There is a world in each person’s brain

Presented at the Annual Conference of PSR/RPS, Winnipeg, Canada, September 2008 Rehabilitation of the Seriously Mentally Ill: Role of the Family in Recovery of Brain Function

Brain Plasticity Brains Have the Ability to Change and Adapt IN RESPONSE TO TREATMENT

The brain can change and rebuild new connections, and this provides a basis for recovery The following slides present key concepts from our work and NIMH’s work on brain function in Schizophrenia

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 a computerized attention task

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

Brain Activity During Computerized Attention Task The red shows increased frontal activity Activity is in a slow Delta Wave Range (8 to 12 cycles a second)

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

Present And Future Methods Of Improving Brain Functioning Present And Future Methods Of Improving Brain Functioning Chemotherapy-the use of specific chemicals to change brain functioning and promote recovery of functioning. The current generation of medications focus increasingly on improving cognitive functioning. Brain Plasticity Training (cognitive retraining)-Individual’s work with computers and manuals to rebuild cognitive functioning. Improving Executive Functioning – cognitive exercises and adaptive devices to enhance frontal lobe functioning and to enable frontal lobe tasks such as planning, reasoning, and prospective memory. EEG Biofeedback – online EEG recording is used to train people with schizophrenia to keep their brain in a normal Alpha Rhythm Magnets and Transcranial Magnetic Stimulation - electromagnets or traditional magnets next to different brain areas to use magnetic force to disable and restart brain function. Neuropsychological Therapeutic Community – environments where individuals work towards “becoming a whole person”.

The Latest Images from UCLA NIMH Funded Imaging Team Comparing Schizophrenia Subjects with Normals Controls The Main Points are: There is a great deal of structural variability in the brains of people with schizophrenia The inter-connection between the right and left side of the brain and the Corpus Callosum tissue contributes to problems in communication between the two sides of the brain We discussed similar ideas in our 1983 papers on the homeostatic brain

A Population-Based Schizophrenia Brain Atlas (Schizophrenia Atlas Team:) Narr KL, Thompson PM, Sharma T, Moussai J, Zoumalan CI, Rayman J, Mazziotta JC, Toga AW Construction of a population-based atlas of the brain in schizophrenia is well underway. Based on large human populations, and containing thousands of 3D structure models, this atlas encodes patterns of anatomical variation. The atlas can also detect group-specific patterns of anatomic or functional alterations. Disease-specific features and asymmetries are beginning to emerge that are not apparent in the individual anatomies. A sharply-defined mosaic of variability and asymmetry patterns are being found across the cortex. These patterns and brain asymmetries also vary according to the functional specialization of each brain system (see below).

Hopewell and the Miran Approach: Implementing holisitic treatment to change brain function in the real world. 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 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:  Family involvement  Assessment- personality neuropsychological  Therapeutic community meetings  Brain plasticity training  Interpersonal skills development  Brain biofeedback training

Effectiveness based treatment demonstrates: –improved psychophysiological functioning –improved ecologically valid functional behavior –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)

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.

ZeroAccuracyConditioner (ZAC )

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

Magnitude of Deviation from Correct Responses

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 and decrease to a score close to “0” The summary of the long coast begin at a score between and decrease to a score close to “0” ZAC ZAC Magnitude of Deviation

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

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.

An Environment of peace and security: with support, structure, and family collaboration State-of-the-Art brain treatment: the brain is plastic and can regain functioning Hopewell and the Miran Approach

EDUCATE YOURSELF Learn about psychosocial rehabilitation programs View videos, read books, and read literature from treatment sites Learn about your feelings of grief and loss of your ideal child Family Members and Significant Others Can

Can Advocate for Your Loved One You are the most powerful advocate Work collaboratively with treatment team Work with advocacy and supports groups Family Members and Significant Others Can

MOTIVATION The strongest reinforcer for the significant struggle to overcome brain dysfunction is the increased self-esteem based on the awareness of success in accomplishing a realistically challenging task.

Families – a journey of recovery with loved ones 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 In Conclusion:

33 CONTACT INFORMATION HOPEWELL THEAPEUTIC COMMUNITY Candace Carlton 9637 State Route 534 PO Box 193 Mesopotamia, OH (440) Voice MIRAN APPROACH Esta Miran 272 Sylvan Rd. Rochester, NY (585) Voice