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Huckabay Teaching
Fellowship:
Sona Dimidjian, Department of Psychology
Project Description
Student Statement
Project Description
Background and Rationale:
One of the most significant challenges facing graduate
programs in clinical psychology is how to effectively teach students the skills
necessary to become competent clinicians. One common method for such teaching is
through one-to-one clinical supervision of a treatment case. This model has
significant strengths, and it is not likely to be replaced in its entirety, but
it also has important limitations. Often, cases that represent the full
repertoire of clinical techniques, which are required for clinical competence,
are not available to assign to students. Moreover, cases and supervisors are not
always available at the most appropriate stage in a student’s career. Finally,
one-to-one teaching is extremely cost-ineffective and, by its very nature, can
only benefit a handful of students.
The other common method of clinical teaching occurs in the traditional
classroom. Offering a class focusing on a specific treatment model may be a
highly effective and efficient way to teach students the basic principles
underlying particular techniques; however, a major shortcoming of this approach
is that it is typically de-contextualized from the therapeutic experience.
Optimally, the advantages of individual case supervision would be integrated
into classroom setting, allowing these two instructional methods to work
synergistically together. Unfortunately, this is rarely the case.
This proposal seeks to develop a hybrid class that blends strengths of both
approaches through the use of an innovative interactive web-based tool in the
context of a traditional classroom curriculum. Specifically, this course aims to
teach students an empirically supported treatment, cognitive behavioral therapy
(CBT), for one of the most common clinical problems, depression. The importance
of such a course at the University of Washington is particularly salient.
The World Health Organization reports that MDD is currently the fourth leading
cause of disability worldwide and is projected to be the second leading cause of
disability worldwide by 2020 (Murray & Lopez, 1997). Individuals with MDD
experience difficulties in multiple life domains, including social,
interpersonal functioning, occupational, economic, and physical health
functioning, and up to 15% of individuals with severe MDD die by suicide
(American Psychiatric Association, 1994). Despite the high societal and
individual cost of depression, it is also one of the most treatable forms of
mental illness. Numerous clinical trials have documented the efficacy of CBT (Hollon,
Thase, & Markowitz, 2003), leading the American Psychological Association to
designate these treatments as “well established” in efficacy (Chambless et al.,
1996).
Given the potential public health advantages of making CBT widely available to
patients, the importance of disseminating this treatment is clear. One of the
main methods by which such treatments are effectively disseminated is through
instruction at the graduate level (Freiheit et al., 2004). Unfortunately,
however, despite the fact that the UW program has been consistently ranked as
one of the nation’s top graduate programs and was recognized in 2003 with the
Outstanding Training Program Award by the Association for Advancement of
Behavior Therapy, in the last decade not a single course on CBT for depression
has been offered. To date, the primary method by which students have learned
such treatments is via individual case supervision, which, as noted above, has
significant limitations.
Project Overview and Objectives:
This proposal aims to develop a graduate level course on
the assessment and treatment of depression, which will be structured to include
two components: 1) a traditional classroom environment component and 2) an
interactive web-based Virtual Clinic. The inclusion of the Virtual Clinic
component of the course is designed specifically to integrate some of the unique
benefits of individual case supervision in a classroom setting.
The traditional classroom component of the course will be designed to introduce
students to core assessment and intervention practices. There will be four
primary content areas covered in the course, organized according to the
following key learning objectives for students. Students will learn: 1) the
diagnostic criteria of depression, common co-morbid disorders, and key
assessment methods; 2) the empirical literature relevant to CBT for depression;
3) specific cognitive and behavioral intervention strategies; and 4) strategies
to manage special clinical challenges (e.g., non-compliance with homework
assignments, suicidality). Particular pedagogical strategies will include
assigned readings, classroom discussion, student completion of standard CBT
patient homework assignments, observation and discussion of videotaped clinical
sessions, and role play exercises.
The Virtual Clinic component of the course is designed to allow students to
apply knowledge learned in the classroom to real-life clinical cases and issues.
By addressing actual and complex clinical problems, it is expected that students
will increase both their engagement with the theory and methods taught in the
course and their competence in using the skills in actual treatment contexts.
The Virtual Clinic is a methodology that has been used extensively in the UW
School of Medicine. The technology to create the Virtual Clinic is provided by
the Catalyst tool Virtual Case. The content for the Virtual Case will be based
on clinical problems and issues that arise in course of individual supervision
that I will conduct with two advanced trainees learning how to implement CBT.
This Virtual Clinic will be developed using the “decision-forcing” approach of
Virtual Case, in which the case material presented in the “clinic” will describe
a clinical problem and possible intervention paths. Based on this material,
students will be asked to determine the appropriate clinical intervention, by
responding to questions for discussion included in the “clinic.” Through a group
messaging feature, students engage in group discussion about their
recommendations and receive direct interactive feedback from me. In addition, in
a resource area in the Virtual Clinic, relevant readings and other supporting
documents can be provided to enhance knowledge acquisition.
The development of this course would represent a significant contribution to the
UW psychology department in terms of the development of the specific curriculum
content, (i.e., CBT for depression), given the significance and prevalence of
this disorder and the notable lack of courses available on this topic. Moreover,
the innovative use of an electronic teaching method (e.g., the Virtual Clinic)
also represents a significant contribution, one which could be easily exported
to other relevant graduate and undergraduate courses in the department.
Project Implementation Plan:
The Huckabay Fellowship is proposed for fall quarter for
use in the development of the course. My work on the development of the course
will involve four main components: 1) development of a curriculum and
identification of teaching resources for the classroom component; 2) supervision
of two individual trainees in the implementation of CBT for depression; 3)
adaptation of case material from the individual supervision for use in the
Virtual Case program; 4) completion of Catalyst workshop and training in Virtual
Case software and development of the Virtual Clinic using Virtual Case. I will
then teach the course in the winter quarter.
Assessment:
A multimodal approach will be used to assess
the success of the course (including the online component) as well as my
teaching and supervisory experiences. First, the course will be evaluated on the
basis of whether students meet the learning objectives as reflected in student
participation in class and via the Virtual Clinic. Second, students will be
asked to provide course evaluations mid-quarter and at the end of the quarter.
Third, my instructional and supervisory skills will be evaluated through the use
of videotaping. I will videotape each class as well as each supervision session
with my individual trainees. To identify areas for further pedagogical
development, I will view these tapes in full and Drs. Cauce and McCutcheon will
view selected segments. Fourth, I will also maintain a teaching and supervisory
journal each week in order to highlight and track key issues for discussion.
Fifth, Drs. Cauce and McCutcheon will also observe my responses to students via
the Virtual Clinic’s group messaging function. In weekly mentoring meetings,
feedback and discussion based on these methods will be used to enhance my
effectiveness as an instructor and supervisor.
References:
American Psychiatric Association. (1994). Diagnostic and statistical manual of
mental disorders (4th ed.). Washington, DC: Author.
Chambless, et al. (1996). An update on empirically validated therapies. The
Clinical Psychologist, 49, 5-18.
Freiheit, S.R., Vye, C., Swan, R., & Cady, M. (2004). Cognitive-behavioral
therapy for anxiety: Is dissemination working? The Behavior Therapist, 27,
25-30.
Hollon, S.D., Thase, M.E., & Markowitz, J.C. (2002). Treatment and prevention of
depression. Psychological Science in the Public Interest, 3, 1-39.
Murray, C. J., & Lopez, A. D. (1997). Global mortality, disability, and the
contribution of risk factors: global burden of disease study. The Lancet, 349,
1436-1442.
STUDENT STATEMENT
Background in Teaching and Preparation for
the Project:
I believe that I am well qualified to undertake this
project. My academic training has provided me with an opportunity to develop
substantive expertise in the area of cognitive and behavioral treatments for
depression. I have authored key empirical and theoretical publications in this
area, and my research and clinical training has been closely mentored by
internationally recognized experts in this area. I have also presented fourteen
times at national conferences, taught guest lectures in graduate and
undergraduate courses at the UW, and taught a number of continuing education
workshops. I have also advised a number of undergraduate students on research
projects, including an undergraduate honors student whom I mentored through the
process of applying for and successfully receiving a Mary Gates Research
Training Grant award. I have consistently received highly positive evaluations
of my work in these areas; however, more importantly, I have learned from these
experiences that I love teaching and working with students.
Reasons for Interest:
I have great interest and excitement about my proposed
project, and I think that the skills I could develop through this program are
critical to my professional development. Specifically, the skills I would
develop in creating the course, providing clinical supervision, and teaching and
evaluating the course are exactly the skills required not only to obtain a job
in academic clinical psychology, but to excel once one is obtained. Half of the
standard courseload for a professor in my area consists of such graduate level
courses, in addition to individual clinical supervision. Unfortunately, none of
my training to date has explicitly prepared me in the skills required for this
work; what I know I have learned primarily through observation and self-study.
The ability to focus directly on the development of these skills under the
mentorship of Drs. Cauce and McCutcheon would be a rare and valuable
opportunity. I asked Drs. Cauce and McCutcheon to mentor my application because
they are two of the most talented teachers I have met during my graduate career.
I want to learn intensively from them in order to become the type of educator
they are – energetic and creative in their pedagogical approaches, passionate
about teaching, and devoted to their students. In addition, I think that the
Virtual Clinic technology holds great promise for teaching a broad range of
students, and I am excited about developing this tool through the proposed
course, and in the future, for use in required undergraduate courses (e.g.,
abnormal psychology) as well as for other advanced trainees through institutions
such as the VA. Moreover, I believe that the innovative use of the Virtual
Clinic will help me establish a strong foundation for thinking “outside the box”
with respect to teaching, which I believe will enhance my professional career
and serve my students well in many ways. Finally, it is also my belief that one
cannot truly develop expertise in an academic field without teaching the
material effectively to others. In this way, developing my teaching in a project
like this is essential not only to my future as an educator but also as a
researcher.
Specific Project Implementation Tasks:
This Huckabay Fellowship application is proposed for fall
quarter to support the development of the course. I will teach and assess the
course in winter quarter as described in the Project Description. Specific
course development tasks are detailed below:
1) In collaboration with Drs. Cauce and McCutcheon, I
will develop a curriculum and identify teaching resources for the classroom
instruction component of the graduate course.
2) Under the supervision of Dr. McCutcheon, I will
supervise two advanced trainees on CBT for depression. I will observe
videotaped treatment sessions conducted by the trainees, hold weekly
supervision meetings with the trainees, and keep a weekly written journal
recording obstacles that the trainees encounter in providing the treatments
and obstacles that I encounter in teaching the treatment. I will also
videotape my supervision sessions with the trainees. Both the trainee/client
and the supervisor/trainee videotapes will be watched by Dr. McCutcheon, and
he and I will meet weekly to review these videotapes and to discuss ways to
enhance my effectiveness as an instructor and supervisor.
3) I will use the case material generated in the
supervision process to develop the content for the Virtual Clinic component
of the graduate course, highlighting, in particular, clinical issues that
arise as obstacles for the trainees.
4) I will work with the Center for Teaching and
Learning Technology, including attending Catalyst workshops, to develop the
Virtual Clinic program.
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