1. There is a world in each person’s brain

2. Presented at the Annual Conference of National Alliance for the Mentally Ill, Orlando Florida, June 2008 Building Life Skills Healing the Brain

3. Hopewell and the Miran Approach 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.

4. 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)

5. Treatment Techniques:  Assessment- personality neuropsychological  Therapeutic community meetings  Family involvement  Brain plasticity training  Interpersonal skills development  Brain biofeedback training

6. 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

7. Effectiveness based treatment demonstrates: improved ecologically valid functional behavior improved psychophysiological functioning the ability to engage in the treatment process

8. 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

9. 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)

10. 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.

11. ZeroAccuracyConditioner (ZAC )

13. 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. ZAC ZAC Correct Response by Trials

14. Magnitude of Deviation from Correct Responses

15. 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” ZAC ZAC Magnitude of Deviation

16. ZAC ZAC EEG 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

17. Standard 10/20 System-Voice Box, Heart Rate, and GSR AbnormalNormal

18. 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)

19. results The results suggest that individuals can: Improve information processing and functional behavior ZAC charts from three trials of 12 responses on a single day. The subject is focused and is able to engaged in the treatment process Improve psychophysiological functioning EEG Record As frontal lobe circuits are activated, hallucinations and circular negative thoughts are diminished by the process of reciprocal inhibition

20. 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.

21. Hopewell – a nurturing residential environment Miran’s Neuropsychological Treatment Improves 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:

22. 22 CONTACT INFORMATION HOPEWELL THEAPEUTIC COMMUNITY Candace Carlton 9637 State Route 534 PO Box 193 Mesopotamia, OH 44439-0193 (440) 693-4074 Voice info@hopewell.cc www.hopewell.cc MIRAN APPROACH Esta Miran 272 Sylvan Rd. Rochester, NY 14618 (585) 473-3558 Voice emiran@mirantherapy.com www.mirantherapy.org