There is a world in each person’s brain

Presented at the Annual Conference of National Alliance for the Mentally Ill, Orlando Florida, June 2008

Building Life SkillsHealing the Brain

Holistic RECOVERY:

Hopewell is a healing environment for individuals recovering from mental illness.

The Mirans adapt the Neuropsychological Therapeutic Community Treatment Model for remediating cognitive deficits and improving brain function.

Time-Line Development of the Miran’s Treatment

1982:Right Brain/Left Brain Models lead to a Homeostatic Brain Model

1989: Adapting the NYU Rusk and the Recanati Institute’s Neuropsychological

Therapeutic Community Model (a brain injury treatment)

2000: Grant from NYS Office of Mental Health

2000- present: Treatment sites at- FEGS (Brooklyn), Jaffa Community Mental Health Center (Israel) and

Hudson River Psychiatric Center (NY)

2006-present: Collaboration with Hopewell (OH)

Treatment Techniques:

Assessment-personality neuropsychological

Therapeutic community meetings

Family involvement

Brain plasticity training

Interpersonal skills development

Brain biofeedback training

Basic Science/Brain Function

The Homeostatic Brain Model describes normal and abnormal activating and inhibiting systems

Psychiatric symptoms occur when there are disruptions in activating and inhibiting Frontal, Temporal, Parietal, and Limbic regions of the brain.

The human brain is plastic, and can recover function and establish new neural-pathways

New MetricsMeasuring Effectiveness based Performance

Effectiveness based treatment demonstrates:

improved ecologically valid functional behavior

improved psychophysiological functioning

the ability to engage in the treatment process

Measuring Effectiveness Based Treatment

In this presentation we measure:

Improved functional behavior by the Orientation Remediation Module subtest Zero Accuracy Conditioner

Improved psychophysiological functioning by EEG Brain Biofeedback

The ZAC is a computerized cognitive training task (developed by Yehuda Ben-Yishay, Ph.D. at the NYU Rusk Institute, Working Approaches to Remediation of Cognitive Deficits in Brain Damaged Persons, 1983)

Includes three subtests• Immediate stop• Short coast• Long coast

Subtests are progressively more difficult and involve more frontal lobe activity

Zero Accuracy Conditioner (ZAC)

Zero Accuracy Conditioner (ZAC)

Next slide is a picture of the stimuli as seen by the subject on the computer screen

Top Picture – Subject achieves the correct response. The clock hand stops at

the top mark.

Bottom Picture – Subject deviates from the correct response. Deviations are

counted.

Zero Accuracy Conditioner

(ZAC)

Trial 1

Trial 2

Trial 3

0

1

2

3

4

5

6

7

8

ZACNumber Correct Responses

3 Trials (each trial is a summary of 12 re-sponses)

Subject Diagnosed with Schizophrenia at Hopewell

Immediate StopShort CoastLong Coast

Num

ber o

f Cor

rect

resp

onse

s

The subject gradually improves ability to achieve a correct response:

The summary of the immediate stop begin at a score in the range of 6-7 and increase to a score in the range close to 8 (The immediate stop is a less demanding task)

The summary of the short coast begin at a score of “0” and increase sharply to a score in the range close to 3.

The summary of the long coast begin at a score of “0” and increase on a straight line to the range close to 3.

ZACCorrect Response by Trials

Trial 1Trial 2

Trial 3

0

10

20

30

40

50

60

70

80

90

100

Immediate Stop

Short Coast

Long Coast

Immediate Stop

Short Coast

Long Coast

ZACMagnitude of Deviation from Correct Response

3 Trials (each trial is a summary of 12 responses)Subject Diagnosed with Schizophrenia at Hopewell

Mag

nitu

de o

f Dev

iatio

n fro

m C

orre

ct R

espo

nses

The subject gradually improves ability to achieve a smaller magnitude of deviation:

The summary of the immediate stop begin at a score close to “0” and

end at the same score (The immediate stop is a less demanding task)

The summary of the short coast begin at a score between 20-30 and decrease to a score close to “0”

The summary of the long coast begin at a score between 80-90 and decrease to a score close to “0”

ZACMagnitude of Deviation

ZACEEG Brain Biofeedback

The EEG Record is of a subject diagnosed with Schizophrenia. Data collected as part of a New York State Office of Mental Health Grant

The EEG Record shows a change in brain function from an abnormal state to a normal state associated with working on the ZAC, long coast

Sta

ndar

d 10

/20

Sys

tem

-Voi

ce B

ox, H

eart

Rat

e, a

nd G

SR Abnormal Normal

Brain Activity During

ZAC Long Coast Subtest

The red shows increased frontal activity

Activity is in a slow Delta Wave Range(8 to 12 cycles a second)

The results suggest that individuals can:

Improve information processing and functional behaviorZAC charts from three trials of 12 responses on a single day.

The subject is focused and is able to engaged in the treatmentprocess

Improve psychophysiological functioningEEG Record

As frontal lobe circuits are activated, hallucinations and circular negative thoughts are diminished by the process of reciprocal inhibition

Caveat

The above slides present single case data demonstrating the possibility of producing changes in brain functioning.

Due to the small sample size we cannot claim that this data generalizes to any larger population.

It would be desirable to do a study with a larger sample size and randomized controls.

Hopewell – a nurturing residential environment

Miran’s Neuropsychological TreatmentImproves functional behavior and brain activity

New Metrics –measures effectiveness based treatment

New Technologies for Treatment – enables the transformation of brain function

Recovery – An urgent need for individuals to feel better

In Conclusion:

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CONTACT INFORMATION

HOPEWELL THEAPEUTIC COMMUNITYCandace Carlton9637 State Route 534PO Box 193Mesopotamia, OH 44439-0193(440) 693-4074 Voiceinfo@hopewell.ccwww.hopewell.cc

MIRAN APPROACHEsta Miran272 Sylvan Rd.Rochester, NY 14618(585) 473-3558 Voiceemiran@mirantherapy.comwww.mirantherapy.org