“People tell us how bad it is to be married as a child, or to be treated the way we were treated. But we can’t change our past, what has already happened to us. Mental health has helped us think about today and tomorrow, and live life in a new way.” – Syedah
I heard about Syedah, a community leader among Rohingya women in Malaysia, before I had the chance to meet her. Our partners had been engaging with her community for some time, and when the opportunity opened up to co-create a mental health program, Syedah stepped up. She saw the need and potential benefits immediately.
It’s no secret that the Rohingya population is one of the most economically and politically vulnerable on the planet. For years, they have been victims of violent assault, murder, rape, and terror in their homeland, Myanmar, at the hands of the military and the police. Hundreds of NGOs and multilaterals have worked to assist the Rohingya exodus across Southeast Asia and beyond— providing critical support for survival.
But what became apparent as we worked with Syedah was that the Rohingya women in her community wanted more than just services, trainings, and provisions. They wanted to build their own lives— even as their traumatic past cast a long shadow, and the future offered no certainty. They wanted new ways to hold the pain and hardship they faced everyday, to be less controlled by it. They wanted to exercise their dignity and agency, even before it was fully acknowledged or respected by others.
Together with Syedah, her family, and her companions, we worked to design a program that would offer them some of that possibility. We co-created a program to help them build psychological flexibility.
What is psychological flexibility?
At Brio, all of our programs are centered on building psychological flexibility— a well-researched concept in behavioral science referring to the ability to respond to our external environment and internal experiences in a way that is open, curious, and kind.
“Psychological flexibility is the ability to feel and think with openness, to attend voluntarily to your experience of the present moment, and to move your life in directions that are important to you, building habits that allow you to live life in accordance with your values and aspirations.” – Steven Hayes, founder of ACT
Psychological flexibility is the primary goal of Acceptance and Commitment Training (or ACT, pronounced “act”), the therapeutic intervention used by mental health professionals to support and treat a wide range of mental health conditions. Among the major therapeutic interventions that exist, ACT has some of the most rigorous supporting evidence, especially for treating otherwise intractable conditions such as schizophrenia and psychosis.
But why does flexibility matter?
Through millennia of evolution, human beings have developed ways to adapt to their environment— including building heuristics to understand our world and falling into patterns of behavior. As these modes of thinking calcify, they become more like assumptions and rules that we stop questioning, creating a kind of internal psychological rigidity.
Even if rigidity helps us to conserve energy and find a sense of coherence in an unpredictable world, it is an unfortunate predictor of mental health challenges. Rigidity can play a role in almost every psychological or behavioral problem— and more broadly, prevent people from living lives that feel worthwhile.
On the other hand, psychological flexibility helps not only those with mental health conditions, but everyone to experience greater freedom and agency to live meaningfully. The skills taught in ACT not only effectively reduce the severity of many mental health conditions, but they also protect against the onset of mental health conditions. As a strategy for mental illness prevention and positive mental health promotion, there is hardly a better candidate.
Furthermore, psychological flexibility can be cultivated across numerous contexts using very few resources. While ACT itself has been proven across more than 1000 studies with a wide range of populations, the skills within ACT can be learned by anyone. There is no required equipment, pharmaceuticals, or years of education required.
Given the strength of the evidence and the accessibility of its underlying ideas, psychological flexibility might be the most effective way to promote mental health at the community and population level.
What happens when a community becomes more psychologically flexible?
If the evidence for psychological flexibility in promoting mental health and wellbeing is overwhelmingly strong at the individual level, we can safely assume that it is useful for groups of individuals. But we suspect that it is even more powerful than simply helping groups of people with their mental health. Given the particular mental skills within ACT, a community that is psychologically flexible can experience the compounding benefits of learning and practicing these skills together.
We want to see not just healing but flourishing in partner communities: a shared experience of vitality that inspires individual and collective action. When a whole community becomes more psychologically flexible — whether that community is a group of families, a cohort of teachers, or network of refugee women, or a youth within a neighborhood— the skills they develop do so much more than support their personal wellbeing. These skills give them the power to make a real change that ripples far beyond themselves.
ACT skills are community leadership skills
Consider the ACT skill of present moment awareness. This practice of learning to pay attention to bodily sensations as well as thoughts and feelings, begins to shift one’s relationship with internal experiences. But it also builds an ability to become mutually aware— to notice what is happening in the experiences of another person, or in a group dynamic. This kind of awareness feeds into deep listening and other critical leadership practices.
More examples of community-empowering skills from ACT include perspective-taking from the skill, self-as-context. Disconnecting our passing thoughts and feelings from our sense of identity frees us to access a part of ourselves that can hold multiple perspectives at once. Perspective taking is key to engaging empathetically across differences. It also helps individuals and communities recognize that they are much bigger than the sum of their experiences.
The emphasis on values and committed action in the ACT framework increase the diversity of values represented in a group, and the action that group can take toward meaningful collective change. As communities become clear on the kind of shifts they want to see in their own environments, they can work together toward reimagining and rebuilding systems to reflect those aspirations.
The exciting possibility of using psychological flexibility as a means of promoting mental health is that it can truly unlock the power and potential of mental health. While mental health can be an end in itself, it is also a means to greater impact, change, and agency— led by the community, for the community. In fact, the Prosocial Framework developed by Nobel Laureate Eleanor Ostrom uses the ACT principles as a guiding tool for groups to develop their sense of values and strategize how to move toward them.
Building psychological flexibility together: experiential learning
How do we actually cultivate these skills together? While it’s true that traditional modes of learning such as reading or didactic training can help individuals build psychological flexibility, experiential learning is much more effective— and fun.
Experiential learning allows people to actively practice the mental processes that the ACT skills comprise, and discuss what they’re noticing within themselves. As each individual develops their own practice and perspectives on these skills, participants can benefit from the collective wisdom of the group’s lived experiences.
Usually, we start with “grounding practices” that build physical and mental stability in the moment. These are common across many ancient traditions, including breathing exercises, engaging the five senses, and connecting our awareness with our physical bodies and the physical environment around us. With these tools, groups are able to practice stabilizing themselves in the midst of difficult conversations and circumstances— within the time spent together and beyond it.
Then, we use illustrative stories and metaphors centered on the participants’ environment and experiences to help them understand the concepts of psychological flexibility. Stories may follow a single character through a journey, or use each person’s imagination to visualize a shared experience or circumstance. The story may be as simple as finding shelter under a tree during a storm, or looking up at the stars, or driving a bus full of passengers. The stories come alive as participants see themselves within them.
While some participants prefer the verbal storytelling format— as it is a common practice in many communities— others deepen their understanding through creative art and movement. Together with our partners, we have used drawing, painting, crafts, music, dance, walking, gardening, and other body movements to help participants feel within themselves what these concepts are like.
What people remember from these activities can be internalized within their own experience. And with repetition and reinforcement, they are able to access these new skills when they are faced with a challenging circumstance in everyday life. Furthermore, the shared experiences are reinforced through frequent interactions with others in the community, who are also learning these skills. We have heard countless times of the ways community members remember the stories and activities in casual conversations, wich serve as reminders of the skills they are building for their own wellbeing.
Does it work? Psychological flexibility in stories and numbers
We can directly measure psychological flexibility, but we can also use scales that are more common such as the WHO-5 Wellbeing Index. Psychological flexibility skills comprise the lion’s share of overall psychological health. If people are effectively building psychological flexibility, prior research tells us that the other benefits are likely.
There’s even more good news. Unlike certain treatment modalities, imperfect implementation is tolerable with ACT, to a degree— which means more room for local adaptation and broader implementation without the need for rigid monitoring to ensure 100% fidelity. This is because ACT is a process-based intervention, rather than a mechanical one.
Psychological flexibility is an ongoing journey of evolution and change, starting with the six skills as pivots— the deeper the engagement, the more effective the pivot in the long-term. Results in the research have been shown to last for months if not years, according to the research, even when an intervention is relatively short (with the caveat that it was implemented well).
The improvements show up on scales.
In India, we co-created a wellbeing skills program for government-school teachers with our partners at Kshamtalaya. The program includes 21 days of short audio stories, with weekly facilitation in a small cohort. The objective of the program is to strengthen psychological flexibility, compassion skills, and a sense of social connectedness.
Since 2020, more than 125,000 teachers across various states in India have completed this program, and we have gathered the data of many participants. In a pre/post evaluation, we found statistically significant improvements of medium effect size as defined by the following validated scales:
- 69% improved in wellbeing on the WHO-5 Wellbeing Index
- 59% improved in mindfulness on the Kentucky Inventory of Mindfulness Skills
- 38% improved in resilience on the Connor-Davidson Resilience Scale
In another implementation round, we measured participants’ movement directly on the AAQ-II scale, and found significant improvement in that as well. Meanwhile, educators shared their positive experiences in their own words, giving color and vibrancy to these numbers.
“I felt a positive shift in energy levels and my overall outlook on life. The guided meditations helped me relax, let go of negative thoughts, and cultivate a more positive mindset. I felt more energized, focused, and inspired to tackle the challenges of my day. I credit the 21 Days Hausla program with helping me find more peace, happiness, and success in my life.”
“I had been feeling down and unmotivated for a long time, and was struggling to find ways to lift my spirits. Hausla perhaps came at a time when I needed it the most, it helped boost my confidence and improve my mental health.”
Young people describe their new sense of internal agency
Across continents and cultures, many children and young people feel they have very little control over the circumstances of their lives. Many find that their realities are shaped by forces around them: family members, systems, cultures, media, and generations past.
But young people also yearn for a sense of agency even in the midst of these realities. We have worked with our partners to contextualize psychological flexibility so that young people can take advantage of these skills as they navigate a turbulent time in their lives.
As we design and refine programs before they go to scale, we are keen to hear young participants validating the transformative power of building psychological flexibility. Here’s what they have to say:
“I’ve shifted the tone around my internal conversation about how I was feeling about things. Stories and creativity helped me think inquisitively about what I was feeling. Letting go of some of the judgment.” – young adult leader, USA
“I did not think that I have choices but I do. I choose to be a brave girl.” – young adolescent, India
“I have learned so much about myself, and that the stories we hold can heal us.” – young adolescent, Ecuador
The alignment of what they have shared to the principles of psychological flexibility are clear: there are so many external realities that are not immediately controllable, but what we can change is the way we relate to them.
In the face of poverty, violence, and ongoing systemic injustice, young people are cultivating the internal skills that help them expand the range of circumstances in which they are free to choose what they do next.
Psychologically flexible communities have the power to change their world.
The scientific literature bears strong evidence for the power of psychological flexibility, but the most important outcome is not simply to prove that our theory of change holds water. It is to witness the power and possibilities that participants discover as they build these skills together.
When Syedah’s community of women began to build and practice psychological flexibility, they made shifts as a group, and in their own lives. Some women shared that they changed their tone of voice with their children. Some signed up to learn English so that they could better navigate their life in the city. Others began to help their neighbors with simple tasks throughout the week. Still others committed to advocate for change with local NGO programs that were serving them.
When communities become more psychologically flexible— when they become more open and curious toward their own experiences— they begin to recognize the range of choices that are possible today. And as they begin to move toward their chosen direction, they help the world become all that they imagine it can be.
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References:
- For a comprehensive overview on the evidence and uses of ACT, see A Liberated Mind by Steven C. Hayes
- For a recent meta-analysis on ACT, see here.
- For more information about mental health promotion research and implementation, especially at community and population levels, see Implementing Mental Health Promotion by Margaret M. Barry, et. al.
- For how Prosocial theory was developed, visit the Prosocial website.