poster session - miran
TRANSCRIPT
How The Treatment Changes Brain Functioning
Left Picture: Brain is in a slow wave state associated with auditory and visual hallucinations.
Right Picture: Brain is in a normal alpha state while trainee is working on a cognitive training task. During the task and after, the trainee’s brain is functioning normally.
Change Behavior Change the BrainChange 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 placements.
WHY IS THIS TREATMENT 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 programs.
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.
INNOVATIVE TREATMENT FOR SCHIZOPHRENIA:
NEUROPSYCHOLOGAL APPROACH
Michael Miran, Ph.D.Esta Miran, Ed.D. 272 Sylvan Rd.Rochester, New York 14618
(585) 473-3558 Voice
Website:mirantherapy.org
Michael Miran(585) 305-7770
Esta Miran(585) 738-9770
Michael D. Miran Ph.D. Psychologist P.C.Adaptation of the Neuropsychological Therapeutic Community Treatment
Results of Treatment Outcome Study Brooklyn NY
Pretreatment
October-03
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Number of Consumers
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Consumer Improved Cognitive Function
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Pretreatment
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Number of Consumers
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Consumer Participates in Vocational and Educational Services Within Treatment
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Results of Treatment Outcome Study Brooklyn NY
Pretreatment
October-03
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Number of Consumers
Pretretment vs October 03
Consumer Participates in Vocational and Educational Services Within Treatment
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Results of Treatment Outcome Study Brooklyn NY
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Reaction Time in Milliseconds
Trials
V ar iable D elay S 1, S 2 , S 3
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Individual Measures of Variance in Reaction Times
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CRISIS INTERVENTIONPeople 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.
SCIENCE TO SERVICEPolicy and Service Implications
Science:The authors used neurophysiological monitoring and neuropsychological
testing to establish the connection between brain/behavior dysfunctions, treatment interventions, and improved brain/behavior functioning.
Services: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.
RESEARCH-NEXT STEPS
• 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, CAUTION, AND CONCLUSION
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.