Treatments

The NeuroCognitive & Behavioral Institute uses a multi-layered treatment approach when treating cognitive and neuropsychiatric disorders. Patients with various cognitive and behavioral disorders are treated by an interdisciplinary team of clinicians. This team typically includes: a clinical neuropsychologist, a clinical psychologist, consulting psychiatrists, a behaviorist, a cognitive rehab/speech language therapist and a neuromodulation clinician as neuromodulation interventions are generally used to enhance the behavioral and cognitive rehabilitation.

We provide a combination of traditional, complementary, as well as, the use of experimental treatments when necessary. This blend of treatment options is typically not available at other clinics and one of the unique attributes of NCBI. For instance, when treating cognitive disorders we typically treat by combining cognitive rehabilitation, with cognitive enhancers, and one or more forms of neuromodulation superimposed on a comprehensive behavioral health plan that utilizes specific nutrition plans, heart-rate variability training, enhancing the quantity and quality of our patient’s sleep and the reduction of stress. Similar combination therapies are used for treating a variety of neuropsychiatric conditions such as OCD, as well as, in the treatment of chronic pain and fatigue.

Some of these treatments and consultation options include:

Cognitive Rehabilitation

Patients admitted to the cognitive rehabilitation program enter a module based on their primary type of cognitive impairment, e.g., the Attention, Working Memory and Executive System Impairment Module. Each patient receives specific treatments for this type of cognitive disorder using a combination of remedial, adaptive and compensatory interventions that have been developed at the NeuroCognitive & Behavioral Institute for their module based on valid therapies from cognitive remediation clinical trials. (Watch video.) Learn more.

Neuromodulation

One of the most exciting areas in clinical neuroscience is the development of neuromodulation interventions for the treatment of neurological and psychiatric disorders. There are generally 2 major categories of neuromodulation: invasive and non-invasive. Some examples of invasive forms of neuromodulation include Deep Brain Stimulation which has been FDA approved for the treatment of Parkinson’s disease and requires neurosurgery. Implanted neuromodulators are also FDA approved for the treatment of chronic pain. These devices require surgery to implant the neuromodulation devices in an attempt to block or attenuate pain messages, usually at the spinal cord level. Electrical Convulsive Therapy or ECT, is also considered invasive because it creates a generalized seizure and patients are anesthetized during the procedure. Where ECT requires 800 – 1,000 milliamps, non-invasive neuromodulation intervention uses, in adults, typical up to 2 milliamps and typically up to 1 milliamp in children.

Only non-invasive neuromodulation (NM) interventions are used at NCBI. These interventions do not require any surgery or anesthesia. NM works typically by applying weak electrical currents to influence or modulate neurophysiological activity in the brain. These currents are generally applied from outside of the head, i.e., transcranial, through EEG sensors that rest on the surface of the scalp. Other common targets are the cranial nerves, accessed from the forehead or outer ear.

IS NEUROMODULATION SAFE?
Presently, over the past 20 years there have been approximately 1,000 neuromodulation studies completed in healthy and clinical populations. In several countries, including the USA, various forms of NM interventions have been approved for the treatment of depression and chronic pain. Many NM studies have also been conducted to study cognitive enhancement in both healthy non-clinical study volunteers, as well as, in clinical populations such as Alzheimer’s disease, stroke, ADHD, Autism and traumatic brain injury. NM is easy to apply, considered to be safe and only mild adverse effects have been reported. These typical consist of mild tingling and light itching under the electrodes. In all the NM studies conducted to date – there has never been a serious adverse event resulting in any hospitalization, permanent injury or death. The PI will discuss in more detail with you potential risk and side effects from NM.

Although many NM medical devices are new and only recently approved by the FDA for conditions such as ADHD, Opiate withdrawal, chronic pain and migraine, others such as CES devices were approved in the 1970s by the FDA for treatment of anxiety/insomnia and depression. However, treatment results with many of these older medical devices have not been that effective. Research is being conducted here at NCBI and the NCBI Clinical Research Foundation and around the world investigating if newer neuromodulation medical devices are more effective for a host of neurological and psychiatric disorder.

Below are some examples of commonly used NM interventions:

Neurofeedback
Among these various neuromodulation applications, Neurofeedback is the only active form of neuromodulation requiring the patient to learn to gain control over specific neurophysiological activity. Although Neurofeedback has been used as a clinical tool since the 1960s, brain mapping neurofeedback using LORETA software is a relatively recent development dating back to approximately 2008. This technology uses advancements made over the past 20 years mapping multiple brain circuits responsible for a plethora of human experiences; from basic functions such as sustaining wakefulness to complex functions such as decision-making. Watch video.

Transcranial Direct Current Stimulation (tDCS)
Among the transcranial NM interventions, transcranial direct current stimulation (tDCS) has been the most widely studied over the past 20 years. This is a non-invasive, painless brain modulation treatment that uses very small direct electrical currents to stimulate specific parts of the brain. A constant, low intensity current is passed through two or more electrodes placed over the head which modulates neuronal activity. Several hundred studies suggest it may be a valuable tool for the treatment of cognitive disorders, as well as, neuropsychiatric conditions such as mood disorders and chronic pain. Although approved in several countries for the treatment of depression and pain, currently, tDCS is not an FDA-approved treatment. Learn more.

Transcranial Alternate Current Stimulation (tACS)
Transcranial Alternate Current Stimulation (tACS) is similar to tDCS as a neuromodulatory technique, but instead of applying a direct electrical current, tACS oscillates a sinusoidal current at a chosen frequency to interact with the brain’s natural cortical oscillations. The advantage of this approach is the entrainment of cortical networks or circuits which can be manipulated a specific speed/frequencies to slow down or enhance activity in these networks or regions. Learn more.

Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective.

Psychiatric Assessments and Mental Health Treatments

The goal of psychiatric exams and clinical psychological testing is to identify the cause of each patient’s neuropsychiatric symptoms and disorders. For example, to determine if a patient’s mood disorder is due to dysthymia or major depression; or to differentiate a bipolar spectrum disorder vs. a trait-based condition such as borderline personality disorder.

Accurately identifying the diagnostic category generally helps determines the best treatment option which increases the likelihood of a positive outcome. These diagnostic procedures are always combined with a comprehensive developmental, social and medical history, as well as, a neurological examination to enhance the probability of making an accurate diagnosis or diagnoses.

There are 3 general categories of mental health treatments used at NCBI:

• Psychotherapy – the type of psychotherapy used if often determined by the results of the comprehensive psychiatric assessment. Although Cognitive Behavioral Therapy (CBT) and its variants are often used, not every patient is a good candidate for CBT. Other forms of psychotherapy, including interpersonal and psychodynamic approaches are also frequently used to effectively mitigate psychiatric symptoms.
• Neuromodulation devices are used to treat depression, anxiety disorders such as GAD, OCD and PTSD, as well as, insomnia and panic attacks.
• Psychopharmacological interventions are also used to treat a variety of mood and behavioral disorders,

Learn more about Psychiatric Assessments and Mental Health Treatments. You may also download a copy of our brochure.

Speech and Language Therapy

Speech and language therapy focuses on improving speech and the patient’s ability to understand and express language. NCBI has speech therapists who can help assess speech delays, restore speech and language skills from young children to adults. Often this form of therapy is administered in conjunction with NM which significantly enhances the treatment outcome.

Learn more about Speech and Language Therapy. You may also download a copy of our brochure.

Other services available:

We are confident we can provide the results patients are needing and improve each patient’s overall cognitive, emotional and behavioral level of functioning. We have three locations in New Jersey staffed with caring experts ready to help.

Additional Services:

We also offer the following consulting/specialty services:

• Brilliance on Demand: Cognitive and Performance Enhancement
• Functional Brain Mapping
• Clinical Research
• Medicolegal Consultations
• Program Development and Unit Design Consultations

Contact Us

If you or know anyone who needs help, contact The NeuroCognitive & Behavioral Institute for assessment and treatment. Call (973) 601 0100 or sign up as a new patient and we will get back to you as soon as we can.