‘Of all the dangers we face, from climate chaos to nuclear warfare, none is so great as the deadening of our response’ (Macy, Reference Macy2007; p. 92)
We are alive at a time of great opportunity, in a world that is burning for transformation. In February 2024, BABCP declared a climate emergency, recognising that planetary health is inextricably linked to human health and wellbeing. As part of a professional collective body, members of BABCP can decide how to be part of a better future. However, before we can determine an appropriate response, we must turn towards the reality of the crises we face today. This special issue orients the reader to the implications planetary crises have for mental health and how we can respond. It explores how developing transdiagnostic approaches can empower people to turn towards the truth and distress of climate change, to find meaning and connection, and support a just transition to a safer world.
Many readers will be familiar with current global ecological challenges, but as others may be less well acquainted with the underpinning science of planetary health, a summary is given first. We then discuss how the CBT community can respond. Being a therapist in a time of climate and ecological breakdown poses unique challenges, and we must adapt our tools accordingly. Some other therapeutic modalities, such as psychoanalytic approaches (Weintrobe, Reference Weintrobe2020) are already engaging with this (Anderson et al., Reference Anderson, Staunton, O’Gorman and Hickman2024; Haase and Hudson, Reference Haase and Hudson2024), and it is time for our CBT communities to do more. We hope this special issue will inspire more engagement, action and advances in theoretical and empirical work. Turning towards the climate and ecological crises is not always easy, so go gently, and remember the community of other practitioners who are reading this alongside you.
Climate change and planetary health
The scientific consensus is clear; the only way to ‘secure a liveable and sustainable future for all’ is to immediately curb greenhouse gas emissions and find just adaptations to human-caused climate change (IPCC, 2023). Without urgent action, existing climate change will intensify, ecosystems will break down, and the societies dependent upon them will unravel. Millions of people have already been subjected to climate change-related floods, heatwaves, droughts, wildfires and other extreme weather events, and worse is to come.
Global heating is an undisputable trend, caused by humans emitting greenhouse gases. The planet is creeping ever closer to breaching the over-arching goal of the Paris Agreement to limit global average temperatures to ‘well below 2°C above pre-industrial levels’, and ideally to limit this to 1.5°C (UNFCC, 2016) to prevent dangerous climate change. The size and speed of warming over the last 150 years is unprecedented, far surpassing that at any time over the last 24,000 years (Osman et al., Reference Osman, Tierney, Zhu, Tardif, Hakim, King and Poulsen2021). The past 12 months from June 2023 to June 2024, were each the hottest on record (Copernicus, 2024) as were the last 10 years (National Aeronautics and Space Administration, 2024), and June 2024 marked the 12th month on record of global temperatures surpassing 1.5°C above pre-industrial levels.
The related concept of ‘planetary health’ is important to understand. It describes how certain planetary boundaries must not be transgressed if we are to ensure the continuation of life on Earth (Steffen et al., Reference Steffen, Richardson, Rockström, Cornell, Fetzer, Bennett and Sörlin2015). Recent data suggest we have already broken six of these boundaries (Richardson et al., Reference Richardson, Steffen, Lucht, Bendtsen, Cornell, Donges and Rockström2023), one of which is climate change. It is destabilising the ecosystems which support life, which in turn are being further weakened by savage degrees of environmental destruction through habitat loss, species extinction and pollution now so pervasive that nanoplastics are found in human placentas (Ragusa et al., Reference Ragusa, Svelato, Santacroce, Catalano, Notarstefano, Carnevali and Giorgini2021).
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.
A pause…
To avoid the worst outcomes, we need to be well informed, but we also need to feel motivated and empowered to respond. Consider the following for a few moments: What is it that you love most about being alive on this Earth? Pause a moment, close your eyes, ask yourself this question a few times and notice what arises. ‘What is it that you love most about being alive on this Earth?’. As you feel into this, gently ask yourself ‘how is this threatened by climate change and the destruction of the natural world?’. How do these reality-based thoughts make you feel?
Compassion, care and community
Facing reality in this way requires courage, compassion, care and support. Climate change is particularly overwhelming if you feel isolated in your concerns, whilst (especially collective) action is associated with less overwhelm and more constructive hope (Schwartz et al., Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe2023). Calabria and Marks (Reference Calabria and Marks2024) investigate these ideas in their study exploring Climate Cafés – a novel, community-based approach for navigating climate change. They interviewed participants who had taken part in this global phenomenon where people come together to talk about their eco-concerns in a non-clinical, community setting. Climate Cafés were found to benefit participants by giving them a place to talk openly about their thoughts and feelings. They built greater compassion and connection with others, even for people with non-ecological world-views counter to their own. Participants’ eco-distress was not ‘cured’, but they learnt to relate to it more helpfully, as often seen in third wave therapies.
The meaning of our distress
The core of CBT attempts to understand the meanings underlying psychological experience. When we uncover a ‘hot thought’ we can usually understand why particular emotions are arising. We feel scared, angry or confused when under threat; we feel sadness and grief in response to loss; we feel angry, ashamed and guilty when a moral code is transgressed. Different beliefs about agency and transformation can lead to hopelessness and helplessness, or to constructive hope, creativity and action. Our feelings and responses to the climate and ecological emergencies are no different, and people reporting eco-distress understandably feel multiple emotions, changing over time, because they see the threats, losses and betrayals that are part of the crises (Pihkala, Reference Pihkala2022). Clear awareness of climate change recognises the ‘wicked problem’ of interlinked global challenges (climate, ecology, social injustice, health and mental health epidemics, poverty, migration, war).
If eco-distress represents a clear-eyed view of today’s world, it is also an expression of human care and ethics. As Doherty and colleagues (Reference Doherty, Artman, Homan, Keluskar and White2024) say in their paper here, ‘we hurt where we care’. Zevallos Labarthe and Marks (Reference Zevallos Labarthe and Marks2024) offer empirical evidence for this, based on interviews with young people about climate change and distress. Their participants describe how they see the climate crisis as arising from fundamental failures by powerful bodies (governments, authorities, and wealthy businesses). They identify how moral distress and relational betrayal significantly contribute to their eco-distress. The authors discuss what innovations this may require for therapeutic approaches and emphasise the legal ramifications of such a formulation. This paper emphasises the imperative for mental health researchers to make the psychological impacts of failed climate action visible to those with power.
Climate change as a chronic planetary health condition
If eco-distress is not a mental health issue but is a rational response to systemic global failure, why is it relevant to a CBT therapist? A helpful analogy can be drawn with people with debilitating, chronic or terminal illness. CBT in this context explores the meaning of a patient’s distress, including ‘reality cognitions’. The very real impact of illness now, and fears about the future, are explored from a stance of validation and empathy, alongside work that identifies cognitive-behavioural factors inflaming distress. In being fully heard and allowed in this way a patient feels less alone and may then be able to explore how attitudes of acceptance and compassion can lead to a new and less troubling relationship with illness.
We can regard climate change as a chronic illness on a planetary scale. As nature degrades and the globe warms, we are already experiencing painful symptoms and the future we had imagined now looks very different. However, unlike most health conditions, climate change affects both therapist and the patient. The degree of impact, and the degree of personal contribution to the crises, intersects with social privileges. Those already marginalised or experiencing socioeconomic hardship, and those who have contributed the least to the problem will feel the impacts most acutely (IPCC, 2023, p. 5, p. 8; Paavola, Reference Paavola2017). Yet regardless of one’s social world, everyone is facing this – you, me, your patients, students, children, parents, grandparents, babies to be born.
You already have the skills you need
Once a therapist is coming to terms with their own relationship to chronic planetary illness, they can draw upon a multiplicity of CBT tools to help others. Assessment and formulation by an eco-aware therapist can identify patterns and beliefs linked to eco-distress, in a validating, non-pathologising way. Whilst existing models are applicable, creative application or the development of new models may be required. A simple cross-sectional formulation such as a Vicious Flower or Five Areas model can be applied (e.g. Marks and Hudson, Reference Marks, Hudson, Haase and Hudson2024), enriched by a compassionate framework. Longitudinal formulation can offer deeper insights into contextual factors explaining particular individual patterns. Doherty and colleagues (Reference Doherty, Artman, Homan, Keluskar and White2024) identify how perfectionism, self-criticism and beliefs about personal responsibility can drive over-engagement and burnout, and how beliefs about emotional expression can fuel emotional avoidance, numbing or withdrawal.
A ‘good outcome’ for someone with eco-distress will not be the elimination of challenging eco-emotions and thoughts. Instead, they may learn to relate differently; shifting away from extremes of paralysis or overwhelm they can learn to allow distress move through awareness with an attitude of acceptance. There may even be an appreciation for eco-distress when it is seen as a sign of humanity and care, bringing more meaning to their life. The relevance of third wave approaches to these ideas is discussed in depth by two papers in this special issue. Williams and Samuel (Reference Williams and Samuel2024) relate key concepts from ACT to eco-distress. They describe how increasing psychological flexibility, and developing a more open and aware relationship towards experiences can help people to recognise and accept eco-distress as a natural human response that can support them in having more engaged, meaningful and values-driven lives.
Calabria et al. (Reference Calabria, Peters and Williams2024) offer perspectives from compassion focused therapy (CFT) using the example of climate scientists. This unique group of people regularly encounter the most terrifying aspects of climate change at work and report powerful psychological responses (Tollefson, Reference Tollefson2021), alongside strong affinity and care for nature. Climate science is critical to secure our future, and people in this field may especially need support to sustain their work. Calabria and colleagues describe how a CFT framework can be used to help people make sense of and relate kindly to their experience, and offer a theoretical basis upon which future research can build.
Conclusion
We are living in a time of change and thus of opportunity. Our CBT community has a choice: we can turn away and give up, or we can turn towards our world in crisis, where everything that we love is at stake. The more we bring these crises into our awareness, the more we need each other’s support to navigate our distress and engage in appropriate action. Climate change is not a risk, it is a reality that is already here. As the scale of the impacts, enormous as they are, will be determined in the next few years, what we do now matters. This uncertainty is a gift, and it brings hope, because we still have an opportunity to influence what happens next.
On behalf of all the remarkable contributors to this special issue, we ask you to stand with us at this moment in history and choose to do what really matters. Let our CBT community be bold, and not bystanders to this crisis, let us work together and play our part in determining the future of life on Earth.
Acknowledgements
Thanks to all of the contributors to this special issue and thanks for support from the BABCP Climate Change SIG.
Author contributions
Writing, editing and revisions: Dr Marks. Editing and revisions: Amanda Cole.
Financial support
Neither author received any financial support for this article.
Competing interests
The authors declare none.
Ethical standards
Both authors adhere to the ethical standards of BABCP and the HCPC.
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