J. Ryan Fuller, Ph.D. is a New York licensed clinical psychologist with extensive training in Cognitive-Behavior Therapy (CBT).
Dr. Fuller specializes in Anger Management and Weight Loss, but the majority of his clinical work focuses on Anxiety, Depression, Relationships (Couples Therapy and Family Therapy), Addiction, Compulsions, and Career challenges. Dr. Fuller conducts weekly psychotherapy sessions on these and a number of other topics.
Dr. Fuller lectures and conducts workshops extensively to a wide variety of audiences. Topics covered include Lifestyle Change, Motivation, Procrastination, Successful Communication with Family Members, Time Management and Organization, Using Cognitive Behavior Therapy (CBT) in the Management of Diabetes and other Chronic Health Conditions, Cross-cultural Universals, Behavior Modification, and Effective Anger Management.
Dr. Fuller also trains health professionals in the areas of Rational Emotive Behavior Therapy (REBT), CBT for Couples, Cognitive Behavioral Treatment of Addictions, Relaxation Training, Problem Solving, Behavior Therapy for Borderline Personality Disorder, and Brief CBT Interventions for Patients in Medical Settings.
CBT Therapy and Research
Dr. Fuller’s weekly psychotherapy sessions cover the areas of Anxiety Treatment, Anger Management, Cognitive Behavior Therapy for Depression, and Behavioral Weight Loss. He has published in the area of Positive Psychology, Weight Loss after Bariatric Surgery, Cognitive Behavior Therapy (CBT), and Rational Emotive Behavior Therapy (REBT). Clinically, Dr. Fuller seeks to reinforce adaptive behaviors; identify, understand, and enhance character strengths, and to improve the quality of relationships as well as to clarify values. Overall these steps are taken to improve life satisfaction, not exclusively reduce clinical symptoms, but rather help clients live meaningful lives.
Overview of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) has evolved over decades. What has not changed is the emphasis on scientifically testing theories and clinical techniques. Behavior Therapy (BT) was developed first. Based on principles of learning from scientific laboratories, behavior therapists began applying techniques to patients. Learning principles established in the classical conditioning work of Pavlov and operant conditioning work of B.F. Skinner (psychologist) and others, could be applied to help people suffering with various disorders, such as anxiety. For example, Dr. Joseph Wolpe (psychiatrist) and his protege, Dr. Arnold Lazarus (psychologist) promoted the use of systematic desensitization.
Systematic Desensitization as Behavior Therapy
Systematic desensitization involves the therapist helping the patient to identify different levels of what triggers their anxiety response. Then a fear or anxiety hierarchy is developed. The next step is for the psychotherapy patient to be taught and practice an effective relaxation technique. Once the therapy patient can effectively produce a relaxation response, the conditioning begins. The therapist or the psychotherapy patient may describe the trigger that will at first produce a lower level of anxiety. After the anxiety response has occurred in response to exposure to the anxiety stimulus, the therapy patient then produces a relaxation response. According to Wolpe, one cannot be simultaneously anxious and relaxed at the same time. He called this concept reciprocal inhibition. An incompatible response, e.g., relaxation is then to be selected to replace anxiety. With practice a therapy patient can learn to have a relaxation response follow the anxiety trigger. As the therapy progresses, the behavior therapist has the psychotherapy patient gradually work up the fear or anxiety hierarchy, until the patient can successfully cope with even the most intense anxiety trigger.
Behavior Therapy (BT) has been effectively applied to numerous disorders, e.g., Autism, major depression, and the clinical applications include prolonged exposure therapy, exposure with response prevention (ERP), assertiveness training, contingency management techniques, behavioral activation, Problem Solving Therapy, Functional Analytic Psychotherapy, Applied Behavior Analysis (ABA), and Acceptance and Commitment Therapy (ACT).
Rational Emotive Behavior Therapy and Cognitive Therapy
Albert Ellis, a clinical psychologist, began conducting psychotherapy after being trained as a psychoanalyst. He eventually changed his approach and incorporated lessons from philosophy into a therapeutic technique, whereby he encouraged therapy patients to adopt more rational beliefs about themselves, a particular situation, others, the world and the future. He proposed that by changing changing irrational beliefs to more rational beliefs, therapy patients could change their emotions. For example, a client with the proper therapeutic intervention or tools learned in therapy, could challenge the belief that she would be a failure if she failed her cell biology final and it would be awful if she received a C in the course. She would then replace those irrational beliefs with something more realistic or rational like, “It may be accurate that I failed that final, but I don’t become a failure for failing an exam. And it may be really bad if I receive a C in the course, sense that will keep me from reaching my goal of an A average, but it is not truly awful.” With rational beliefs about a negative event, a negative emotional state will still occur. For example, irrational beliefs about a potential bad grade may produce anxiety, while rational beliefs would produce concern. Removing emotions or changing negative ones to positive ones as the consequence of a negative activating event is not the goal. It would not be adaptive to feel joyous after failing to meet a goal. According to Ellis’ Rational Emotive Behavior Therapy (REBT), healthy negative emotions, e.g., concern, disappointment, sadness, etc. can motivate adaptive behaviors. Disappointment after a poor grade may encourage more preparation before the next exam. But unhealthy emotions such as panic, depression, or rage are likely to be followed with self-destructive behaviors. Ellis called this model of events, beliefs, and consequences (emotional and behavioral) the ABC model. A stands for activating events, “B” for beliefs (rational and irrational), and “C” for consequences (emotional and behavioral). This ABC model has been adopted by many cognitive behavior therapists.
Aaron T. Beck, a psychiatrist, developed a similar therapy that emphasized the role of cognition on emotional states and behaviors. Beck’s original work focused on the clinical issue of depression. Beck helped his psychotherapy patients become keenly aware of different types of cognitions, e.g., automatic thoughts, cognitive distortions, core beliefs, and schemas. Again one of the targets emphasized in his cognitive therapy (CT) is challenging the cognitive distortions in order to make them more realistic and helpful. In the case of depression, he proposed therapists should focus on cognitive distortions about the self, world, and future. This is now called the Cognitive Triad. As is true with Ellis’ Rational Emotive Behavior Therapy (REBT), Cognitive Therapy (CT) also included more behavioral technique such as activity scheduling. Many proponents of Beck and Ellis’ cognitive theories of emotion believe the mechanism of change is cognitive restructuring, i.e., changes in cognitions produce changes in emotions in these treatments. While there is little argument that these treatments can be effective at reducing anxiety and depressive symptoms, many behaviorists believe the mechanisms of change are not solely cognitive, but rather rely on the behavioral learning principles identified above in the section on behavior therapy. The mechanism of change is one of the biggest reasons for disagreement between the more cognitive therapists and those who ascribe to behavioral therapy. Nonetheless, most people view cognitive and behavior therapists as operating under one large umbrella, Cognitive Behavior Therapy (CBT).
References for Cognitive Behavior Therapy (CBT)
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Carol Publishing Group.
Walen, S. R., DiGiuseppe, R. A., & Dryden, W. (1992). A practitioner’s guide to Rational-
Emotive Therapy (2nd ed.). New York: Oxford University Press.
New York City Cognitive Behavior Therapy Practice
Dr. Fuller’s private practice is located at 330 Madison Avenue, New York, NY 10017. Cognitive Behavior Therapy (CBT) sessions at this location take place between 10:00 am and 9:00 pm Monday through Friday. If weekends are of interest please call to inquire and a referral can be made.
About this New York Psychologist
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