A few years ago, Lorraine was working as a psychologist in a mental health, in-patient hospital in London, and also a member of the ProSocial World Health Circle. The facility that Lorranie worked for was in the midst of an incredibly turbulent time, needing to drastically improve its service while it integrated a significant number of new staff. As a leader at the facility, Lorraine was struggling to bring her team together and work as a cohesive unit.
“We needed to find a shared language because [the staff] all had really, really different backgrounds. All were medical professionals, but from really different contextual backgrounds. One worked in a prison, another in rehab services, and so on. We really needed to find a common language.”
Lorraine and her team knew Acceptance and Commitment Therapy (ACT) as a therapeutic approach used with patients, but an Acceptance and Commitment Training, or ACTraining which is different from therapy, showed them how it could be used as a solution to their work-related challenges.1
Very simply, ACTraining allowed staff to identify their personal values and ways they could bring them to life in their work, a practice that research has shown increases productivity, reduces errors, accelerates leadership skills, helps professionals acquire new skills, and improves [patient] engagement.2
“It became about how you work with people and what is important to them, not what you do to people,” Lorraine said.
At the heart of ACT and ACTraining is a concept called psychological flexibility, which is the ability to stay true to one’s values and pursue one’s goals, even in the face of inevitable difficulties. While psychological flexibility is a relatively simple concept in theory, it is difficult for many people to put into practice. It requires one to be aware of their thoughts and feelings, accepting of more challenging ones, and able to flex and adapt their actions while staying aligned with their core values and beliefs. Given the demands and pressures many professionals today face it’s a tall order for even the most emotionally intelligent individual.
Lorraine’s ACTraining was so impactful on her team, she began to look for other professionals who were, like her, interested in building psychological flexibility and advancing a values-based approach in systems of health. She found the ProSocial World Health Circle.
ProSocial World & Psychological Flexibility
To be prosocial means to act in a way that benefits others or society at large (one might think of it as the opposite of antisocial). Prosocial behaviors center empathy and care. Sharing, giving, comforting, or helping behaviors are all examples of prosocial behaviors as they all involve serving someone(s) beyond oneself. Prosocial behaviors require one to see perspectives beyond their own and to advance goals–theirs and others’–that are in alignment with their core values and beliefs. These sorts of behaviors are enhanced by the development of psychological flexibility.
ProSocial World was formed in 2012 with the vision of advancing prosocial behaviors in systems around the world. The organization's approach–the ProSocial method–focuses on helping groups of individuals effect systems-level change. The Prosocial method not only cultivates psychological flexibility, but also advances eight Core Design Principles (CDPs) which govern collective action and are based on the work of Nobel Laureate Dr. Elinor Ostrom. (See Figure 3). Prosocial’s work is done, in part, through a number of communities of practice, including one focused on health.
ProSocial’s Health Circle (HC), with members spanning the United Kingdom, United States, Canada, and Australia, strives to put prosocial methods into practice in health systems. Its membership includes individuals from varying health care and system settings: providers to administrators; small, private facilities to large health systems. Together, the group explores prosocial concepts, puts them into action in their organizations, and shares learnings and challenges as they do so.
The Intersection of Prosocial Behaviors and ACTraining
In order to spread and scale prosocial behaviors, psychological flexibility is essential. Individuals need to partner with others, which requires they agree upon a set of shared group values and goals. This may mean, at times, they may need to ‘unhook’ from their own, often rigid, aims and beliefs.
In 2021, two mental health care professionals, Gretchen Kelly and Stuart Libman, came to the HC after having significant success increasing the psychological flexibility of staff in their workplace, PLEA Agency, through ACTraining. As Kelly and Libman engaged with the HC they began to wonder if their experience with ACTraining–which increased work satisfaction, well-being, and cooperation in their organization–might do the same for individuals and groups in other organizations. Given the importance of psychological flexibility to prosocial groups, this observation prompted two important questions:
- What, if anything, about ACTraining might enable individuals to become more psychologically flexible and better grasp and deploy the CDPs?
- Is ACTraining an effective entry point for individuals interested in prosocial methods and in forming and sustaining prosocial groups?
This led to Kelly and Libman sharing their professional experiences–particularly their experiences with ACT and ACTraining–with the HC.
PLEA’s Experience with ACT and Psychological Flexibility
PLEA Agency is a nonprofit mental health and education provider based in Pittsburgh, Pennsylvania, in the United States. It provides adult mental health, school-based partial hospital, respite care, and educational services.
PLEA began using ACT in the early 2000s, initially as a framework to use in serving clients and case formulations. However, as the agency’s offerings expanded, so too did the demands being placed on PLEA’s staff. The stress of dealing with clients who often presented with severely challenging behaviors began to increase.
ACT is designed to help individuals manage situations such as these. In its very simplest form, the idea behind ACT is that stressful events happen in everyone’s lives. As these stressful events happen, thoughts and feelings arise which can be difficult to manage; if not dealt with, those feelings can increase the intensity of the frustration or crisis one is experiencing. ACT, as a therapeutic method in clinical settings and a training method in organizational contexts, helps individuals notice their thoughts and emotions, process them, and find ways to act that align with their intentions, thus building their psychological flexibility.
For example, imagine a staff member experiencing a challenging client. If the staff member tries to address the challenging behavior without success they may say to themselves, “I’m not a very good professional.” Without a way of processing that sort of thinking, the staff member may not try another approach, believing they aren’t skilled enough to manage the situation.
ACT would have the staffer simply notice the thought (“I’m not a very good professional”), and– rather than attaching to that thought and potentially acting on it (by not trying another approach)–help the staffer, instead, re-ground themselves in their personal values, such as “I strive to provide care that meets my client’s unique needs.”
In an effort to mitigate the increasing stress and strain on staff, PLEA began training staff in the ACT framework. The results were impressive: greater retention, higher rates of staff satisfaction, and better patient outcomes as staff were better equipped to manage difficult situations they encountered, psychologically flex their thoughts and behaviors, and act in ways that met their and their client’s needs.
As the use of ACT expanded, PLEA began using a graphic, known as the ACT Matrix (see Figure 2), to explain key concepts and integrate it more deeply into PLEA’s day-to-day operations. For example, team meeting notes were captured on the ACT matrix.
PLEA also began to share the ACT matrix with other mental health providers through their work at the ACT Institute, PLEA’s consulting service. While they had much success with ACT on an individual level, scaling the framework with larger organizations proved challenging. Many larger entities appreciated that ACT helped them foster psychological flexibility, but they wanted to build and manage shared goals across teams and organizations. ACT’s focus on an individual made the framework less useful at broader, systemic levels.
ProSocial and the Core Design Principles (CDPs)
ProSocial World emerged in 2012, with a mission to help individuals come together to successfully catalyze systems-level change. ProSocial’s approach centers on the eight CDPs, which require mindfulness, the ability to take another’s perspective, and an openness to meeting one’s goals in new ways–in short, they require psychological flexibility. Unlike ACT, however, ProSocial concentrates on fostering collective efforts; helping individuals to broaden their perspective and build shared values and a shared vision across a group.
Prosocial strives to both cultivate psychological flexibility and integrate it into an institution’s cultural fabric, with demonstrated success. In two recent experiences, involving an Australian Government Agency and an Australian Government Division, measures of employee engagement, communication, innovation, leadership, and performance showed extraordinary levels of change up to eight years after the initial Prosocial intervention. (More detailed case studies on these experiences can be found here.)
In light of PLEA’s challenges in scaling ACT with teams and organizations, ProSocial’s CDPs were of interest. ACT offered a proven process (noticing and acknowledging one’s thoughts, yet acting in line with one’s values), successful primarily at an individual level; ProSocial offered proven principles, successful at a broader, systems-level. Leaders from the two organizations began to wonder: could we integrate ACT’s core processes and ProSocial’s core principles in a way that could enable values-driven change at a larger-scale?
The initial integration of the ACT and ProSocial elements proved difficult, but over a 4-year period the two organizations created and tested what they referred to as a “CDP Matrix” which brought the two together by overlaying ProSocial’s eight CDPs on the ACT matrix, as shown in Figure 4.
The CDP Matrix served two key purposes:
- to help individuals identify and align around their personal values and goals and
- to engage in dialogue, see the perspectives of others, build shared values and vision across a group, and lean into new ways of advancing (1).
Results
One of PLEA’s first applications of the CDP Matrix was during the COVID-19 pandemic. As with many organizations, particularly health care organizations, there were many decisions, clinical challenges, and intense emotions to navigate.
“The CDP Matrix allowed PLEA, as an organization, to make a lot of decisions, quickly, collaboratively and with confidence.” said PLEA’s medical director, Stuart Libman.
With the help of a series of grants from the Staunton Farm Foundation, PLEA trained staff in how the agency was going to use CDP Matrix in-house going forward and how they could use it with the families they served. And they began sharing it through the ACT Institute, training others in how to apply it within their teams and organizations.
“If you can, think about the [CDP] matrix as a camera with an interchangeable lens. We can zoom in on a treatment plan for a client, zoom out for a classroom or team, zoom out more to the organizational level, and zoom out further to see a broader, systemic context,” Libman said.3
“The CDP Matrix enabled us to integrate PLEA’s value system with something larger that helped us interact with funders, other providers, governmental agencies–it helped us move in a values-based way with our partners,” Libman said.
PLEA’s results have been impressive. Centering the CDP Matrix in their work has resulted in:
- A significant funding increase from one of their partners;
- A lower turnover rate than peer agencies;
- A low rate of medication use (in conjunction with intensive therapeutic service delivery);
- An improvement in PLEA staff’s ability to view children with challenging behavior as individuals, not grouping or labeling them in negative ways;
- Better staff management of increasing demands; and
- Leadership being better able to engage and manage in a values-aligned way.
Recent Experience
Building on the success of the past years, PLEA has worked to find new ways to bring the psychological flexibility, ACTraining, and the CDP Matrix to life. Their recent efforts have focused on simplifying the concepts and helping staff to incorporate it into their daily work.
In 2024, they began using the Mindful Action Plan (MAP), a checklist designed by researchers Daniel Moran and Siri Ming, that allows individuals a simple way to access and apply ACT principles by prompting them to notice their thoughts and emotions, and identify actions they can take in the near-term that align with their values. In addition, they’ve trained staff in mindfulness and meditation and have helped staff to link those strategies with daily activities (i.e., meditating while brushing teeth, etc.)
Conclusion
ProSocial World is focused on enhancing psychological flexibility in concert with the implementation of the eight CDPs in an effort to cultivate prosocial cultural and normative contexts, including in the healthcare sector. The importance and potential impact of this approach raised two critical questions:
- What, if anything, about ACTraining might enable individuals to become more psychologically flexible and better grasp and deploy the CDPs?
- Is ACTraining an ideal entry point for individuals interested in prosocial methods and in forming and sustaining prosocial groups?
Libman and Kelly believe their experience with ACTraining and psychological flexibility provided them with a strong foundation to engage with prosocial behaviors within their professional context. Their sense is that, given their robust experience with ACT and ACTraining, they were well-equipped to understand their own values and goals and to hold them lightly so they could dialogue with others and be open to new, collective ways of achieving them. Without that foundation, they believe some will engage with others rigidly attached to their point of view and ideals: unable to see challenges from new perspectives and unwilling to compromise. That sort of narrow approach will doom any prosocial or collective effort, and indeed, systems-level change.
For those interested in advancing prosocial methods, at minimum, a willingness to practice the “inner work” of “outer change” is required. ACT and ACTraining provide one with the opportunity to practice that. While not the only entry point to prosocial behaviors, it is one that is proven–not only through the experience of PLEA leadership, but also extensive research–to build the sort of psychological flexibility needed to achieve the prosocial evolution of organizational culture.
Notes:
1. The term “ACTraining” comes from researcher Daniel Moran.
2. Moran,D. J., & Ming, S. (2020). The Mindful Action Plan: Using the MAP to apply Acceptance and Commitment therapy to Productivity and Self-Compassion for behavior analysts. Behavior Analysis in Practice, 15(1), 330–338. https://doi.org/10.1007/s40617-020-00441-y
3. Harte, C. (2021, August 17). ACT and RFT as Prosocial OBM in an ABA School Based Partial HospitalProgram. https://science.abainternational.org/2021/08/17/act-and-rft-as-prosocial-obm-in-an-aba-school-based-partial-hospital-program/
Further References:
Atkins, W.B., Wilson, D.S., & Hayes, S.C. (2019). Prosocial: Using Evolutionary Science to Build Productive, Equitable and Collaborative Groups. Oakland: Context Press.
Polk, K.L.& Schoendorff, B. (2014). The ACT Matrix: A New Approach to Building Psychological Flexibility across Settings and Populations. Oakland, CA: Context Press.
