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Change the Brain Change Behavior


									         How The Treatment Changes
             Brain Functioning

Left Picture: Brain is in a slow      Right Picture: Brain is in a normal alpha
                                      state while trainee is working on a
wave state associated with            cognitive training task. During the task
auditory and visual hallucinations.   and after, the trainee’s brain is
                                      functioning normally.
   Change Behavior Change the Brain
   Change the Brain Change Behavior
This treatment connects improved behavior with improvements in brain function.

This treatment remediates brain dysfunction.

This treatment is an adaptation of a head injury treatment program developed at
   the Recanati Institute in Israel and at the New York University, Rusk Institute,
   Head Trauma Center.

This treatment reduces stigma. People with Schizophrenia use the treatment to
   build skills and develop competencies i.e. restore brain function. They are
   referred to as trainees i.e. people in training.

This treatment has been established as an effective and evidence based
   treatment. It has been developed in a private practice setting in Rochester,
   NY: and replicated in Brooklyn NY; Jaffa, Israel; and Hudson River Psychiatric
   Center, NY. Treatment outcome data shows substantial cognitive and
   interpersonal improvement leading to transition to educational and vocational
               IMPORTANT NOW?
This treatment provides the field with a set of psychological interventions that
   augment the most effective medications.

Atypical antipsychotic medications, as discussed in the MATRICS project,
   improve cognitive functioning to some extent; but they are not sufficient to
   permit people with schizophrenia to succeed in educational and vocational

This Neuropsychological Treatment provides the field with:
    1. Hierarchical tasks that train attention/concentration, then higher ordering
       thinking skills and creative development of the mind.
    2. Hierarchical tasks that train interpersonal relating and leaderships skills.
    3. Measurement that is embedded in daily skill training exercises.
    4. Manuals for staff that provide running commentary on how to implement
       the treatment.
    5. Manuals for trainees that provide structure and support for trainees to
       lead groups, and improve their cognitive and interpersonal functioning.
    6. DVDs that use state-of-the-art technologies and provide digital video
       examples of the treatment.

Michael D. Miran Ph.D. Psychologist P.C.
Adaptation of the Neuropsychological Therapeutic Community Treatment

Michael Miran, Ph.D.
Esta Miran, Ed.D.                     Michael Miran
                                      (585) 305-7770
272 Sylvan Rd.                  
Rochester, New York 14618
                                      Esta Miran
(585) 473-3558 Voice                  (585) 738-9770
Results of Treatment Outcome Study Brooklyn NY
Results of Treatment Outcome Study Brooklyn NY
Results of Treatment Outcome Study Brooklyn NY
People with mental illness are vulnerable to crises. What are typical problems in living for
   most people can become elevated to crises for a trainee. Problems with brain
   function limit the trainee’s ability to reason and cope.

This treatment approach to crisis intervention is an extension of the training in reasoning
    and problem solving. Improved reasoning skills are critical to success in crisis
    management. The goal of treatment is to improve reasoning and prevent trainees
    from having crises.

When trainees have a crisis, the therapist guides the trainee in evaluating the crisis and
  determining how to manage the problem. Often the therapist enlists the families and
  support networks to work collaboratively in helping the trainee cope with the crisis.

This approach to crisis management uses a series of questions in the crisis interview:
• What is the nature of the crisis?
• Whose crisis is it?
• What have you done to cope with the crisis?
• How can you tell when the crisis is resolved?
• What additional help do you need to resolve the crisis?
• Make a plan to resolve the crisis.
      Policy and Service Implications
    The authors used neurophysiological monitoring and neuropsychological
       testing to establish the connection between brain/behavior dysfunctions,
       treatment interventions, and improved brain/behavior functioning.

    An adaptation of a head injury treatment model addresses the interpersonal
       and cognitive deficits of people with schizophrenia. The existing
       neuroscientific literature was used to develop the treatment interventions
       and training manuals. Given the strong scientific base, the treatments are
       robust, user friendly, and replicable.

Policy and Systems Change:
     From treatment tools to systems change, these treatment techniques are
        individualized to meet the needs of facilities, counties, states, and
        countries. Administrators and public officials can see the cost
        effectiveness of the treatment. As trainees improve their functioning, they
        move from being consumers of cost intensive treatment to become
        productive members of the community. Planning is underway to convert
        the mental health system of Israel to this model.

• Use online EEG feedback to train the brain. Trainees
  will maintain normal brain states for longer periods
  of time.

• Apply multi-electrode and depth arrays to measure
  sub-cortical functioning. Validate the effectiveness
  of interventions.

• Increase sample size studied to be a Phase II clinical
  trial, including random assignment.

• Adapt treatment technologies to the needs of diverse
  multicultural and third world communities.
Caveat and Caution - While the majority of trainees respond very
  positively to this treatment, not all trainees are equally
  responsive to this set of interventions. Trainees currently using
  substances and some patients with personality disorders
  typically need other types of treatments. If the treatment is not
  provided consistently or sustained long enough to engage the
  trainee, the therapeutic change is reduced.

Conclusion - This is a treatment which has been in development
  for many years. As the field has progressed to focus on the
  importance of cognitive and interpersonal deficits, the value of
  this treatment to the field is increasing. This innovative
  treatment is synergistic with NAMI’s mission to improve the
  lives of individuals with mental illness.

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