The psychological burdens of climate change

These facts are extremely alarming and likely to elicit painful cognitive and emotional reactions. For example, a reader might think ‘a CBT practitioner can’t make any difference’ and feel powerless. BABCP recognises that ‘we can and must take action on climate change … it is within our professional remit to apply our skills and knowledge to what is clearly an existential threat to humanity’ (British Association of Behavioural and Cognitive Psychotherapies, 2024). Indeed, CBT practitioners are well placed understand and respond to the psychological mechanisms associated with climate change, including those which are driving the problem. However, the individual may feel too overwhelmed to begin.

Feeling overwhelmed by climate change and distressing eco-emotions is increasingly common and has been associated with impaired mental health and functioning, which has been described as eco-anxiety or eco-distress (Hickman et al., Reference Hickman, Marks, Pihkala, Clayton, Lewandowski, Mayall and Van Susteren2021; Ogunbode et al., Reference Ogunbode, Pallesen, Böhm, Doran, Bhullar, Aquino and Lomas2021; Whitmarsh et al., Reference Whitmarsh, Player, Jiongco, James, Williams, Marks and Kennedy-Williams2022). Therapists working with eco-distress need to recognise that it is a non-pathological, understandable response to our reality (Marks and Hickman, Reference Marks and Hickman2023). To do so effectively, they may first need to spend some time reflecting upon their own cognitive and emotional responses to the crisis. Wilsher and Freeston (Reference Wilsher and Freeston2024) explore this in their unique paper about the lived experience of a CBT therapist who is deeply concerned about climate change. Wilsher offers courageous and honest reflections about her personal journey with eco-distress, supported by Freeston’s explanations linking these to the evidence base. Together they teach us how therapists can use self-reflection, supervision, personal and community support to navigate their own eco-emotions, improving their capacity to validate and work with eco-distress in patients.

Finding new perspectives and understanding environmental identity

CBT therapists are particularly skilled in uncovering the stories we tell about ourselves, other people, and the world. These are key to understanding climate change. A story dominant in Western cultures combines the idea that carbon-heavy, consumerist lifestyles are required to ensure physical, emotional and relational security with the idea that individual behaviour cannot mitigate climate change. Multiple media messaging reinforces this story so profoundly there is rarely time to pause and consider alternative perspectives. Yet finding alternative perspectives (bread and butter to a CBT practitioner) may be the only way we can transition away from fossil fuels. Remembering the deep interdependence between humans and nature can move us from isolated, individualised perspectives to one where small actions matter, because the self and others are not separate.

This perspective reminds us that (once basic needs are met), fulfilment and meaning in life comes from protecting and connecting with human, animal and plant communities, indicating the reciprocity inherent in pro-social and pro-environmental behaviours. Such perspective-taking has a dual benefit; it motivates the actions the world needs and changes how we relate to our distress about planetary challenges. In other words, there is a synergistic relationship between how we see, feel and act that can incrementally reduce the overwhelm which commonly accompanies climate change and ecological degradation.

Thomas Doherty and colleagues (Reference Doherty, Artman, Homan, Keluskar and White2024) develop these ideas in their paper, describing specific skills you can learn to help clients understand their responses to the climate and ecological crises and find new perspectives. This involves including a client’s relationship with the natural world in formulation and therapy. Offering a mixture of theory and case-study, their paper depicts the relevance of environmental identity, and illustrates nature-based therapeutic skills that can be integrated into third wave approaches such as ACT and DBT.

Nature connection and mental health

Environmental identity is just one aspect of human-nature relationships. Robust evidence demonstrates multiple physiological and psychological benefits of nature-connection (e.g. Coventry et al., Reference Coventry, Brown, Pervin, Brabyn, Pateman, Breedvelt and White2021; Jimenez et al., Reference Jimenez, DeVille, Elliott, Schiff, Wilt, Hart and James2021; White et al., Reference White, Alcock, Grellier, Wheeler, Hartig, Warber and Fleming2019). Reciprocal benefits are increasingly found too, for example people who are more connected to nature are both healthier and more likely to act pro-environmentally (Barragan-Jason et al., Reference Barragan-Jason, Loreau, de Mazancourt, Singer and Parmesan2023). Such knowledge is ancient and implicit; many old-world cultures and spiritual traditions revere the natural world (Armstrong, Reference Armstrong2022), and we can tap into this directly simply by paying attention to how we feel when we are in nature. Eco-therapies are not the focus of this review, and are yet to influence mainstream CBT, but evidence supports their effectiveness, with one review showing equivalence to CBT for depression (Rueff and Reese, Reference Rueff and Reese2023). Third wave CBT approaches are a natural fit for wider experiential practices for connecting with nature. Practices such as mindfulness, viewed with scepticism decades ago, are now placed firmly within an orthodox evidence base. Other traditional practices rooted in our evolutionary relationship with the natural world could similarly inform the vanguard of CBT.

Rosie Jones and Chris Johnstone (Jones and Johnstone, Reference Jones and Johnstone2024) offer fascinating insight into an existing methodology known as Active Hope (Macy and Johnstone, Reference Macy and Johnstone2022). Influenced by systems thinking, ecology, spiritual and wisdom traditions, Active Hope has much to offer modern therapy. The authors describe this approach and align its techniques, processes and proposed mechanisms with CBT. The skills presented here should inspire confidence in practitioners wishing to bring nature into their therapy so that it remains consistent with CBT, and to find new ways to work with eco-distress. The papers of both Jones and Johnstone (Reference Jones and Johnstone2024) and Doherty et al. (Reference Doherty, Artman, Homan, Keluskar and White2024) delineate how eco-distress and nature-connectedness go hand-in-hand, and what CBT needs to learn about the profound relationships between human and planetary health. They also suggest why it has taken our profession until now to see the relevance of climate change to mental health.

Running through this special issue is the importance of reciprocal relationships between human and planet. CBT places individual wellbeing as central, and interpersonal practice focuses on working with a client’s current patterns and system. Wider environmental aspects may be considered (e.g. in Padesky’s Five Area model), but ecological issues are not specified. A time of radical planetary change demands that we clearly see the inescapable context of contemporary human experience, where person and environment are not separate. CBT already recognises the contribution of environment to experience, but it can develop this further. It could explicitly encourage consideration of ecological factors when understanding distress, and explore how such factors shape our relationships with self and other, potentially benefiting both the individual and the world around them.

The pain of increasing awareness

As people come to terms with our environmental reality, recognition about its effects on mental health is growing. It is becoming increasingly difficult to ignore, with obvious signs such as blistering summer heatwaves, or more subtle seasonal changes such as earlier springs (Büntgen et al., Reference Büntgen, Piermattei, Krusic, Esper, Sparks and Crivellaro2022). Distal to the UK, there are increasingly frequent extreme weather events, such as 33 million people in Pakistan losing their homes from floods, and unprecedented wildfires ravaging Greece, France, Portugal, Canada, USA and Australia. Climate change is not a future ‘risk’ but a current certainty, and perceived threat exists within inescapable auguries of fundamental planetary change.

Such psychological reckoning is painful, and by catching one fraying thread of the global system into which we are interweaved, we see how the whole cloth is at risk of unravelling. Sometimes even a glimpse of this reality feels too much, and so it is pushed out of awareness. Such awareness may be particularly painful for people whose core values include caring for other beings (Bouman et al., Reference Bouman, Verschoor, Albers, Böhm, Fisher, Poortinga and Steg2020). One way to avoid personal suffering is to turn away, and people who report being less informed about climate change are both less distressed, and less likely to act pro-environmentally (Whitmarsh et al., Reference Whitmarsh, Player, Jiongco, James, Williams, Marks and Kennedy-Williams2022). This points towards the complexity of understanding the factors at play in eco-distress. Some regard eco-distress as simply another expression of mental ill health, whilst others argue strongly against pathologising an experience that drives positive action in the world (Marks and Hickman, Reference Marks and Hickman2023). Either way, it is a stressor likely to exacerbate existing mental health problems.

In their empirical paper, Freeston and colleagues (Reference Freeston, Sermin-Reed, Whittaker, Worbey and Jopling2024) use network analysis to investigate transdiagnostic factors contributing to eco-distress. They focus upon intolerance of uncertainty, a known factor contributing to general anxiety and distress, and they report an unusual finding. Contrary to most research into anxiety, uncertainty about climate change is not a factor in distress. The authors discuss how uncertainty about climate change may actually help to reduce pain by avoiding the reality, showing the importance of empirical research in developing our understanding of those mechanisms which may be relevant to eco-distress. Perhaps some people find psychological safety in the uncertainty, rather than accepting the more the intolerable certainty of human-caused climate change and its consequences.