal to be an independent researcher or for those who want to pursue sleep and circadian research alongside clinical work. The primary emphasis is to develop a clinician researcher who will gain skills in conducting research within a health care setting. Our institution also offers a Postdoctoral Fellowship program, and interns will be encouraged to apply for a position.

The intern will be matched with a primary mentor from the Sleep Disorders and Research Center. Faculty available to serve as a mentor, and a description of their research program and projects, are described here. 

Interns will complete a major rotation in Clinical Research and work alongside their primary mentor over the entire internship year. Additionally, interns will also engage in a year-long major rotation in Behavioral Sleep Medicine (see below), and have the option for additional minor rotations. Interns will meet with the training director to design a program based on their own unique training goals and interests.

Behavioral Sleep Medicine Training

Insomnia

Training in behavioral treatment for insomnia will include Cognitive Behavioral Therapy for Insomnia (CBT-I), including adaptations for various populations, including pregnant individuals, shift workers, and patients with depression. Interns will also have exposure to implementation of digital CBT-I in health care settings, including adjunctive coaching to enhance adherence and treatment completion. Opportunities may also include combination medication and behavioral management of insomnia.

Training will also be available for other behavioral treatment modalities, including mindfulness-based interventions, as well as brief behavioral therapies to both treat and/or prevent insomnia disorder.

Obstructive Sleep Apnea

Training may include behavioral management of CPAP adherence such as CPAP desensitization. Opportunities may include combination treatment for comorbid Insomnia and Obstructive Sleep Apnea (COMISA).

Circadian rhythm disorders

Training will include behavioral management of circadian rhythm disorders, including shift work disorder, delayed/advanced sleep phase disorder, and other more rare forms of circadian disruption.

Primary Care Liaison

Primary care is often the gateway to healthcare for most patients, and many patients seek help for their sleep problems in primary care. Trainees will have the opportunity to experience serving as a behavioral sleep medicine liaison in a primary care setting, bridging the gap between primary care and specialty services.

Other Rotations

In addition to behavioral sleep medicine training, interns may also select from a variety of other opportunities.

Internal Medicine/Primary Care

The Internal Medicine rotation will provide exposure to a number of experiences for psychology interns working from the primary care behavioral health model. The Academic Internal Medicine clinic has a large multidisciplinary team, including physicians, over 90 internal medicine residents, a clinical pharmacist, nurses, medical assistants, social workers, and community health workers, to assist in the care of our patients.

Clinical care:

• The intern will complete initial consultations, ideally via ‘warm handoff’ from providers in clinic, and brief goal-directed therapy where appropriate. Reasons for consultation requests include depression, anxiety, pain management, weight management, ADHD screening, adjustment to life stressors, non-adherence, substance concerns, psychosis and somatoform disorders. Most of these patients also have co-occurring chronic illnesses impacting their presentation and management.
• The intern may have the opportunity to co-leads a 6 week behavioral weight management psychotherapy group.
• Interns will also have the option to learn more about providing biofeedback in appropriate patient populations.

Educational opportunities:

• Interns will gain knowledge in assessment and diagnosis, pharmacology, general medicine, brief evidenced based therapies, and learn to work with the primary care team.
• Interns may get the option to help develop and provide content for the multidisciplinary team and Internal Medicine resident didactics.
• Interns will also have the opportunity to join the Internal Medicine residency didactics to broaden their knowledge base of general internal medicine.
• Supervision occurs regularly throughout the day.

Psych-oncology

Our Psycho-Oncology rotation is designed to provide comprehensive training in the assessment and management of a diverse and complex medical population with cancer. The intern will have the opportunity to care for, and engage with, patients and their families through all phases of the cancer journey, including diagnosis, active stages of treatment, post-treatment survivorship, recurrence, advanced illness, and end of life. The intern will learn how to assess and manage common psychiatric concerns in the oncology population, help mediate complex psychosocial issues, gain knowledge regarding psychopharmacological interventions, evaluate medical decision making capacity, and work within interdisciplinary teams. Training experience occurs in both ambulatory clinic (including telemedicine) and inpatient consultation-liaison settings. The intern will work closely with a variety of complimentary and integrated disciplines, including Palliative Care and Hospice, Medical Oncology, Radiation Oncology, and Surgical Oncology. Opportunities to train in a multidisciplinary specialty clinic are available based on interest.

Bariatric Surgery

The Bariatric Surgery service consists of performing outpatient psychological pre-surgical evaluations for suitability for patients pursuing bariatric surgery. Evaluations consist of a diagnostic interview and brief assessment measures. Patients present with a variety of diagnoses including mood disorders, anxiety disorders, eating disorders, personality disorders, etc. The intern will also have the opportunity to provide brief treatment for patients aimed at improving psychological symptoms and problematic eating behaviors. Clinical care is a hybrid of virtual and in-person. The intern may also participate in routine post-surgical group-based visits. Knowledge gained includes factors contributing to obesity, commonly occurring medical comorbidities, and evidence-based treatments for weight management. Supervision will occur throughout the day.

Women’s Health

The rotation in Women’s Health will involve intake diagnostic assessments and interventions with patients during the perinatal period. The intern will conduct evidence-based individual psychotherapy with perinatal patients, from brief (up to 8-12 sessions) to longer-term (if selected to complete this rotation for a longer period of time). The intern may also conduct group psychotherapy with perinatal patients which could include Dialectical Behavioral Therapy and/or a brief prevention group. Patients commonly present with mood and anxiety disorders.

Gastroenterology

The Gastroenterology (GI) rotation will involve providing psychological evaluations and evidence-based short-term psychotherapy for outpatients under the care of a Gastroenterologist. Commonly seen disorders include inflammatory bowel disease (IBD; Crohn’s and ulcerative colitis), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), gastroparesis, and a variety of GI conditions. The intern will gain experience conceptualizing goals and implementing treatment plans for patients who have GI conditions. Treatment typically focuses on providing mind-gut interventions to help with managing GI symptoms, strengthening skills for coping with illness, managing sequelae such as depression and anxiety related to the GI condition, and improving quality of life. Primary treatment approaches include CBT and hypnosis. The intern will learn how gut-directed hypnotherapy is used in treatment of GI conditions. Interns who complete an introductory hypnosis skills course will be able to provide GI-focused hypnosis during this clinical rotation. Depending on the intern’s days on the GI Health Psychology Service, there may be an opportunity to conduct pre-surgical evaluations for patients for whom gastric neurostimulator placement or gastric peroral endoscopic myotomy (G-POEM) has been recommended for treatment of gastroparesis. Supervision will occur throughout the day or at scheduled meetings.

Transplant Surgery (Kidney/Multivisceral/Living Liver Donation)

Henry Ford Hospital’s Transplant Institute draws from the entire state for kidney, pancreas, and multivisceral transplantation, as well as living donors for liver donation. Candidates for organ transplant have a wide range of psychiatric pathologies including mood, anxiety, personality, and substance use disorders. Psychiatric and substance use disorders can have serious negative impact on outcomes after transplantation. Therefore, identification of these risk factors prior to transplant with recommendation for patients to engage in empirically validated interventions to mitigate risks can significantly improve outcomes, including quality of life and survival, after transplantation.

The interns in transplant psychology will learn about organ transplantation and the role of an integrated clinical health psychologist in interdisciplinary transplant teams. This includes exposure to both outpatient and inpatient care. Clinical work involves exposure to complex medical patient presentations, experience in performing clinical chart reviews and pre-surgical psychological semi-structured evaluations, engagement in post-transplant clinical care, and experience in performing brief cognitive screeners. Interns are also encouraged to participate/observe selection committee meetings if on service on those days.

Normal Pressure Hydrocephalus Clinic

Supervisor: Brent Funk, PsyD, ABPP

The Normal Pressure Hydrocephalus Clinic is a multidisciplinary clinic consisting of a neuropsychologist, behavioral neurologist, neurosurgery, and registered nurses. Patients are primarily referred by neurology for evaluation of whether they may have the condition and could benefit from surgical intervention. Patients also follow-up at least yearly after surgery for monitoring of their status. Brief neuropsychological interview and screening is conducted during clinic visits. Consultation is also conducted with other professionals during the visits. The intern will have the opportunity to be involved with all aspects of clinic visits including interviewing, administering and scoring tests, interpreting findings writing progress notes, providing feedback to patients, and providing report to other professionals on neuropsychological findings. Clinics typically are one day weekly and may be either a half or full day. Supervision will occur throughout the day and will include live observation and case discussions. If available, interns can attend the NPH surgical board meetings, which occur on a separate day from clinic. Rotation length can vary depending on availability but should be at least 2 months.

Neuropsychology

Supervisors: Brent Funk, PsyD, ABPP, Brad Merker, PhD, ABPP, Adrianna Zec, PsyD, ABPP, Dana Connor, PhD, ABPP, Maya Pinjala, PhD, & Jannel Phillips, PhD, ABPP

The neuropsychology division is a primarily outpatient service for evaluation and diagnosis of patients with suspected cognitive disorders. Referrals come from throughout the health system but are mostly from neurology, primary care, and behavioral health providers. Patient populations include TBI, stroke, multiple sclerosis, epilepsy, dementias, genetic and developmental conditions, mental health conditions, and various other conditions that affect cognitive functioning. For interns with prior experience or who are able to provide additional time in service to neuropsychology opportunities to be involved with presurgical evaluations (including inpatient epilepsy and outpatient deep brain stimulation) are available. Rotation length will be a minimum of 6 months with at least 1 day per week spent with neuropsychology. Interns will be required to select a primary adult or pediatric focused experience. Interns will be required to attend a week long training session at the beginning of the year for instruction on test administration and scoring. Over the course of the rotation the intern will gain proficiency in conducting all aspects of a neuropsychological evaluation including chart reviews, interviews, test selection, administration, scoring, and interpretation, report preparation, and feedback of test results. Supervision will include live observation of aspects of the evaluation process and meeting weekly to discuss cases with their assigned supervisor. Interns will likely rotate with several supervisors. If interns are available and interested other opportunities within the division could include attendance at the neuropsychology didactic series, attendance of surgical boards (DBS and epilepsy), or shadowing of other specialty services (Wada studies, Autism evaluations).

Supervision

Interns will receive daily supervision from their primary supervisor on their current rotation. The intern will discuss each new case with the supervisor as well as any difficult cases the intern is following with. Interns can also request meetings with supervisors for discussion of other areas such as to receive individualized feedback or professional growth. Interns from all tracks also participate in a one-hour, weekly group supervision with the Director of the Psychology Internship Program. Interns will rotate presenting a case paired with a question or topic for discussion for the group.

Didactics

The intern on this track may also attend “Bagel Rounds” and a Team Meeting with the Health Psychology interns and fellows. Bagel Rounds is a weekly teaching conference. For the early part of the year, staff members present topics designed to orient trainees to the service and provide a crash course for needed medical information. The weekly Team Meeting occurs after Bagel Rounds in which senior staff, health psychology fellows, and the health psychology interns participate. This meeting includes discussion of patient care, professionalism, and brief teachings.

Outcome/evaluation

The intern in the Behavioral Sleep/Circadian Medicine & Research track will be evaluated in a number of ways. Informally, the interns are evaluated on clinical progress via individual supervision. Additionally, the intern will be formally evaluated at the end of each 4-month period by their primary supervisor(s). Interns will also be formally evaluated through formal case presentations. This case presentation includes a presentation by the trainee of the nature of the diagnosis, a review of the literature regarding the case, and an assessment of the specific case in light of that literature.

Application Instructions

Those applying to this track may also apply to other tracks in our program. Interns who match to our other tracks still have the opportunity to become involved in research and work with a research mentor, if interested. If applying to this track, please include your research interest and career goals in your cover letter.