1. UNIVERSITY OF JYVÄSKYLÄ Training Staff Members to Apply Acceptance and Commitment Therapy for Persons Using Sign Language ACBS World Conference IX, July 13-15, Parma, Italy Leena Hassinen, Raimo Lappalainen, Department of Psychology, University of Jyväskylä, Finland Eeva-Marja Loukola The Service Foundation for the Deaf, Helsinki, Finland

2. UNIVERSITY OF JYVÄSKYLÄ Introduction In Finland there are approximately 4000 - 5000 people who are deaf and use sign language as their mother tongue. About 250 of these persons attend the housing and sheltered work services of the Service Foundation for the Deaf.

3. UNIVERSITY OF JYVÄSKYLÄ Introduction There is some data (Lindfors, 2005) suggesting that deaf persons have slightly increased number of psychological symptoms as compared to Finnish population in general: 25% vs. 19%. The most common psychological symptoms among the deaf population were loneliness, depression and anxiety symptoms. Deaf persons reported that they needed help for discussing problems with relationships, work-related and other psychological difficulties.

4. UNIVERSITY OF JYVÄSKYLÄ The aim The aim of the study was to develop an intervention model to increase wellbeing of deaf or deaf-blind clients. As there is a lack of psychotherapists who can use sign language we wanted to investigate if training of counsellors using sign language can have positive impact to deaf clients’ wellbeing.

5. UNIVERSITY OF JYVÄSKYLÄ Method: Procedure The study was conducted in the service centre Sampola, which is owned by the Service Foundation for the Deaf. It provides supported housing services and workshops, and other work activities in sign language for deaf and deadblind persons. There are 19 staff members and 43 clients of which 35 live in Sampola.

6. UNIVERSITY OF JYVÄSKYLÄ Method: Subjects There were 14 clients who attended the trial. All were deaf sign language users. Their mean age was 44.3 years (22-60). All except one were working in the Service centre Sampola (94%), 9 (64%) were living there. There was an equal amount of men and women. Ten (71%) of the subjects were single. Seven (50%) clients had psychiatric diagnoses and medication, only 4 (29%) were receiving treatment. 9 staff members attended the trial.

7. UNIVERSITY OF JYVÄSKYLÄ Method: Intervention 1. Two day workshop for staff members: case formulation and ACT. 2. Supervision every other week. 3. Study groups: The staff members studied the theory and the methods of ACT and had group discussions five times during the intervention period. The staff members met one client 8 -10 times during a 10-12 week period. On session/week.

8. UNIVERSITY OF JYVÄSKYLÄ Method: Intervention The staff members were instructed to draw a case formulation of the clients´ situation and then formulate a value analysis based on ACT principles with the client. According to the clients needs the intervention included experiential exercises and metaphors of ACT. All intervention was done in sign language. Following exercises were translated into the Finnish sign language: the Observer exercise, The Putting Emotions In Front of You Exercise. 7 metaphors were translated: The Quicksand, The Man in the Hole, The Tug-of-War with a Monster, the Jelly Donuts, Hungry Tiger, The House, The Bird House.

9. UNIVERSITY OF JYVÄSKYLÄ Method: Measurements The clients´ situation was assessed by The Symptom Checklist 90 (SCL-90), Beck Depression Inventory (BDI) and AAQ 2 before, during and after the trial. These measurements were translated into sign language before the trial. The time between Pre- and Post-measurements was 3 months. The follow –up was done six months after the intervention ended.

10. UNIVERSITY OF JYVÄSKYLÄ Results: Pre- Post and Follow-up groups results (n =14)

11. UNIVERSITY OF JYVÄSKYLÄ Results: Figure on changes in SCL GSI (n =14) Decrease of symptoms 10 of 14 subjects reported decrease of psychological symptoms

12. UNIVERSITY OF JYVÄSKYLÄ Results: Figure on changes in BDI (n = 14) Decrease of depression symptoms 8 of 14 subjects reported decrease of depression symptoms

13. UNIVERSITY OF JYVÄSKYLÄ Results: Figure on changes in ACT-2 (n = 14) Increase of flexibility 10 of 14 subjects reported change/increase of psychological flexibility

14. UNIVERSITY OF JYVÄSKYLÄ Conclusions It is possible to train counselors working with deaf persons to apply ACT. It is possible to use ACT with sign language. But the treatment process takes more time. Short ACT intervention delivered by the counselors seems to have some positive effects to psychological and depression symptoms of deaf persons, and the intervention has some positive effects on the psychological flexibility among the majority of the deaf persons. This is an example that in some cases the only way to influence the quality of life of the minorities is to train staff members to use psychological methods

15. UNIVERSITY OF JYVÄSKYLÄ Discussion The ACT sign –intervention was well accepted both by the clients and by the counselors. There were reports indicating that there were positive changes at the Sampola community during and after the intervention. The measures were translated into Finnish Sign Language and they were used for the first time in this study. Thus, there is a possibility of misunderstanding of the measurements. We must be careful when we draw conclusions on the basis of the data. The model of training staff members to use ACT seems to be workable. leena.hassinen@pp.inet.fi