how long is a phd in occupational therapy

Standing Out in Occupational Therapy Now Requires a Doctorate

by Brooklyn Chillemi, based on an interview with Stanley Paul , occupational therapy director

While some may see driving, folding laundry or scrubbing the dishes as mundane tasks, an occupational therapist knows that mastering these everyday activities represents freedom and a degree of independence for many. 

If you’re interested in helping patients master their daily living skills following an injury or illness, becoming an occupational therapist may be an ideal position for you – and the field is only growing. The employment of occupational therapists is projected to grow 14% from 2021 to 2031 , much faster than the 5% average growth projection for all occupations, making now the perfect time to pursue a job in the field.

Do I need a master’s degree or a doctorate to become an occupational therapist?

Right now, occupational therapy is considered a dual-entry field , meaning you can secure an entry-level occupational therapy position with either a master’s or doctoral degree . But as occupational therapy expands, those holding a doctorate degree are rising to the top .

Experts in the field are seeing a shift from dual entry to a strong preference for doctoral degrees, especially for high-level occupational therapy positions. As of April 2023, the Accreditation Council for Occupational Therapy (ACOTE) reports that over 30 accredited master’s degree programs are transitioning to the doctoral degree level ( source ). As a student studying occupational therapy, choosing a doctoral degree will give you a leg up. 

In the near future, many believe the field of occupational therapy will shift away from dual-entry programs (accepting either a master’s or a doctorate to be certified) and instead focus solely on doctorate programs . Other medical fields, such as physical therapy , have already made the switch to requiring a doctorate after originally accepting a masters. It’s expected that occupational therapy will do the same. By earning your doctorate now, you will be ahead of the curve in evidence-based practice and a competitive candidate for the widest range of jobs. 

Plus, earning your doctorate opens doors for teaching and research for which having a master’s degree isn’t enough. As you continue to grow in your field, more opportunities arise for job openings and connection-building. 

What does a master’s degree in occupational therapy require?

A master’s degree in occupational therapy (OTM) typically takes about two years to complete, including academic coursework and some clinical experience. During this time, students learn about the theoretical foundations of occupational therapy, as well as how to conduct evaluations, develop treatment plans, and work with patients.

What does a doctorate in occupational therapy require?

First offered in 1999 , an entry-level doctorate in occupational therapy (OTD) typically takes about three years to complete. An OTD is designed to provide evidence-based practice to further knowledge and skills – including leadership, advanced clinical practice, education, and research in the field. 

Is there a difference in pay between those who have a master’s degree and a doctorate in occupational therapy? 

Occupational therapists typically make between $60,680 and $123,840 a year in the United States with a median salary of $85,570. Although no data currently exists comparing the salaries of occupational therapists by degree type, as the field shifts more and more toward doctoral degrees, earning a doctorate now will give you the best chance of landing the best job. 

Additionally, those with doctorates in occupational therapy are eligible for research and teaching positions, which tend to pay more than entry-level positions.

Can you earn your doctorate after you’ve already earned your master’s degree? 

You can. It’s usually easier to dive into the doctorate program first, and you’ll save time and money by doing so, but if you’ve already earned your master’s degree, you can return to earn your doctorate at one of the over 80 ACOTE-accredited OTD programs in the U.S.

What is a capstone project, and are those solely in doctorate programs? 

In both a doctorate program and a master’s program, you will have the opportunity to focus on an area of interest in occupational therapy by creating a hands-on experience toward that specialization. This can look like a research project, fieldwork, or something else, depending on what you would like to specialize in. 

This grants you an extensive background in research and scholarly inquiry through evidence-based practice, making you well-versed in using the most up-to-date and effective assessment and treatment models. 

What are fieldwork rotations, and where can I complete them? 

Before you enter the field, both master’s and doctorate programs require fieldwork rotations or clinical experience. This typically occurs within the last six months of your program, and your coursework throughout the program gives you the tools you need for your fieldwork experience. 

At George Fox University, rotations can be completed in traditional and non-traditional settings, including hospitals, medical centers, rehab facilities, mental health settings, pediatric hospitals, home care settings, nursing homes, and assisted living facilities, to name a few. 

Where can I find details about licenses, exams, prerequisites, and observation hours? 

After completing an accredited program and required fieldwork, you’ll need to pass the NBCOT Certification Exam and apply for your license in the state you wish to practice in. 

Assistance with specific details like these may vary based on the program, but most will guide you through the initial requirements for licensure.

Learn more about George Fox University’s occupational therapy doctorate (OTD) program in Newberg, Oregon.

• UNC Chapel Hill

PhD Program

Since fall 2006, the Division of Occupational Science and Occupational Therapy has offered a PhD in Occupational Science. We accept qualified applications from individuals who have completed a graduate level degree in occupational therapy (e.g., MS OT, OTD), relevant social and behavioral sciences, or related fields. The PhD is designed for individuals who wish to pursue academic careers that include research, and the program is in-person.

Graduates will be prepared to generate new knowledge in occupational science and translate their understanding of the complexity of occupational engagement to support participation in life situations.

The PhD program in Occupational Science benefits from a highly collegial and interdisciplinary environment. Students may participate in faculty research programs and have opportunities to be involved in teaching in our MS OT program.

The doctoral course of study includes content in four domains:

• Occupational Science
• Research design and methodology
• Academic career development
• Cognate areas that support the study of occupation of interest to students

We anticipate a four to five year course of study that allows doctoral students to build a deeper understanding in an area of interest in occupational science, learn how to study occupation and complete a doctoral dissertation.

View our current PhD Handbook .

Nancy Bagatell, PhD, OTR/L

Email: [email protected]

Education at USC Chan

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Doctor of Philosophy (PhD) in Occupational Science

The PhD in Occupational Science degree program prepares you to become a career scientist engaged in the study of human occupation — the purposeful activities that constitute our life experiences. Occupational scientists examine the function and structure of occupation, the impact of occupation on individuals and communities, and the interrelationships among the complex array of factors associated with human occupation. We emphasize the development of research skills, and encourage you to organize and synthesize knowledge to contribute to occupational science theory and interdisciplinary understandings of occupation, health, and social participation.

A career scientist conducts independent and or collaborative scientific discovery as part of an identifiable and distinct program of research, engages in effective knowledge mobilization, and is often supported by extramural funding. Within the discipline of occupational science, career scientists engage in these activities across a variety of academic, clinical, community, and industry contexts, and often serve as content experts within collaborative research teams.

USC Chan PhD graduates have:

• Received prestigious post-doctoral research fellowships.
• Obtained tenure-track faculty appointments at R1 designated universities (Doctoral Universities-Highest Research Activity).
• Secured external grant funding from competitive governmental agencies.
• Launched new lines of inquiry through systematic research programs.
• Disseminated their work in peer-reviewed publications and at national and international conference presentations.
• Contributed to theory development in occupational science.
• Informed occupational therapy and related practices through intervention development and basic and translational science research discoveries.

Full Financial Support

To produce strong career scientists, we believe that it takes full commitment on the part of all involved—the mentor, you as the doctoral student and the interdisciplinary research teams in which you are immersed; thus, USC Chan allocates funds to provide significant financial support for you. 

At USC, tuition for every PhD student is currently covered by the university. This means that if you are admitted and enroll, you will receive full tuition support while completing your coursework. Further, our Division awards a stipend of $43,890 per year to each student as part of a 12-month appointment as a Graduate Research Assistant. Annual stipends are typically available for up to five years if you make exceptional progress in your program.

Supporting you as a PhD student at this level is intended to free you from the need to supplement your income through outside employment, allowing you to devote yourself full-time to your PhD studies.

Select applicants are also nominated for prestigious fellowships awarded by the Graduate School (see Graduate School website for a description of the Provost PhD Fellowship Program).

Finally, as a PhD student, you will receive funding to attend national and/or international scientific meetings related to your area of focus.

Curriculum and Requirements

The USC Chan PhD in Occupational Science degree requires 60 units of coursework beyond the baccalaureate degree, including:

• Core and elective coursework
• Immersion in an interdisciplinary, extramurally funded research group
• Passing a qualifying exam
• Submission of an approved independent dissertation

You are required to maintain a GPA of 3.0 or better (both applied and overall) throughout the program and, in general, you are expected to graduate within 5 years of your entry date.

• View/download the Student Handbook of Policies and Guidelines for the PhD in Occupational Science (updated August 2023)

Advanced Standing If you have earned a masters and/or doctoral degree, you may apply for Advanced Standing, reducing the units required for the degree from 60 units to 40 units.

Foreign Language or Research Skills The PhD in Occupational Science does not require a demonstration of competence in a foreign language. Although no research skills are required at the time of admission, you are expected to develop and demonstrate skills in quantitative, qualitative, or mixed research methodologies as applicable to your future career scientist goals. You gain these skills through a combination of coursework, research immersion experiences, and independent dissertation research.

Qualifying Exam The qualifying examination is comprehensive in nature and requires you to demonstrate a grasp of content from the core courses and the cognate area. The examination is both written and oral and is set and administered by your qualifying exam committee. Your qualifying exam committee is composed of five faculty members. Three members of the committee must be regular faculty from the USC Chan Division of Occupational Science and Occupational Therapy. One member must be from outside the division.

Dissertation You must submit a dissertation based on your original research according to the policies and procedures of The Graduate School . It was decided that the structure and content of the proposal be tailored to whether the dissertation follows a three discrete studies model or a more traditional dissertation/book model. On the former model, the proposal should include an introduction that talks about the 3 studies and any overarching themes that tie them together. It then should include for each study a literature review and a methodology section (the completed dissertation would thus include the addition of a results and discussion sections based on the completed research). For the latter, more traditional dissertation model, the proposal should include an introductory chapter, a review of literature, and a methodology chapter.

Upon approval of the preliminary copy of the dissertation by all members of the dissertation committee, you must pass an oral defense of the dissertation. Upon successful completion of the oral defense and revisions, the manuscript is approved and the committee recommends you to the Graduate School for the PhD. The dissertation committee is composed of at least three faculty members. The chair of the committee and at least one additional member of the committee must be regular faculty from the USC Chan Division of Occupational Science and Occupational Therapy. One member must be from outside the division.

Teaching To prepare you for anticipated roles as a faculty member, a teaching component is incorporated into the program. You work with your faculty advisor for your research immersion (OT 660) experience to identify an appropriate course or courses, arrange mentoring experience, and ensure that the timing of the teaching experience complements your research lab participation and dissertation plans. If you are not assigned a full course, you are required to present a minimum of four lectures or seminars.

Intensive Mentoring At the time that you enter into the program, you decide, in conjunction with the faculty, which faculty member will act as your adviser/mentor. This individual typically serves as your primary mentor and guidance committee chair throughout your graduate studies. Your chair assists you in designing the correct combination of coursework to equip you with the knowledge and skills needed to accomplish your future aims as an academic. Your mentor also guides you in taking the necessary extracurricular steps that will best position you as a career scientist in your area of concentration. Such advisement may include recommending your attendance at a particular conference, suggesting contact with specific funding agencies, guiding your pursuit of external funding opportunities, aiding in your curriculum vitae and manuscript preparation, and assisting you in locating an appropriate postdoctoral fellowship or in your job search. Because the goal of our program is to position you to become an extramurally-funded researcher, mentors are faculty members who have conducted or currently are conducting grant supported programs.

Scientific Meeting Attendance and Other Supports Becoming a career scientist involves attending meetings and networking to learn about the latest advances in the field. The Division provides some funding for your attendance at such meetings when they are of relevance to your research program, although funding is more likely to be awarded if you are presenting a paper or poster at such meetings. To maximize this possibility, you are given informal support in conference proposal development. Intense tutorials in publication development and submissions are also provided, as well as support for data analysis. The Division also hosts an Occupational Science Symposium , attracting interdisciplinary scholars from all over the world, which is widely attended by our PhD students.

WASC Accreditation USC has been accredited by the Western Association of Schools and Colleges (WASC), one of six regional accrediting organizations recognized by the U.S. Department of Education, since 1949. View the student learning outcomes (PDF) for our academic programs.

Course Sequence

Becoming a career scientist requires developing expertise in both an area of research and specific methodological approaches, possessing the knowledge to critique occupational science research and scholarship in particular core conceptual areas, demonstrating the ability to produce publishable papers, synthesizing interdisciplinary knowledge and communicating a theoretically-driven understanding of occupational science. You will be able to develop these capacities through your program of study, which will cover: 1) methodological approaches, 2) occupational science core content, 3) specialty emphases linked to the ongoing research programs in the Division, and 4) content addressed in the interdisciplinary cognate selected. As part of the course requirements within each occupational science class, you are mentored in the process of producing publications by the faculty member who teaches the course.

You are required to complete the following courses to be eligible to take the qualifying examination: OT 640, OT 641, OT 648, OT 649, OT 661, and 4 semesters of OT 660. In addition, you must complete a minimum of 26 units (10 units if you have Advanced Standing) of elective cognate courses. After passing the qualifying exam, you must take a minimum of 4 units of OT 794 as you complete an independent research dissertation. A total of 60 units is required to graduate (40 units if you have Advanced Standing); thus, you will need to complete 4 additional units of either OT 794 or elective cognate courses.

Sample Course Sequence

View course descriptions for OT courses.

Note: If you have Advanced Standing, you will typically complete 3-4 elective cognate courses in years one and two instead of 7-8 elective cognate courses noted in the sample course sequence that follows. 

First Year Course Overview

Fall semester one.

Fall semester begins in late August and continues for 16 weeks.

• OT 640 (4 units): Conceptual Foundations of Occupational Science
• OT 660 (2 units): Research Practicum
• Elective Cognate Course (4 units)

Spring Semester One

Spring semester begins in January and continues for 16 weeks.

• OT 648 (4 units): Researching Occupation: Engagement, Meaning, and Society

Summer Semester One

Summer semester begins in late May or early June and continues for 10-16 weeks.

• Elective Cognate Course (2-4 units)

Second Year Course Overview

Fall semester two.

• OT 641 (4 units): The Nature of Occupation

Spring Semester Two

• OT 649 (4 units): Researching Occupation: Function, Participation, and Health

Summer Semester Two

• OT 661 (2 units): Grant Writing for Occupational Science

Third Year Course Overview

Fall semester three.

• Completion of Qualifying Exam (GRSC 800)

Spring Semester Three

• OT 794 (2 units): Doctoral Dissertation

Summer Semester Three

Fourth year course overview, fall semester four, spring semester four.

Note: If additional semesters are needed to complete the dissertation, you will register for OT 794 each semester until the dissertation is submitted to the university.

Research Immersion Experiences

The hallmark of our PhD program is immersion for 20 hours per week in an interdisciplinary, extramurally funded research group. Within this group, you will gain experience in interdisciplinary collaboration, grantsmanship, and dissemination through presentations and publications that includes work related to research designs, methodologies and measurement; data collection, management, and analysis; and data interpretation and theory building. An intensive immersion model can be thought of as a learner-centered research apprenticeship. More specifically, this immersion experience provides a context in which you can develop competencies in four domains: 1) participating in the development and implementation of empirically and conceptually sound scientific research, 2) understanding research as a socially embedded and cognitively distributed social practice, 3) developing an appreciation of the career trajectory of a research scientist, and 4) becoming an expert in domain-specific knowledge, methodologies and scholarship.

Our Blueprint for Translational Research

You will be immersed in cutting-edge translational research using a methodology our faculty has been refining for over 20 years. This blueprint was developed based on research related to well elders and persons with spinal cord injury, and it begins with studying a problem for which one eventually intends to develop an intervention. Results of the qualitative work then inform the intervention design. In the next step, efficacy and cost-effectiveness studies, employing randomized clinical trials and theory, are performed. In the final stages, the mechanisms hypothesized to mediate outcomes are tested in order to build theory using sophisticated statistical procedures. Within the USC PhD program, you can explore a rich mix of methodologies, such as measurement of biomarkers, fMRI, utilization of a digital laboratory for analysis of videotape and narrative data and large randomized trial designs.

Immersion Assignment

It is expected that the research immersion will provide a foundation for you to pursue dissertation work that is related to the research domain in which you have been immersed. Assignment to an immersion is made at the time you are admitted to the program. This assignment is based on the faculty mentor’s willingness to accept you as a mentee, your acknowledgment that you intend to pursue a career scientist trajectory within the domain in which you will be immersed, and the forecasted likelihood of the continuance of the immersion throughout the years in which you will be in the PhD program. In most cases, you are immersed in one research group for the duration of your PhD program. On occasion, and assuming there is academic justification, your immersion experience could involve a customized configuration crossing more than one research group.

This work is not done in isolation or in class-based simulations; rather, you contribute actively to the productivity of investigative teams. Our faculty have received over $27.6 million in federal funding for active research projects and we have one of the finest funding track records among departments and divisions of occupational therapy and occupational science worldwide. Our extramural funding portfolio has included other grants from the CDC, the NIDRR, the U.S. Department of Education, the American Occupational Therapy Foundation and others.

Available Immersions

We believe that the wide-ranging content of our research programs prepare you as a career scientist who can confidently make a valued contribution to an interdisciplinary research group. It also places you squarely at the center of translational research that is at the forefront of health-related research. As such, we aim to provide a rich immersion experience by involving you in funded division research , but a variety of immersion experiences are available with all of our PhD program faculty:

Joy Agner PhD, OTR/L Amber Angell PhD, OTR/L Lisa Aziz-Zadeh PhD Grace Baranek PhD, OTR/L, FAOTA Alison Cogan PhD, OTR/L Leah Stein Duker PhD, OTR/L Mary Lawlor ScD, OTR/L, FAOTA Sook-Lei Liew PhD, OTR/L Bobbi Pineda PhD, OTR/L Beth Pyatak PhD, OTR/L, CDCES Shawn Roll PhD, OTR/L, RMSKS, FAOTA, FAIUM

A Global Community and Interdisciplinary Partnerships

Our PhD program has had a significant impact in building an international community of occupational scientists. Of the more than 75 students who have graduated from the PhD program , 17 have been international students who, for the most part, have gone on to establish occupational science programs at universities in their home countries and now comprise an international network of occupational scientists. We encourage all of our students to become networked in this larger global community. We are currently developing partnerships with other international academic programs to provide opportunities for our PhD students to participate in global developments in occupational science.

USC Chan has also forged numerous interdisciplinary partnerships that can be tapped to strengthen your program of study. For example, our PhD students are currently participating in activities at USC’s world-class Brain and Creativity Institute and the Dana and David Dornsife Cognitive Neuroscience Imaging Center (directed by Antonio and Hanna Damasio), the cutting-edge Laboratory of Neuro Imaging (directed by Arthur Toga), the Institute for Creative Technologies (directed by Albert “Skip” Rizzo), the Davis School of Gerontology, the Childhood Obesity Research Center, the Institute of Preventive Medicine, and the USC Viterbi School of Engineering. Students also collaborate in research with extramural interdisciplinary teams at other sites, including Children’s Hospital Los Angeles, Rancho Los Amigos National Rehabilitation Center, and many other local, regional, and national partners.

In addition to direct research experiences, USC Chan has access to a vast infrastructure that supports scientific enterprise at the university. For example, through our interdisciplinary partnerships, you are able to perform studies using cutting-edge MRI and attend university seminars offered on topics related to career trajectories or teaching excellence. You can take cognate courses in any of the university’s Schools and Divisions, including, among others, anthropology, education, gerontology, health promotion, neuroscience, public policy, rehabilitation science and sociology.

Diversity, Access, and Equity

USC Chan recognizes that the composition of faculty in occupational therapy and occupational science departments nationwide is not sufficiently representative of the diversity of the healthcare consumers whom the profession serves. Consequently, we strive to recruit superior applicants for our PhD program from culturally, linguistically and economically diverse populations and to provide financial packages that will make it possible for our PhD colleagues to recommend promising students from underserved populations. Read more about diversity, access, and equity at USC Chan and our Diversity Mentorship Program .

Consideration for International Students

For international F-1 applicants, please note that the PhD in Occupational Science program is not currently a STEM-designated program, therefore the STEM Optional Practical Training (OPT) extension is not available.

A Day in the Life of an Occupational Science PhD Student

Dominique , a student in the Doctor of Philosophy in Occupational Science degree program, shares about daily life as a PhD student studying occupational science at the University of Southern California.

PhD in Occupational Science Admissions

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ACOTE accreditation | NBCOT certification

The USC entry-level master’s degree program ( cost of attendance ) is fully accredited by the Accreditation Council for Occupational Therapy Education® (ACOTE). The USC entry-level OTD degree program ( cost of attendance ) has been granted Candidacy Status by ACOTE. View our program’s ACOTE standards public data . ACOTE c/o Accreditation Department, American Occupational Therapy Association, Inc.®, 6116 Executive Boulevard, Suite 200, North Bethesda, MD 20852-4929, (301) 652-6611 x2914, acoteonline.org

Professional program graduates are eligible to apply for certification by National Board for Certification in Occupational Therapy, Inc.® (NBCOT), nbcot.org . Program results from the NBCOT can be found online at www.nbcot.org/Educators-Folder/SchoolPerformance .

Frequently Asked Questions

Eligibility

No. We welcome students with Bachelor's or Master’s degrees from all different educational backgrounds and fields of study.

Yes. All international applicants (Canadian institutions included) must have their foreign transcripts evaluated by the  World Education Service  and have that evaluation submitted directly to the Occupational Therapy Application Service (OTCAS) (study abroad courses do not apply if they are listed on the USA-transcript). Please note that the OTCAS transcript verification process can take 4–5 weeks.

AP credits that are accepted by your undergraduate institution are also accepted as part of your  OTD application, but may not be used to fulfill Prerequisite Knowledge Domains. 

We will accept coursework from a community college that has been accepted by your undergraduate degree-granting institution. If the online course was administered by an accredited undergraduate institution that can provide a transcript that includes the course, OTCAS will verify it and include it in your GPA calculation. 

Our unique curriculum does not allow the transfer of students to our program. 

Yes. Eligible applicants include individuals who have been granted Deferred Action for Childhood Arrivals (DACA) by the U.S. Citizenship and Immigration Services at the time of the applications as well as undocumented students. If admitted, undocumented students could be eligible for institutional financial aid on the basis of financial need.

We require applicants to have completed a Bachelor’s or Master’s degree from a regionally accredited college. Degrees in progress are considered as long as the completion date is prior to matriculation.  

No. If you already have a Master’s in Occupational Therapy and want to pursue a doctorate degree, a “post-professional OTD” is the program you are looking for. At this time, Duke does not offer a post-professional doctorate program. 

Duke does not require a GRE score and it is not a factor in admissions.   

Pass/Fail classes are accepted. Your undergraduate institution and OTCAS will determine the weight of these courses regarding GPA. You may use a pass/fail course in which you earned a Pass to fulfill a Pre-requisite Knowledge Domain.

OTCAS only accepts official transcripts. 

All courses used to substantiate the Duke OTD prerequisites must have been completed no earlier than 5 years prior to application. Second career applicants should contact the admission office. More recent prerequisite coursework is valuable as it may demonstrate readiness for entry into a rigorous academic environment. All courses used to substantiate Duke OTD pre-requisites must be completed by December 31 of the application year. 

Application

You can apply through the  OTCAS service . For any questions on OTCAS, visit the  OTCAS Applicant Help Center .

Duke Application Submission Deadlines (OTCAS verification may occur after the submission date): Early Cycle:  Monday, October 24, 2022 Standard Cycle:  Monday, January 16, 2023

We review applications and make offers in two cycles. Early cycle applications are due in October; standard cycle applications are due in January. Interviews are conducted by invitation, in November and February. Offers of admission are made in December and March.

Interviews will be conducted entirely online and are by invitation only in December and February.

Offers of admission will begin in December and continue until all seats are filled.

Our class size is 45 students.  

Because Occupational Therapy is situated at the juncture of the social sciences, biomedical sciences, and the humanities, we want to welcome students with bachelor’s degrees in any field. In fact, the Division seeks to admit cohorts rich in disciplinary diversity. Toward this aim and to save the expense of additional coursework, the Duke OTD does not require traditional prerequisite courses. Prerequisite requirements are fulfilled instead through evidence of knowledge mastery in eight areas we consider foundational to studying of occupational therapy and occupational science. We refer to these on the application as the Prerequisite Knowledge Domains. We don’t want you to spend money on additional courses if you’ve already learned the content you need to master for a doctoral program. Instead, Duke requires that you demonstrate your learning of particular topics that will help you succeed in OT practice. You can see details of our prerequisite knowledge domains on the OTCAS website. 

Duke does not have specific pre-requisite course requirements. As long as you can demonstrate you’ve taken courses that have furthered your learning in the prerequisite knowledge domain areas, you are ready to apply. 

Duke does not require that you complete any observation hours.   

There is no need to submit observation hours to Duke. They will not impact your application either way. 

Please see the application checklist:

OTD Checklist for Applicants.pdf

We encourage you to carefully review the distinctive commitments of the Duke OTD found on our website, including the program’s vision, mission, and curriculum design. If these distinctive components resonate with you, use your application to communicate clearly how your background and learning goals for an OTD degree align with the Duke OTD.  

Either is acceptable, however, it may better show your capabilities to take, and do well in, a more rigorous course.

Duke requires evaluations from 3 specific sources--someone who knows your academic performance and potential, someone who has supervised you in a work setting (paid or unpaid), and someone who knows your commitment to service . There is no advantage to sending additional letters beyond the required 3; however, if you need to submit additional letters to meet Duke's evaluation requirements, and you have already used the OTCAS maximum of 5 letters, please use this link to request evaluations external to OTCAS.

Once your application is verified through OTCAS, you will receive an email with a link to the payment website for the $50.00 secondary Duke application fee. We currently accept credit card payments. Please note, we DO NOT accept cash.  

Students who are granted fee waivers by the OTCAS Fee Assistance Program (FAP) will be given fee waivers for the Duke secondary application.  A student must request this waiver by sending in proof of the OTCAS waiver to  [email protected]  once the application is complete. We will not waive the fee for any other requests.

Program Basics

The Duke OTD is a three-year program, including summer terms. Students begin their studies in the fall semester and finish in the spring semester, three years later.

Successful progression is defined as the completion of all year one and year two required courses and all year one and year two required APEx experiences before starting Level II Fieldwork, the completion of all Level II Fieldwork requirements before starting the Capstone Experience, and completion of both Level II Fieldwork requirements and the Capstone Experience within two years of ending didactic coursework. 

All OTD students are required to be full-time students 

As long as it is safe and legal in the state of North Carolina, the city of Durham, and Duke University, this program will be mainly offered in person. Even after COVID, there may be a few courses that will offer partial online delivery, but the bulk of instruction is hands-on and therefore, in person. 

See details on scholarships and  financial aid .

The department employs a number of student workers, including Graduate Assistants. There are also potential opportunities for Research Assistants, as well as various employment opportunities across campus.

Only full-time students are admitted to the OTD program. Due to the rigors of the curriculum, students may find it difficult to work. However, we anticipate some of our students will need to hold flexible part-time jobs either on-or off-campus. Due to the rigor of the program, student employment may jeopardize one’s ability to remain in satisfactory academic standing and to successfully complete the program. Full-time participation in the Duke OTD should be each student’s first priority.   

All of our information is available electronically via our website. If you have circumstances that require hard copies of information, please contact us directly. 

Visit Duke Student Health for a complete list of immunization requirements for Health Science Students (including OTD).

Students will also need to complete a series of safety modules required by the university and the school of medicine.

A criminal background check (CBC) is a mandatory component of the post-acceptance matriculation process. All admitted students will undergo a criminal background check (CBC) involving federal, state, and local records that extend back a minimum of five years. Matriculation into the program is contingent upon review and acceptance of the applicant’s CBC report. A felony conviction may impact your ability to take the certification exam or attain a state license. For more information, contact NBCOT .

For more information about these requirements, please reach out to the fieldwork office: [email protected] .

A PhD is a Doctor of Philosophy degree which is more heavily focused on research, requires the defense of a dissertation, and prepares a graduate for a career most often in academia and research in a field. The OTD is a clinical doctorate, sometimes called a “practice doctorate.” This degree is more heavily focused on clinical or practice expertise and prepares graduates for research-based practice and the clinical skills for the candidacy exam. 

We offer a full constellation of courses. We will be able to post those to the website once the Duke Registrar approves course names and descriptions. The courses, however, won’t be organized by the subspecialties of the field that you named. We are taking a contemporary and occupation-centered approach to occupational therapy education. You will learn the subspecialties, but the courses will foreground the occupational therapy process that cuts across all subspecialties. You’ll take courses, for example, on how occupation works in all our lives as a source of health and well-being, courses on what happens when occupation is disrupted, courses on how to enable occupation for people, families, communities, and populations whose occupations have been disrupted. There will also be courses on programmatic interventions, education interventions, research, etc. Every semester will be capped by a week of simulation and a week of practice, so there will be a rich amount of practice-based experiences. 

Duke has fieldwork opportunities in the Raleigh-Durham area, as well as throughout the country. Your fieldwork team will work with you to identify a site that is a good match for your interests and needs. 

All sites are selected and approved by the Academic Fieldwork Coordinator (AFWC) to ensure that experiences align with our curriculum and philosophy of the program. When possible, the AFWC considers the student’s preferences for fieldwork experiences, but the primary consideration is based on the quality of education during the fieldwork experience.   

The cost of fieldwork courses is incorporated into tuition. However, costs incurred during fieldwork are the student’s responsibility. Potential costs may include housing, travel, and other living expenses, arrangements for pet care, and childcare. 

In collaboration with the Capstone Coordinator and faculty mentorship, Duke OTD students begin preparations for the Capstone project and experience in the first semester of the program. We encourage students with strong preferences regarding Capstone to collaborate with faculty and the Capstone Coordinator to discern the best Capstone site for their learning needs, keeping an open mind to new or previously unidentified possibilities.  

Both degrees currently allow you to practice as an occupational therapist. One key difference between the OTD and Master's degree is the inclusion of the 14-week  Doctoral Project and Experiential Component called the Capstone. The Capstone experience allows students to build on their academic foundation and pursue in-depth an area of professional interest, thus gaining additional leadership, research, advocacy, program development, and practice experience.  

Accreditation

As the ACOTE website notes, there is a risk involved. However, as ACOTE also notes, the number of programs not receiving accreditation is low; we know that those are typically under-resourced programs or programs without experience in the curriculum design and accreditation process. The process has lots of incremental feedback built in to minimize the possibility of not gaining accreditation. In other words, if something were not on the right track, ACOTE would let us know early and often and give us plenty of opportunities to make any adjustments or changes necessary.  We are also lucky that the Duke School of Medicine is fully supportive of the program and is generously providing all of the resources we need to start up a competitive program. 

At its meeting, April 10-11, 2021, ACOTE voted to GRANT CANDIDACY STATUS to the Occupational Therapy Doctoral Program at Duke University School of Medicine, Durham, North Carolina. As a result of this action, the institution may admit students into the Occupational Therapy Doctoral Program according to the approved timeline (August 2021) and may proceed to the Preaccreditation Review step of the accreditation process. The Occupational Therapy Doctoral Program at Duke University School of Medicine, Durham, North Carolina, will be included on ACOTE's list of programs that are holding Candidacy Status and are eligible to admit students.

Who should I contact if I have more questions?  Email  [email protected]  with any questions. We look forward to hearing from you!

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Otd/phd dual degree.

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Otd phd degree.

Although the Occupational Therapy Doctorate (OTD) prepares students to practice occupational therapy, as a professional graduate degree, it does not prepare students for research or academic careers. Students who are interested in becoming a researcher or a faculty member prepare for these careers by completing a PhD degree program.  At The Ohio State University, students can combine the OTD program with the Health and Rehabilitation Science PhD program through entry into the dual degree program. The primary goal of this dual degree program is to prepare students for academic positions in Occupational Therapy and Rehabilitation Sciences programs at research-centered universities. Therefore, in addition to the professional training, the program emphasizes higher education teaching, research and writing grants. 

Advantages of the OTD PhD program

Application to the otd phd program.

Students who are interested must first apply, be accepted into, and enroll in the OTD program. Students apply to the OTD program through OTCAS. Students can apply to the PhD portion of this dual program at any point during their OTD program. This PhD application requires 3 letters of recommendation and a second personal statement that describes a student’s interest in a PhD degree, describes past leadership or scholarship, and explains career goals. In addition, students must request a letter of support from one of the OT faculty. It is recommended that a potential applicant meet with one of the OT faculty to discuss his or her interests and ask for the letter. The application will be reviewed by the SHRS PhD Committee.

Description of the OTD/PhD program

Students accepted into the dual OTD/PhD program complete all of the OTD courses in the order and sequence of their cohort. The student completes additional courses to gain research exposure and experience. Students will incorporate research practicum into their schedules with an OT faculty they've identified. Through these practica, students complete a research specialization of their choice in an area of research that aligns with the expertise of an OT faculty member. OTD/PhD students receive full-time funding when they become a full-time PhD student. Students continue to take the PhD core courses and teach an OTD or undergraduate course. In the second year of the PhD portion of the program, students complete the core courses with the goal of taking the candidacy examination by the summer term. After passing the candidacy examination, students propose their dissertation and focus on completing the dissertation full time for the remainder of the program. For more information, contact the Director of the OT program, Erika Kemp at [email protected]

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A Doctor of Philosophy (PhD) in Occupational Therapy is offered by dissertation. This degree develops the candidate's advanced research skills, enhancing scholarship in an area of occupational therapy or occupational science. Through the research process, candidates advance their scholarly identity and practices.  

Admission Requirements

A master’s candidate may apply to upgrade his or her candidature to PhD

Duration of the degree

The PhD (Occupational Therapy) must be completed in a minimum period of two years and a maximum period of five years of study.   The candidate will need to provide proof of completion of an approved course in research methods and in medical research ethics. The course may be completed prior to registration, may be an online course, or may be a course offered at UCT.  

Application Procedure

Before starting the application process the student is advised to contact the postgraduate convener, Prof Roshan Galvaan , to discuss possible areas of research and to identify a possible supervisor.

(a) A completed UCT application form

(b) A study outline  

UCT Application Form

Online application forms may be found on the University of Cape Town website.

Applications for the PhD (Occupational Therapy) are accepted throughout the academic year. However, a completed application form is required for the candidate to be considered for admission to study. Please contact Ms Salega Tape   (Telephone:  +2721 406 6340) with any further enquiries regarding the application form.

Submission of a Study Outline  

The study outline, Curriculum Vitae, academic transcript and contact details of two referees should also be submitted to Prof Roshan Galvaan .  

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PhD, Occupational Therapy

Do I have to take the Graduate Record Examination (GRE)?

Although the GRE is typically required for this program, for the 2022 admissions cycle GRE scores will not be required. For more information see   testing requirements .

How long is the program?

Occupational therapists holding a master's degree take a total of 52 credits (including course work) and complete a dissertation. NYU Steinhardt graduates with a post-professional master's in OT must complete a minimum of 42 credits and write a dissertation. Full-time or part-time study is available.

Is the degree funded?

All full-time PhD students are eligible for a multi-year funding package that supports tuition and living expenses. Learn more about  funding for full-time PhD students .

Where can I reach out with additional questions?

Please email  [email protected] .

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Home Blog MOT vs OTD

If you’re planning to become an occupational therapist, you must be wondering whether you should pursue a Master’s in Occupational Therapy ( MOT ) or an Occupational Therapy Doctorate (OTD).

The Occupational Therapy Doctorate (OTD) vs. Masters in Occupational Therapy (MOT) has become a fairly common conundrum, especially when considering the 2027 OTD mandate .

While the ACOTE trusts that the doctoral level is the appropriate entry point for the profession of occupational therapist, the ACOTE accepted AOTA’s stay of the 2027 mandate requiring all entry occupational therapy programs to transition to the doctoral level.

Table of Contents

Before we dive into the debate, let’s take a closer look at the profession itself. Occupational therapists assist injured, ill, or disabled patients in recovery, improvement, and development of skills needed to fulfill their everyday activities.

An occupational therapist, a doctor of occupational therapy, or an occupational therapist consultant will also help patients recover from injuries or illnesses that may prevent people from performing everyday tasks.

A degree in occupational therapy will pave the way for a rich and fulfilling career. Traditionally, prospective students could start their practice immediately after their bachelor’s degree. However, more recently, a master’s or doctor’s degree in occupational therapy has been deemed mandatory.

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ASSOCIATE'S DEGREE

MASTER'S DEGREE

POST-PROFESSIONAL DEGREE

Let’s look at how an Occupational Therapy Doctorate (OTD) differs from a Master’s in Occupational Therapy (MOT).

MOT vs OTD – Complete Guide

Both degrees, the master’s and doctoral are currently routes of entry to the profession of an occupational therapist, prepare graduates to be entry-level practitioners and are accredited by the Accreditation Council for Occupational Therapy Education (ACOTE©).

Still, some professionals choose to pursue more advanced degrees, including a doctorate in occupational therapy, instead. The commitment can be costly and time-consuming.

Recently, the ACOTE proposed a mandate which would require all aspiring occupational therapists to complete their master’s or doctoral degree before beginning work in the field, starting in 2027. However, not everyone supports the move. In 2018, the American Occupational Therapy Association ( AOTA ) proposed a suspension of the mandate.

The ACOTE agreed. Still, the debate has left many prospective members of the field confused about which educational path they should pursue.

Let’s compare the two occupational therapy degree programs to understand the key similarities and differences, the costs, opportunities, and salary expectations associated with both of these occupational therapy educational programs.

What is a Master’s in Occupational Therapy?

A Master’s in Occupational Therapy (MOT) is a two-year professional postgraduate degree program to prepare students for work in the field.

Coursework covers therapeutic skills, patient care, rehabilitation, and kinesiology. These programs also require a combined level I and level II fieldwork experience of up to 24 weeks in an approved facility.

NBCOT certification is the preliminary requirement for obtaining licensure as an occupational therapist in all the U.S. states. After completing their MOT program’s requirements, students can sit for the NBCOT certification examination.

With the proposed ACOTE mandate, a master’s degree may only remain valid till 2027, after which an occupational therapy doctorate would be mandatory to work as an OT. On a brighter note, those who have obtained their MOT degrees before 2027 can still receive their licensure.

What is a Doctorate of Occupational Therapy?

The Doctor of Occupational Therapy (OTD) is a professional (or clinical) doctorate, the maximum academic groundwork that an entry-level OT can attain. The training for this program goes well past that of the master’s degree.

A doctoral degree in occupational therapy is an excellent option for students and professionals looking to further their careers. The doctor’s degree program can take anywhere between three to four years. Although you can apply for an OTD immediately after your bachelor’s degree in occupational therapy, admissions for doctoral-level programs are highly competitive.

What Are the Similarities Between MOT and OTD?

• With a doctoral or master’s degree, students can expect to learn to evaluate patients, formulate treatment plans, and document patient progress.
• Generally, the curriculum in bachelor’s degree programs focuses on similar topics in MOT programs. Students have to participate in evidence-based practice research, supervised fieldwork, and intensive research to successfully obtain their degrees.
• According to the Bureau of Labor Statistics, the average salary for occupational therapists is just over $86,000 annually . Therefore, based on the organization’s additional information, entry-level positions with an MOT degree will earn roughly the same amount of money as an OTD graduate.

What are the Differences Between a Doctoral Degree vs. Masters in Occupational Therapy?

• One of the key distinguishing factors between an MOT and OTD is that a doctorate in occupational therapy incorporates advanced subjects focused on research and leadership. While a capstone project is not generally included in the MOT curriculum, it forms a vital component of the doctor’s degree in all OT schools.
• While you obtain your MOT degree in about two years, OTD is a research-oriented program that requires 3-4 years for completion.

Advantages and Disadvantages of an MOT vs. OTD

• On average, MOT programs permit you to finish your program a year in advance than a Doctorate of Occupational Therapy (OTD).
• With an MOT, you can reduce your student loan debt and start practicing much sooner. For MOT, you must qualify the National Board Exam (NBCOT) and fulfill the prerequisite of continuing education courses each year.
• Even if the ACOTE approves its mandate in the future, individuals who have already completed an MOT program before 2027 can still transition into the profession, allowing them to find jobs in traditional clinical settings throughout their careers.
• Another advantage of going for an MOT is that you can always apply for doctoral programs in the future to earn your OTD.
• Students who pursue doctoral programs conduct independent research as a part of their degree requirements, thus having the edge over other occupational therapists.
• You can also pursue a broader range of career opportunities after an OTD and get into teaching, research, and policymaking.

General Outcomes

Check out the table below for a summary of these programs and their general outcomes.

MOT vs. OTD: Program Length and Tuition

Unsurprisingly, most people want to know how long it takes and how much it costs when selecting their graduate degree program. Since a doctorate in occupational therapy is a higher-level degree with an advanced scope of studies, you can expect it to exceed all master’s programs in occupational therapy in terms of cost and time.

Cost Considerations

Typically, a doctoral degree in occupational therapy (OTD) will take around three years to complete.

Comparatively, masters of occupational therapy programs run about 6 to 8 months shorter than an OTD program.

Those eager to save money and collect a paycheck may want to think about the costs of an extra year of school. It is important to note that graduates of an MOT program can always go back and pursue OTD programs later in the future. This is an important detail for those struggling to cover their educational expenses to consider.

Discover the various financial aids and scholarships that the New England Institute of Technology offers.

Differences in Curriculum

Graduates of MOT programs will also learn to provide treatments, evaluate the patient’s condition, and adjust treatment plans as necessary. Both MOT and OTD graduates will attain the ability to complete patient discharges independently as well. 

OTD programs require students to take courses in occupational science, quantitative research techniques, clinical leadership, and management.

In addition to this list, OTD programs will likely introduce students to real-world exposure through a capstone project or experimental component. They will also learn how to conduct independent research. Your curriculum may also incorporate leadership and advocacy-based subjects.

Online Vs. In-Person Programs

While on-campus programs are well-suited for students continuing their education, online degrees are an excellent option for working professionals. These programs give you the freedom to learn at your own pace without sacrificing your current obligations.

In an on-campus program, you can interact better with your peers, finish your degree at a pre-defined pace, and gain access to other on-campus facilities.

You can also choose hybrid programs which include a mix of online and offline teaching.

MOT Vs. OTD: Salary and Job Opportunities

Although both of these occupational therapy programs prepare students as entry-level practitioners, certain differences are essential to keep in mind. They include:

The initial salary for MOT graduates does not vary much from entry-level occupational therapists with an OTD. According to BLS statistics collected in 2020, the median pay for OT professionals was $86,280 per year .

The BLS also predicts that the employment of occupational therapists will grow by 16 percent from 2019 to 2029.

Job Opportunities

A master’s degree is mandatory for entry-level jobs as a therapist or clinician. Most occupational therapists work at private clinics, hospitals, and rehabilitation centers, while others practice independently. With an MOT, you can also work at private, local, and state elementary and secondary schools.

An OTD graduate might supervise the work of an occupational therapy assistant in clinical settings.

Some of the positions you can apply for after obtaining your OTD include Occupational Therapy Professor, Occupational Therapy Program Director, Occupational Therapy Researcher, Clinical Research Associate, etc.

Begin Your Career as an Occupational Therapist with The New England Institute of Technology

The Masters of Science in Occupational Therapy (MSOT) is a great program for certified occupational therapy assistants to further their educational and clinical experience and enjoy significant professional advancements. Our master’s degree program can also act as a bridge for current professionals to advance their responsibilities as registered occupational therapists.

The New England Institute of Technology offers the MSOT program on the weekends to accommodate working students better. Students will be expected to participate in on-campus training for five weekends, every ten-week academic term. 

Students must also participate in our online learning services during alternate weeks. This hybrid learning methodology allows graduates to complete the program in as little as ten terms.

By the end of our MSOT program, students will be able to operate across several different settings, from traditional medical environments to residences and more.

MSOT graduates will walk away armed with a variety of assessment techniques learned throughout our program. This will help them make important observations surrounding a patient’s functional problems and their underlying physical, mental, and psychosocial challenges. 

After completing all classroom training on campus and Level 1 Fieldwork off-campus through volunteer experience and shadowing hours, students will enter the community for Level 2 Fieldwork. Two full-time twelve-week Level 2 Fieldwork experiences give students many opportunities to apply classroom training in real-life situations.

Upon successful completion of all degree requirements, MSOT students will be eligible to sit for the National Certification Examination for Occupational Therapists. Those who complete the program and pass the exam obtain the title of Occupational Therapist Registered.

Those who already possess this title can look into our specialized Post-Professional Doctorate of Occupational Therapy. The doctorate program, which students can complete in as little as 12 months, is offered in a hybrid learning format to better accommodate the schedules of working practitioners.Our online courses crafted by faculty members and leading experts in the field help provide an edge over other doctoral degree programs. Individuals also have the option to study part-time and earn their degree over two years.

Both MOT and OTD are great ways to kickstart a rewarding career as an occupational therapist. A master’s degree is more financially feasible and provides faster access to jobs. On the other hand, a doctorate in occupational therapy is more suited for those more interested in teaching and research roles.

The New England Institute of Technology offers a Master’s of Science in Occupational Therapy and Post-Professional Doctorate in Occupational Therapy programs. 

Our graduates gain advanced knowledge in promoting healthcare, wellness, and participation across as it pertains to people of all ages and become innovators of contemporary practice in traditional and emerging settings.

Read as our graduates share their experiences with our occupational therapy program in our student testimonials section. Check it out today! Apply now and start your journey today. You can also visit our website or call us at 877-511-1958 for your candidacy status and information on our degree programs.

Is it better to get a Master’s or Doctorate in Occupational Therapy?

A master’s degree in occupational therapy is more suited for those eager to save money and start earning immediately. However, if you’re more inclined towards research, academics, and policymaking, a doctorate is the perfect option. While a master’s degree can take up to years to complete, doctoral degree programs span over 3-4 years.

Is an OTD a Doctor?

An occupational therapy doctorate (OTD) holder is not a doctor. Instead, occupational therapy professionals fall in the category of clinicians and therapists. Such professionals primarily work to recover and rehabilitate people post an injury, accident, surgery, or severe trauma.

Can you be an OT with a Master’s?

You can become an occupational therapist after completing your master’s degree and applying for licensure in your state. However, the minimum criteria may change, as ACOTE has proposed a mandate which would require all aspiring occupational therapists to complete their doctor’s degree for all entry-level positions, starting in 2027. 

Should ACOTE approve the mandate, the minimum criteria for becoming an OT will change in the coming year.

Can an Occupational Therapist start their own practice?

Yes, OTs can start their own practice once they obtain their license.

After completing their master’s degree in occupational therapy, graduate students can apply for the NBCOT certification exam. This certification is mandatory for obtaining licensure in all U.S. states.

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9 things people get wrong about sociopaths, according to a sociopath

• Sociopaths are often depicted as unfeeling criminals and abusers.
• Dr. Patric Gagne, a psychologist and a diagnosed sociopath, wrote a memoir about her experiences.
• She described the many ways she felt misunderstood by others and struggled with finding help.

Diagnosed with sociopathic personality disorder in her 20s, Dr. Patric Gagne struggled to find resources to treat the symptoms she had all her life.

Since childhood, Gagne has felt starkly different from everyone else. She's wrestled with pervasive apathy, and violent urges that feel more calm than charged.

"Everyone else had access to hope," Gagne says in her new memoir, " Sociopath ." "Schizophrenics, alcoholics, bipolar depressives — there were treatment plans and support groups for all of them." Sociopaths in popular culture are "loathsome villains with few exceptions," like Hannibal Lecter in "The Silence of the Lambs" and Patrick Bateman in "American Psycho."

The lack of available care for sociopaths inspired Gagne to pursue a PhD in psychology, where she specialized in the relationship between sociopathy and anxiety. Eventually, she worked as a therapist, where she "earned a low-key reputation as 'the sociopath therapist,'" taking on clients with sociopathic tendencies.

Gagne's memoir cast light on a lot of misconceptions about sociopaths, from how they process emotions to how they form relationships.

1. Sociopaths do feel emotions, just not "social" ones

Sociopaths are often depicted in media as devoid of feelings entirely. But that's not true.

"Some feelings came naturally to me, like anger and happiness," Gagne writes. "But other emotions weren't so easy. Empathy and guilt, embarrassment and jealousy were like a language I couldn't speak or understand." She compares her emotional range to "a cheap set of crayons," where she can access primary colors but struggles with "more nuanced hues."

As an adult researching sociopathy and going to therapy, she learned that sociopaths — and even psychopaths — can feel basic emotions. But they don't experience "social emotions," such as shame, remorse, and even romantic love, because they feel a lack of attachment to people.

2. Anxiety drives violent or risky urges

In pop culture, sociopaths get a thrill out of hurting and manipulating others. But the driver of high-risk and harmful behavior is more complicated, Gagne argues.

She describes feeling a "pressure" and anxiety whenever she feels apathetic. "The nothingness, I'd started to notice, made my urge to do bad things more extreme," Gagne says.

Throughout the book, she tried to mitigate her violent or unlawful urges by committing smaller risky acts, like breaking into people's homes or temporarily stealing cars from drunk fraternity brothers.

Ultimately, she sees her past behavior as a "subconscious drive for feeling." Doing something dangerous didn't actively bring her joy as much as relieve tension and stress — similar, she said, to an OCD compulsion .

3. Unlike psychopaths, they can shows signs of change

"Sociopath" and "psychopath" are often used interchangeably, but there are some key differences . To make matters more confusing, they both fall under the term " antisocial personality disorder ," which Gagne finds unhelpful.

"While I could easily identify with most of the traits on the sociopathic and psychopathic checklists, I was only able to relate to about half of the antisocial ones," she says.

Gagne was diagnosed via a psychopath checklist , where scoring within a lower range indicates sociopathy more than psychopathy because the symptoms are not as extreme.

Related stories

While research on the diagnoses is still limited, Gagne says experts believe that, unlike psychopaths, sociopaths can feel anxiety and also show signs of learning right from wrong.

4. They're not devoid of healthy interests or hobbies

Sociopaths are often portrayed as stoic loners in media, with no hobbies other than committing crimes and hurting people.

In truth, they can have interests and hobbies just like anyone else. In the book, Gagne describes her passion for music (particularly jazz), her love for her childhood pet ferret, bonding with the kids she babysits, and becoming fascinated with psychology enough to turn it into a career.

5. They don't understand why some things are "wrong"

Throughout the book, Gagne explains how she finds it difficult to identify "bad" behavior.

"I may have been missing an emotional connection to the concepts of right and wrong, but I knew they existed," she says. Because she can't naturally feel fear, shame, guilt, or remorse, she wouldn't know when she was doing something that could make people uncomfortable or scared, like stealing or stalking.

Later in adulthood, she would try to pay people back when she felt she was doing something wrong. She'd bring flowers to the strangers' funerals she'd crash and fill up the cars she briefly stole with gas.

"One time someone left the stove on, so I turned it off," she said of a house she broke into. "It's my way of trying to balance the karma."

6. They may lie to avoid being judged

A common assumption is that sociopaths always lie for the fun of it, or for personal gain. In Gagne's case, she says she often lied about her feelings just to fit in. She felt claustrophobia whenever she realized she wasn't feeling the way she was "supposed" to, she says in the book.

When her pet ferret died, she felt sadness but couldn't authentically sob the way her sister did. Throughout her childhood, she didn't feel remorse or fear, and sharing that with others didn't help.

That made it hard for her to form genuine connections with others, because she feels like she has to perform or exaggerate emotions to make others comfortable.

7. They crave connection, too

Another big sociopath stereotype is that they're perfectly content being on their own. While Gagne always enjoyed solitude, she also felt loneliness from her inability to be honest about her disorder.

"No one could relate to me," she says. "Nobody wanted to spend time with me. Not the real me, anyway. I was utterly alone."

Over time, she learned how to be more honest, and found people who wouldn't judge her.

8. Treatment can improve their symptoms

In the book, Gagne mentions Dr. Ben Karpman, who theorized that sociopaths "are not hardwired to pursue an antisocial lifestyle and may be responsive to treatment."

Because of the lack of available treatment options, Gagne researched ways to help mitigate her symptoms. She found that cognitive behavioral therapy helped her unpack the feelings of anxiety that triggered unwanted actions. "It all boiled down to mindfulness," she writes.

Acceptance of being a sociopath also helped her, because she realized her anxiety often came from the pressure to fit in. She started to become more open about her diagnosis to reduce the feeling of always needing to hide from others.

9. They can maintain long, healthy relationships

Gagne got married to David, her childhood sweetheart. Together, they share two children, a dog, and a cat.

"I am a passionate mother and wife," she says in the book. "I am an engaging therapist. I am extremely charming and well-liked. I have lots of friends. I am a member of a country club. I throw parties for every occasion you can imagine."

She's been able to have lasting relationships with her friends and family because she sought treatment and answers, which is why she pursued her PhD and started publicly speaking about her experiences.

"I am a twenty-first-century sociopath," she says. "And I've written this book because I know I'm not alone."

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Psychedelic Therapy—A New Paradigm of Care for Mental Health

• 1 Department of Mental Health, James J. Peters VA Medical Center, Bronx, New York
• 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
• Original Investigation Single-Dose Psilocybin Treatment for Major Depressive Disorder Charles L. Raison, MD; Gerard Sanacora, MD, PhD; Joshua Woolley, MD, PhD; Keith Heinzerling, MD; Boadie W. Dunlop, MD, MS; Randall T. Brown, MD, PhD; Rishi Kakar, MD; Michael Hassman, DO; Rupal P. Trivedi, MD; Reid Robison, MD; Natalie Gukasyan, MD; Sandeep M. Nayak, MD; Xiaojue Hu, MD; Kelley C. O’Donnell, MD, PhD; Benjamin Kelmendi, MD; Jordan Sloshower, MD, MSc; Andrew D. Penn, RN, MS, NP; Ellen Bradley, MD; Daniel F. Kelly, MD; Tanja Mletzko, MA; Christopher R. Nicholas, PhD; Paul R. Hutson, PharmD; Gary Tarpley, PhD; Malynn Utzinger, MD; Kelsey Lenoch, BS; Kasia Warchol, BS; Theraysa Gapasin, MS, aMFT; Mike C. Davis, MD, PhD; Courtney Nelson-Douthit, BS; Steffanie Wilson, PhD; Carrie Brown, MA; William Linton, BS; Matthew W. Johnson, PhD; Stephen Ross, MD; Roland R. Griffiths, PhD JAMA

An increasing number of clinicians and researchers have become interested in the potential of psychedelic drugs for the treatment of mental health disorders, including depression, anxiety, posttraumatic stress disorder, eating disorders, and addictions. 1 , 2

Currently, most psychedelic compounds are illegal under federal law. They were placed on the most restrictive class of drugs, Schedule I, in the 1970s as part of the “war on drugs,” meaning that they were considered to have high potential for abuse with no accepted medical use. 2 However, the ever-growing global mental health crisis, coupled with the shortage of effective therapeutic strategies, has given rise to a reconsideration of the therapeutic potential of these compounds in recent years.

Classic psychedelics have rapid and profound effects on perception, cognition, and consciousness that result in part from their actions at serotonin 5-HT2 A receptors. 1 This can result in heightened awareness of one’s internal states and feelings of connectedness that last for several hours. Psychedelics can also induce challenging and difficult experiences and need to be used carefully and in the presence of facilitators or therapists who are trained to work with people experiencing nonordinary states of consciousness. But these compounds offer unique therapeutic possibilities in their ability to promote openness to engage with things that are often avoided and suppressed. In fact, before they were determined to be Schedule I drugs, psychedelics were used therapeutically to help patients open up and identify and discuss emotionally triggering material in psychotherapy. 2

The study by Raison et al provides an excellent example of the promise of this new approach using psilocybin therapy for patients with major depressive disorder. 3 Although the trial was relatively small, it demonstrated that a single dose of psilocybin in the context of a 6-week period that included active psychotherapy resulted in a rapid, robust, and sustained reduction in depressive symptoms.

Psilocybin is a naturally occurring compound belonging to a class of compounds known as tryptamines, similar to lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), and mescaline. Understanding its therapeutic efficacy requires an appreciation of the context in which it is used, and not just its pharmacological profile or biological mechanism of action. The psychotherapy that occurs with the psychedelic medication is a critical component of this approach. 4

When a psychedelic is taken with the proper preparation, intention, facilitation, and therapeutic environment, the patient can use the experience to gain new insights that can catalyze healing and recovery. The psychedelic allows feelings such as self-compassion, forgiveness, understanding, and self-acceptance to surface that can be powerful antidotes to shame, guilt, anger, isolation, disconnection, or other negative emotions that patients find difficult to discuss in therapy and that do not seem to be mitigated by traditional antidepressants. 1 Furthermore, a sense of boundlessness or ego dissolution may be felt as a mystical or spiritual experience, helping people find meaning, perspective, and connection with others and the world. These experiences have been associated with symptom reduction and may represent an important mechanism of action. 4

The psychedelic approach Is radically different from traditional approaches that seek to suppress depressive symptoms by targeting presumptive underlying pathophysiology or biological dysregulation. Dysphoria, irritability, anxiety, and sleep problems can respond to classic antidepressants and help patients manage symptoms and improve functioning. But the benefits of psychopharmacotherapy and psychotherapy are often small and incremental, and true remission is generally not obtained for months or years. 5 , 6 Furthermore, psychotropic medications require chronic use, can be difficult to discontinue, and cause a variety of adverse effects, including weight gain, sexual dysfunction, and feelings of sedation or emotional numbing. Symptoms can reappear, even in stabilized patients, when the medications are discontinued, creating a heartbreaking dilemma for patients.

In contrast, psychedelic therapies address the cause of symptoms rather than merely suppressing them. Here, a medication is administered acutely for only a few sessions—sometimes even a single medication session—in the context of a therapeutic framework that provides the opportunity to integrate and synthesize the revelations that occur during the medication session. The acute pharmacological effects of the medicine, including potential adverse effects, resolve quickly and the safety profile is good. Clinically significant response rates are robust and can be maintained for weeks or months.

However, it is clear that despite the enthusiasm, psychedelic therapies do not represent a panacea for every patient. There are no silver bullets in psychiatry. In the study by Raison et al, similar to all other reports, there are a significant number of patients who did not respond to therapy. 3 , 7 It is important to analyze and understand adverse outcomes in psychedelic trials and conduct longitudinal studies to determine how sustained the effects will be and what may initiate a recrudescence of symptoms. Future studies will help identify who is most likely to benefit from psychedelics, whether booster or repeated treatment is safe and beneficial, and what the optimal dose and therapeutic frameworks are.

Nonetheless, psychedelic therapy represents a novel way of approaching mental health treatment that may benefit many people. It will also bring new knowledge regarding molecular bases of mental illness and how they relate to consciousness. Inquiries into the mechanisms of action of psychedelics will open new windows of understanding regarding neuronal plasticity and brain functioning. 1

Psychedelic therapies necessitate a rethinking of mental health care delivery in which medication is integrally paired with psychotherapy and delivered in a novel setting and framework. This will require an investment of time and resources, and it is not likely that these approaches will be broadly available to psychiatric patients except in clinical trials for the next few years. However, if the gains are strong and enduring and patients report symptom reduction and existential and spiritual transformation, the investment may be warranted. Meanwhile, clinicians should be knowledgeable about these new treatments as public interest and the empirical base grow.

The social, economic, and public health impacts of untreated mental disorders demand solutions. If psychedelic therapies do prove to have enduring effects after just a single or a few administrations in the context of a few sessions for preparation and integration, they have the potential to offer not just a new approach to mental health care, but an entirely new paradigm of care.

Corresponding Author: Rachel Yehuda, PhD, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, 526 OOMH, Bronx, NY 10468 ( [email protected] ).

Published Online: August 31, 2023. doi:10.1001/jama.2023.12900

Conflict of Interest Disclosures: Dr Yehuda reported receiving nonfinancial support from MAPS PBC (Multidisciplinary Association for Psychedelic Studies Public Benefit); grants from COMPASS Pathways, Steven and Alexandra Cohen Foundation, and The Bob and Renee Parsons Foundation; and honoraria for talks at the National Institute for the Clinical Application of Behavioral Medicine, Danish Psychiatric Society, Boston Trauma Conference, and UPenn Nursing School outside the submitted work and reported consulting for TeraMind, Wesana, and the Noetic Fund. Dr. Lehrner is an investigator on a trial sponsored by MAPS PBC financially supported by the Steven and Alexandra Cohen Foundation and a trial sponsored by COMPASS Pathways and reported receiving honoraria for talks at Psychedelic Science 2023 and Philadelic 2023.

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Yehuda R , Lehrner A. Psychedelic Therapy—A New Paradigm of Care for Mental Health. JAMA. 2023;330(9):813–814. doi:10.1001/jama.2023.12900

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$6.2 million to help develop gene therapy for HIV

Genetically engineered B cells could produce super-antibodies to HIV

by Julia Evangelou Strait • April 18, 2024

Researchers at Washington University School of Medicine in St. Louis have received a $6.2 million grant from the National Institutes of Health (NIH) to develop a gene therapy that would modify the immune system’s B cells to spur them to produce broadly neutralizing antibodies against HIV. In theory, such an approach could control or eliminate the infection without need for ongoing antiretroviral therapy. Shown is the engineered adenovirus designed to deliver HIV superantibody genes into B cells.

HIV infections can be controlled with medication, but such therapy must continue throughout patients’ lives because no strategy exists to eliminate the virus from the body or control the infection without ongoing treatment.

With the aim of developing such a strategy, researchers at Washington University School of Medicine in St. Louis have received a $6.2 million grant from the National Institutes of Health (NIH) to develop a gene therapy that would modify the immune system’s B cells to spur them to produce broadly neutralizing antibodies against HIV. In theory, such an approach could control or eliminate the infection without need for ongoing antiretroviral therapy.

“Permanent ways to control or eliminate HIV infection remain elusive, and their development is a major goal of the field,” said David T. Curiel, MD, PhD , the Distinguished Professor of Radiation Oncology. “The idea of modifying B cells — which naturally produce antibodies — to ensure that they manufacture specific antibodies that are broadly effective at targeting HIV is an exciting strategy. We have brought together a great team with expertise in HIV, gene therapy, and animal models of infection to work toward this goal.”

Curiel’s co-principal investigators are Michael R. Farzan, PhD, of Harvard Medical School and Boston Children’s Hospital, and Mauricio de Aguiar Martins, PhD, of the University of Florida.

Over the decades since HIV appeared, researchers have learned that about 1% of people with the virus are able to produce what might be considered superantibodies against the virus. Such individuals — known as elite neutralizers — can produce antibodies against multiple strains of HIV.

“Some people naturally have antibodies that can bind and destroy or deactivate very diverse strains of HIV, and we now have the ability to build those types of antibodies in the lab,” said Paul Boucher, a doctoral student in Curiel’s lab. “But just giving other patients these superantibodies is not an ideal solution, because these proteins would stay in the body only temporarily. Instead, our approach is to genetically modify the cells responsible for making antibodies — the immune system’s B cells — so they can always produce superantibodies against HIV whenever they may need to.”

Such engineered B cells could create, in theory, a state of permanent vaccination against the virus. Even if such a gene therapy doesn’t fully clear HIV from the body, the strategy could allow the amount of virus in the body to be controlled, keeping it at a minimal level and creating a functional cure, according to the researchers.

The strategy involves modifying a different type of virus, called adenovirus. When used in gene therapy, such viruses are genetically disabled so they can’t cause disease. The researchers then could engineer the adenovirus to carry the gene responsible for manufacturing broadly neutralizing antibodies to HIV. In the same viral vector, they also could include genes responsible for manufacturing the CRISPR/Cas9 gene editing proteins. In this way, the gene therapy delivery vehicle would carry into the body both the antibody gene that will be edited into the B cell genome and the genes to build the molecular tools to carry out that editing.

Using a three-part targeting strategy, the researchers would design the adenovirus to deliver its genetic payload only to B cells, avoiding other cell types. They have developed ways to modify the virus so that it is targeted directly to a protein that is expressed on the surface of B cells and no other cell types. The researchers can further restrict the targeting by using genetic methods to ensure that the CRISPR/Cas9 proteins can only be manufactured when their genes are delivered into B cells. Finally, they have developed strategies to modify the adenovirus in a way that stops its natural tendency to accumulate in the liver.

This strategy to modify B cells is distinct from another adenoviral gene therapy approach to HIV treatment that is currently in clinical trials led by principal investigator Rachel M. Presti, MD, PhD , a professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine. HIV is difficult to eliminate from the body because the virus integrates its genome into the DNA of the infected individual’s T cells. The strategy currently in clinical trials is focused on using precise targeting of the CRISPR/Cas9 gene editing proteins to excise the virus from the genomes of all of a patient’s infected T cells. This strategy is being tested in a first-in-human, phase 1 clinical trial to determine its safety and preliminary efficacy at various doses.

Curiel said engineered B cells are ripe for developing new therapies to treat a wide variety of diseases. In November, a genetically engineered B cell therapy was administered to a patient for the first time at the University of Minnesota Medical Center. In that case, the therapy was designed to treat mucopolysaccharidosis type 1, a life-threatening condition in which the body lacks an enzyme necessary to break down large sugar molecules inside cells.

“Gene therapy with engineered B cells is an exciting new area of research,” Curiel said. “We look forward to combining our expertise in adenovirus gene therapy, HIV infection and preclinical models of disease to realize our plan for developing an HIV therapy that we hope can permanently control the infection.”

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