Reflective statement
This article consists of a first-person narrative by the first author, interwoven with a commentary by the second author based on the academic and clinical literature.
I (C.W.) am a cognitive behavioural psychotherapist who first trained in 2011 after a background in counselling. I spent the first 5 years of my career with the NHS and have now been working in private practice for the last 7 years, working with both adolescents and adults. Since becoming climate aware in 2019, my practice has evolved to include working with those with climate anxiety.
I (M.F.) have been an anxiety researcher, treatment developer and trainer for 35 years. I started reading and researching into extreme weather and climate change distress in 2020. The commentary is based on my evolving understanding of the scientific and clinical literature on climate change distress.
We have worked independently on the narrative and commentary; each is responsible for their own contribution. C.W.'s narrative is presented in standard font, M.F.'s commentary is formatted in italics in blue boxes. The narrative and the commentary on it are linked by numbers because specific statements led to specific published sources that are used in the commentary. We have cowritten the abstract, reflective statement, discussion and conclusion.
My climate journey
I have been invited to write this article to raise awareness of the impacts of eco-anxiety, not just for our clients but also for all of us as therapists. I am a person with lived experience of climate anxiety, and a cognitive behavioural psychotherapist, not an expert on the climate crisis. I hope that by sharing my climate experiences I will encourage others to reflect on where they are in their own journey. I aim to raise awareness of the impact the climate crisis has had on the individual, personally and professionally. This article is intended to add to the conversation within our community and to acknowledge our own emotions before we attempt to hold space for our clients. My hope is this would enable us to better support those clients and to empower the CBT community to work together to explore and develop new and effective treatments.
My awakening
April 2019. The date the true scale of the crisis humanity is facing came into my awareness. Extinction Rebellion had parked a pink boat in the middle of London and succeeded in gaining the media and the public’s attention. The group of environmental activists were featured on the BBC news (Extinction Rebellion Protests: What Happened?; BBC, 2019), bringing attention to the cause. Doctors, nurses, teachers and therapists were amongst those occupying Trafalgar Square, piquing my curiosity. The pink boat was the catalyst for the start of my climate journey. Like many, I was aware of global warming, but as a distant threat, not something that was going to impact the present day. I now recognise I had been oblivious to the true severity of the crisis. I was alarmed by what I heard from the protestors, and recognising the need to find out more, I began to research the issue. I read the Intergovernmental Panel on Climate Change (2018) report in an attempt to rationalise my thoughts. I had hoped this research would suggest the protestors were catastrophising, but I found evidence to confirm my worst fears. The future we faced, the future my children faced, was far worse than I had ever imagined. Hundreds of the world’s scientists are now in agreement that we are responsible for warming the planet to over 1.1°C warmer than pre-industrial levels. The agreement seems to be that we need to keep the warming below 1.5°C to allow our children a liveable future. This was terrifying news to me. I had never for a moment considered the climate crisis would have such a catastrophic impact on the future of humanity.
I went from oblivious to terrified in the space of three short months.1 I joined Extinction Rebellion (XR) and I found myself on the streets of London before the end of the year. And no, I didn’t get arrested. I was and still remain, reluctant to take part in actions which could result in arrest. I am unsure of how this would be received by future employers, and I was unclear whether the BABCP would support such actions, or if this would affect my accreditation.2 I have since discovered I am not alone with these concerns; despite the growing calls for health professionals to engage in action, these actions do not come without personal cost (Lindemer, 2023). I joined a march through London instead, and learnt that activism takes countless different forms. There was much I could do without risking arrest. This was the first of many actions for me, and many conversations spreading the word. Understandably, we encountered a huge range of reactions from the public, the majority of whom are numb to it, or in denial of its severity.3
With the benefit of time support and reflection, I have now conceptualised the vicious cycle that I became entrenched in at the start of my climate journey (see Fig. 1). Figure 1 highlights how my search for more information to rationalise my fears caused more distress, not less. I thought I would find out that XR had been exaggerating but I learnt that the situation was worse than I feared. I continued to search for information to counter my fears, but found the opposite, and I was initially stuck in this vicious cycle.
Vicious cycle.
The awakening
1 Claire’s account of her growing awareness and her subsequent reactions aligns with Pihkala’s (Reference Pihkala2022) conceptual account of the process of eco-anxiety and eco grief: ‘The early phases of Unknowing and Semi-consciousness are followed potentially by some kind of Awakening and various kinds of Shock and possible trauma (p. 1)’. Her experience is also consistent with empirical studies where for example, Rehling (Reference Rehling2022) conducted semi-structured interviews with 15 self-selecting adults. Interview transcripts were analysed using an existential framework and a theory-driven thematic analysis. Participants’ experiences were conceptualised within four higher order themes, namely, climate change equated with death or loss, intense emotions (guilt, anger, isolation, powerlessness), chronic uncertainty about what to do, and a challenge to one’s sense of meaning in life. Claire’s awakening reflects all four themes.
2 Likewise, Claire’s concerns about the professional implications of arrest were shared by many. For example, Clery et al. (Reference Clery, Embliss, Cussans, Cooke, Shukla and Li2022) consider medical activism about climate change from several perspectives, including moral, historical, personal and legal. While the trigger for their article was civil disobedience as part of the XR protests, they also discuss the range of alternative forms of activism. Claire also began to explore alternative forms of activism beyond the confrontational style of those initial protests.
3 Claire’s observation of many people being numb or in denial is not just a UK experience. For example, Wullenkord and Reese (Reference Wullenkord and Reese2021) conducted two studies (n=354 and n=453) among adults in Germany and identified several self-protective strategies. They proposed a two-part framework where the first is interpretive denial: climate change is recognised as real, but the severity of outcomes at personal and global levels are re-interpreted and ultimately denied. The second is implicatory denial: climate change is recognised, but people rationalise, avoid, or deny guilt for the psychological, political, and moral implications. Given the level of perceived crisis that may occur with awakening (Pihkala, Reference Pihkala2022; Rehling, Reference Rehling2022), it is unsurprising that people adopt self-protective strategies and do not engage behaviourally.
Action, confusion and distress
I took multiple actions to address my own carbon footprint.4 I began to buy less, fly less, use less, waste less and eat less meat and dairy. I grew my own fruit and vegetables, I planted trees and bought pre-loved wherever I could. I became a climate activist. I wrote to my MP and joined local environmental groups. I used public transport wherever possible and changed my car to an electric vehicle when it needed replacing. I felt that if I did more it would mitigate the lack of action from others. Throughout, I struggled with my own guilt and cognitive dissonance.5 I had been brought up in a family that embraced travel (four generations of airline staff in one family). I experienced discomfort over two opposing views and confusion over which view to let go of. Uncertainty as to how I could find a way to honour my desire to reduce my carbon footprint, but still visit family in long-haul destinations. My choice to give up meat, for example, has been topic of conversation at nearly every family gathering since I made the decision. I was beginning to question things that were part of my identity, part of where I came from, and the world I had grown up in. So much of how we live today has become entwined in our social identity and part of the culture we live in, it was hard for me to see how I could be so different from those around me but still fit into my family and social group. However, the changes that I made have sustained and enabled me to live in line with my values. About this time, I realised I was taking too much personal responsibility for the crisis, a presentation I have since seen in other activists which can lead to burnout and needs to be challenged.6 My threat system was activated, and I was driven by the adrenaline and fear. The more I read, the more anxious I felt.7 I was searching for the data, trying to find an alternative perspective but the data backed up my anxiety. The more I knew, the more scared I felt and the more I felt I had to ‘do’ something to ‘fix it’.
I stepped back from my activism and spent some time reflecting on my own emotional reaction to all that I was experiencing. It was first important for me to experience and acknowledge the feelings I was feeling, and then I began to formulate my experience in an act of self-practice. The whole process was hugely beneficial to me personally and the self-reflection marked a shift in my personal journey. Figure 2 shows a simple five aspects formulation of the cycle I was in, enabling me to make sense of my own climate anxiety.
Five aspects formulation – maintaining my distress.
Action, confusion and distress
4 Claire’s ‘call to action’ and activism driven by her sense of crisis and making up for other people’s inaction fits with Pihkala’s (Reference Pihkala2022) second stage of the process model labelled coping and changing which includes action, distancing and grieving. This aligns, for example, with a study of 2070 people in Finland which found that both climate hope and climate anxiety led to action, and to diversity of action, but in subtle ways (Sangervo et al., Reference Sangervo, Jylhä and Pihkala2022). They concluded that supporting people with strong climate anxiety to channel anxiety into climate action may be helpful. However, they also recognised that different social contexts and intersectional justice issues need to be considered, as people do not have the same opportunities to feel efficacy and/or engage in action. Claire’s action on behalf of others may represent both those who could act, but did not, but also those who did not have agency or means.
5 Claire’s experiences of guilt and cognitive dissonance illustrates the type of complex reaction found throughout the literature that challenges the more limited construct of climate change anxiety or eco-anxiety. In their review of climate concerns, negative emotions and mental ill-health in young people, Ramadan et al. (Reference Ramadan, Randell, Lavoie, Gao, Manrique, Anderson, McDowell and Zbukvic2023) (consider a number of differently named constructs describing distress related to climate change such as climate anxiety, climate change anxiety, climate change worry, and eco-anxiety, but also ecological grief and distress, eco-paralysis, environmental concerns, environmental distress, environmental grief and solastalgia (loss of place). The range of emotions varies; some are mainly in the anxiety register, some include other primary emotions (e.g. anger, sadness), and others include what are often labelled as self-conscious emotions (e.g. guilt, shame). The point at which these emotional reactions or distress becomes problematic in that it impacts on people’s functioning remains to be determined, but it is likely that some people report what would be considered clinical levels of distress (see Whitmarsh et al., Reference Whitmarsh, Player, Jiongco, James, Williams, Marks and Kennedy-Williams2022).
6 The experience of burnout and the overwhelming sense of responsibility reported by Claire can be found in the literature. For example, Nairn (Reference Nairn2019) conducted in-depth interviews with five young activists (aged 18–29) in New Zealand. Nairn argues that when society avoids or denies guilt about environmental damage, there is an unconscious transference of guilt onto climate activists, which can lead to despair and so may lead to burnout. Furthermore, there may be a sense of dual responsibility for solving climate change as well as their own burnout. Nairn also discussed the issue of responsibility from an analysis of power: ‘In thinking about how to cultivate collective forms of responsibility for climate change and collective forms of hope, it is important to acknowledge uneven power relations which can shift an unfair sense of responsibility for solving climate change onto young people and privilege particular groups of young people’s hopes and dreams over others (p. 437).’ In the context of this article, I would suggest that these issues of responsibility, commitment and potential burnout may apply to the ‘climate aware’ of any age.
7 Finally, Claire’s reflection that ‘the more I read, the more anxious I felt’ is consistent with Whitmarsh et al.’s (Reference Whitmarsh, Player, Jiongco, James, Williams, Marks and Kennedy-Williams2022) study among 1338 adults in the UK which found that the strongest predictor of climate change anxiety was climate information seeking behaviour.
Active hope
I became aware that my carbon footprint could be zero and it still would not avert the crisis. Whilst individual actions are important, we need the system to change too. It is not ‘either or,’ but ‘both and’. This led me to join XR. I then found my tribe in XR Psychologists (see https://xrpsychologists.co.uk), a group of like-minded professionals doing all they can to raise awareness of the crisis we are in. We think, feel and act together. I realised that the climate crisis was also a mental health crisis. The power of connection and talking with others who truly understood cannot be overstated. The support around me helped me balance my pain for what we are losing, with my joy and wonder for the natural world which we must make space to cherish.8 Macy and Johnstone (Reference Macy and Johnstone2012) describe the concept of ‘active hope’, and I identify with this idea of becoming an active participant in bringing about the future we hope for but not being lost in either hopelessness or anxiety.
Managing distress and sustaining activism
8 Claire discovered progressively what would help her to manage her distress and sustain her activism. Pihkala (Reference Pihkala2022) proposes that through adjustment and transformation, people move to a third stage of living with the ecological crisis characterised by action, emotional engagement, and self-care. As for what is known to be effective, the literature about intervention and support strategies for climate distress is still sparse, but there are two reviews. First, Baudon and Jachens (Reference Baudon and Jachens2021) conducted a scoping review of interventions for eco-anxiety and identified 34 sources, of which 13 describe specific psychological approaches. Using thematic analysis, they identified five major themes for individual and group treatment of eco-anxiety. Interestingly the first addressed practitioners, specifically what they describe as inner work and education. The other themes were fostering client’s inner resilience, encouraging clients to take action, helping clients find social connection and emotional support by joining groups, and connecting clients with nature. Taking a different and more strongly evidence-based approach by grading the evidence, Bingley et al. (Reference Bingley, Tran, Boyd, Gibson, Kalokerinos, Koval, Kashima, McDonald and Greenaway2022) reviewed essentially the same studies and identified problem-focused action, emotion management, and enhancing social connections as having beneficial effects on the widest range of outcomes. Importantly they identified that some interventions may have mixed effects, helpful for some, but detrimental for others. These include often proposed interventions such as (re)connection with nature (because it may highlight losses) and positive reappraisal (‘silver lining’ strategies). The evidence grading approach is helpful and is neatly summarised on their interactive webpage which also links to sources, but they also comment on how weak the evidence is overall.
From my standpoint, developing treatments and the evidence base generally takes time and it will be several years before we have an established and credible cumulative evidence base specific to the prevention, support, and treatment of climate change distress. Time is short but the pandemic showed what can be done well and done quickly. In the meantime, CBT has much to offer with generic approaches to emotion management, problem focused action and self-compassion, which when evidence exists, can also be informed in their implementation by the climate change literature. Additionally, it will be possible to adapt more specific treatments where there are parallels, using approaches which have been developed for other client groups such as those living with adversity, complex grief, addressing burnout, working with moral injury, etc.
Climate conversations
I learnt the importance of talking about the climate crisis to help tackle the climate crisis (as highlighted by Hayhoe, Reference Hayhoe2018). People are influenced by those they identify with. We need to connect with people where they are now and talk to the values that matter to them. Your friends and colleagues are more likely to listen to you than the person on TV in a suit quoting statistics.9
When thinking about how important it is to find accessible ways of talking about the climate crisis to other people, I have found it helpful to use metaphors, just as I would in therapy. When people ask me if it is too late to take effective climate action, I often use the cancer metaphor.10 Back in 2019 it was as if I found out the world has ‘cancer’. It took me a while to realise how bad it was, and sometimes I still wish I did not know. However, the problem is there, and we need to treat it or the symptoms will just get worse. Initially I poured all my energy into understanding the science and trying to make sense of the disease we have, perhaps in an attempt to avoid my grief. Then I allowed myself to connect to my emotions fully. I felt anxiety, guilt, fear, anger, and frustration that we were in this place. I had been part of the problem. I had had more than my share of international travel and been completely oblivious to the damage this was causing. I soon realised I cannot sit and look at the diagnosis all day every day. I realised I had to learn to live with it, but also do all I can to fight it. I realised I needed to take action to work through my own emotions.11 I work full time and I am a single parent to three boys. I still tussle with the question of how best to make a difference in the time I have available to me. We know the situation is dire, but we also know it is not too late. Every action we take to reduce carbon emissions and to keep warming below 1.5°C will improve future outcomes for all life on earth.
Effective communication
9 Claire’s experiences of talking to people also align with the literature. Sippel et al. (Reference Sippel, Shaw and Marshall2022) conducted extensive reviews of the communication literature and then listed key principles on how to communicate climate change for effective public engagement. Their first principle to help ‘open the door’ is, as Claire proposes, ‘connect with people’s values (p. 2)’.
10 The sixth principle of Sippel et al. (Reference Sippel, Shaw and Marshall2022) is ‘tell powerful stories and use effective imagery’ (p. 2), so it is interesting to see Claire’s use of the cancer metaphor. Metaphors are frequent in psychotherapy, including CBT, where they have been empirically measured in 48 therapy recordings at 31.5 metaphors per thousand words (Mathieson et al., Reference Mathieson, Jordan, Carter and Stubbe2016). While some metaphors may be inappropriate for some people and all metaphors can be stretched too far, as Stott et al. (Reference Stott, Mansell, Salkovskis, Lavender and Cartwright-Hatton2010) describe, metaphors compare something people may not understand (or understand unhelpfully) to something that they may understand better. In this case there are formal points of comparison that can be unpacked: cancer and climate change both involve real world threat and real-world uncertainty, they both disrupt people’s lives, psychological distress is predictable and normal, and denial has costs. No single action can guarantee an outcome, but appropriate forms of hope can be found, and adaptation is possible to allow life to continue, even if it may be a different life. Stott et al. (Reference Stott, Mansell, Salkovskis, Lavender and Cartwright-Hatton2010) state ‘the constructive and therapeutic use of metaphor allows them to “step outside” their immediate preoccupations in ways which can increase their cognitive flexibility so that they can see things in a different and more helpful light than before, and crucially, do so in ways that may enable them to try out different ways of responding to it in terms of meaning and behaviour (p. 27)’. In this case Claire’s cancer metaphor also has practical implications: there is an extensive evidence base for interventions for people with cancer at different stages of their journey. Furthermore, many therapists will have worked with people with cancer or other life-threatening or life-limiting conditions, and some will have done so while holding personal experience of such conditions themselves or through family and friends. Thus, the metaphor may also lead lay people and therapists alike into more familiar territory, and where they may connect with knowledge, skills, and experience they already hold, or where the experience how they acquired them could be relevant to developing competences for managing climate change distress.
11 Claire’s description of her evolution is not unique. For example, Samuel et al. (Reference Samuel, Greaves, Morgan, Li, Sunglao, Belkin, Henson, Salcedo and Lawrance2022) report the results of conversations between eight mental health professionals from around the world and their experiences of engaging with the climate crisis both as citizens and mental health professionals. Their collectively generated themes reflect how engaging with the crisis had: ‘(i) disrupted our personal and professional experiences; (ii) helped us adapt and grow; and (iii) enabled us to live, work and act in more accordance with our values (p. 525)’. Furthermore, they reflected on the non-linear nature of the responses, a point echoed by Pihkala (Reference Pihkala2022) who describes how a sense of crisis may return during the phases of adjustment and coping, and even living with the ecological crisis. Although Claire describes the process of adaptation and growth and greater alignment of values, the literature would suggest that the process for most will not be linear, will be always ongoing, and will never be completed in any absolute sense.
Recovery
I am an accredited Counsellor (in Transactional Analysis) as well as a CBT therapist. Readers may be aware that to qualify as a counsellor it is compulsory to have engaged with personal therapy throughout your course. I have always embraced the concept of personal practice, self-reflection, and self-practice (Bennett-Levy, Reference Bennett-Levy2019) in my work, so it felt natural to me to seek therapy to talk through my emotions and to enable me to find a balanced perspective. The importance of finding a climate aware therapist cannot be overstated.12 I began to explore my own ecological identity13 and what I could sustainably offer to the climate movement. I recognise now that I met the criteria for the condition known as ‘eco-anxiety’, defined as ‘a chronic fear of environmental doom’ (Clayton et al., Reference Clayton, Manning, Krygsman and Speiser2017). Also known as climate anxiety, it is not even mentioned in the DSM-5 (American Psychiatric Association, 2013). Humans are heating the planet so fast my children may not have a liveable future. I am not sure how I feel about the terms eco-distress and climate anxiety. Do these terms locate the disorder within the client, or do they acknowledge that anxiety is a normal healthy response to the situation we find ourselves in? I am heartened that it appears more and more professionals are speaking out and normalising this response to the crisis (e.g. Kurth and Pihkala, Reference Kurth and Pihkala2022). My therapy was integral to my recovery, but so too was taking action.14 I knew I needed to be able to tell my children that I had done everything in my power to raise awareness of the crisis we face and to avert this existential crisis.
A virtuous cycle was beginning to emerge (see Fig. 3). Mapping this new cycle helped me to see that I was evaluating evidence differently now. I was aware that the situation was still dire, but it was not too late. For every 0.1°C of global warming we can prevent, we will improve the quality of life for future generations. Spending time with like-minded professionals, processing my grief and taking meaningful action had restored something fundamental in me. I had hope again.
Emergent virtuous cycle.
Therapy and therapists
12 Claire describes the importance for her of finding a therapist who was climate aware. This chimes with Budziszewska and Jonsson (Reference Budziszewska and Jonsson2022) who interviewed 10 clients in Sweden who had sought help for climate change related distress. Their first major theme was ‘“It is a person who understands what I am talking about” – looking for a competent companion while facing the climate reality (p. 610)’.
13 Claire’s mention of her ecological identity resonates with various identity-based terms found in the environmental education literature (e.g. ecological identity; Thomashow, Reference Thomashow1995), in environmental psychology (e.g. environmental identity; Clayton, Reference Clayton, Clayton and Opotow2003), and in the ecotherapy literature (environmental identity; Doherty, Reference Doherty, Jordan and Hinds2016). Each of these fields approaches individual and often social identity through the lens of interaction with the natural world. The common feature is the notion that to understand people you must understand how their history, experiences, values, feelings, and behaviours have been constructed in relation to the natural world. For the therapist, this ecological or environmental identity is an additional aspect of a person’s identity to consider along with others found in either of the frameworks often used in training, namely, the ADDRESSING model (Hays, Reference Hays2009) or Social GGRRAAACCEEESSS (Burnham, Reference Burnham and Krause2012). The notion of identity also applies to the self, and so to truly know oneself, one must understand how experiences of the natural world have shaped this important aspect of one’s identity.
14 Finally, Claire’s clarity about her need for action and to raise awareness also aligns with the limited literature. Bingley et al. (Reference Bingley, Tran, Boyd, Gibson, Kalokerinos, Koval, Kashima, McDonald and Greenaway2022) concluded that problem-focused action, emotion management, and social connectedness all have direct evidence of positive outcomes at the individual level.
Activist and therapist
Undoubtedly, this journey impacted my identity both personally and professionally. I endeavour to balance my personal beliefs with how I practise as a therapist.15 My counsellor training highlighted to me the importance of congruence in my work, and I endeavour to remain true to this principle. This is an ongoing journey and there is much to be done to understand how everyone working in health can ‘prepare for and be equipped to respond to the health impacts of the climate crisis’ (Office for Health Improvement & Disparities, 2022). I have made practical steps to make my own business sustainable.16 For example, I have embraced the use of remote video technology, I have changed to sustainable suppliers where possible. I use recycled paper and refill products for everything from washing-up liquid to pens. I do not use any single use plastic and only have plant milks in the office. These small acts have often acted as talking points for clients and other therapists visiting my clinic. I also use public transport where possible, or drive an electric vehicle if no public transport options are available. Interestingly, my increased awareness in the role of the environment around us has also influenced the way I work. I have long been aware of the link between exercise and mental health, but I am also now aware of the power of green spaces in promoting well-being (Sideman, Reference Sideman2012).
My role as an activist and a voice for local groups is not a secret. I now work with clients with climate anxiety and climate activists. I aim to understand where they are on their journey, and to help them to process their grief, their anger, and their sense of loss for the world we once knew. On the occasions where a client has learnt that I am involved with XR (often through local paper reporting activism, not my disclosure), they have reported it to be enormously helpful to them. They do not feel so alone and report that my empathy validates their own emotion.17 Activists risk experiencing burnout due to the enormity of the task ahead and benefit from balancing activism with regeneration and self-care.18 I believe we need to offer support to these brave, often young, people who are fighting for all of our futures. This is a marathon, not a sprint.
Activist, therapist, and expert by experience
15 Claire’s awareness of needing to join up the personal and the professional was also reported by Silva and Coburn ( Reference Silva and Coburn2023) who interviewed eight therapists from across Australia. They identified four super-ordinate themes: Being in the experience of climate change, Disorientation in an ‘Unreal’ world, Clients in ‘Changing Times,’ and Professional uncertainties in the climate. My impression from this article, and indeed reflected in its title, is an ongoing dialogue or dialectic between the personal and the professional. The key question, then, for practitioners is how to harness both in their practice. Bennett-Levy (Reference Bennett-Levy2019) considered a range of personal practice paradigms, namely, personal therapy, meditation programmes, self-practice/self-reflection programmes (SP/SR), and experiential/personal development groups. Although personal preference will be key, he cites evidence in support of personal therapy, meditation, and SP/SR across a range of therapist outcomes. SP/SR typically uses workbooks and has been adapted for different therapies within a broader CBT umbrella (e.g. CBT, schema therapy, compassion-focused therapy and ACT). Preliminary evidence indicates that SP/SR during training (compared with a cohort with no SP/SR resulted in greater self-awareness and lower burnout (Scott et al., Reference Scott, Yap, Bunch, Haarhoff, Perry and Bennett-Levy2021). The general procedures are readily adapted to specific areas of practice and content (see also Freeston et al., Reference Freeston, Thwaites and Bennett-Levy2019) so more formal adaptation to practise in the area of climate change would certainly be possible.
16 One aspect of Claire’s actions is making her practice more sustainable. This is perhaps the area where mental health organisations have made some progress. Based on an earlier consensus statement from nine UK organisations on sustainability in mental healthcare (Mortimer, Reference Mortimer2015), Monsell et al. (Reference Monsell, Krzanowski, Page., Cuthbert and Harvey2021) have put forward a number of recommendations and practical steps for individuals and organisations to address their responsibilities in what is described as both a climate emergency and a mental healthcare emergency. Those more easily implemented by individuals are the use of digital technologies, remote consultations, promoting use of active travel and public transport (staff and clients), and increasing the use of green and blue space activity as part of treatment and maintenance plans, especially when linked to the community.
17 Claire reflects that her activist status and having experienced a similar journey to her clients helps validate their experiences. This echoes Budziszewska and Jonsson’s (Reference Budziszewska and Jonsson2022) second theme, ‘“I cannot help you with your anger because it is valid” – experiencing validation of climate change-related emotions (p. 610).’ But it also raises the interesting issue of empathy. A review of 43 definitions led to the following definition, which suggests the need for some distance: ‘Empathy is an emotional response (affective), dependent upon trait capacities and state influences. Empathic processes are automatically elicited but are also shaped by top-down control processes. The resulting emotion is similar to one’s perception (directly experienced or imagined) and understanding (cognitive empathy) of the stimulus emotion that the source of the emotion is not one’s own (Cuff et al., Reference Thomashow2016, p. 150)’. In a similar vein, Thwaites and Bennett-Levy (Reference Thwaites and Bennett-Levy2007) describe a pathway by which complex empathic attunement draws on both the person of the therapist and the self as therapist to facilitate skilful communication that has both emotional resonance and cognitive perspective-taking (figure 2, p. 603).
There seem to be several key points in Claire’s story where taking time to reflect has allowed some distancing and perspective. As commentator, I would see these when first stepping back from her initial activism, the second with her own therapy, and the third with the conscious evolution of her practice and congruence between her personal views and her practice. These different stages allow the person and therapist to co-exist, and so empathic attunement develops. Maintaining this position of empathic attunement in the face of one’s own complex emotions is the ongoing challenge for a climate aware and activist therapist like Claire.
18 As Pihkala’s (Reference Pihkala2022) model proposes, the complex phase of coping and changing consists of action (pro-environmental behaviour of many kinds), grieving (including other emotional engagement), and distancing (including both self-care and problematic disavowal). Finally, reflecting Claire’s concern for activists, but equally applicable to herself, the model emphasises the importance of ongoing self-care in the third phase of living with the ecological crisis. If there is disruption to these processes, Pihkala (Reference Pihkala2022) warns us that the ‘possibility of stronger eco-anxiety and/or eco-depression is always present, including the danger of burnout (p. 1)’.
My sustainable future
Personally, I began to find balance between activism and everyday life. I saw the value of talking to others, seeking input from people who understood whilst staying feelings aware. I continue to enable climate conversations – at work and in my personal life.19 Taking action to reduce my carbon footprint and raising awareness of the crisis will continue to be important to me. I now live in a way that is in keeping with my values, easing my guilt and fear over what the future holds. In Fig. 4, I have again used a five aspects model to highlight my sustainable future, and the shift from my previous distress as highlighted in Fig. 2. This is an example of how we can use a simple CBT formulation, a core skill we all have as CBT practitioners, to help to understand ourselves and others. I now had more positive thoughts about the future, and I had space for hope alongside the fear. I integrated both activism and self-care into my life and felt the benefits in better sleep and less tension in my body.
Five aspects formulation – my sustainable future.
Personally, I have also noted the public’s reaction to climate activism appears to be changing. Last year, I attended the peaceful collaborative climate protest in London, ‘The Big One’. Spying both my lanyard identifying myself as a psychotherapist and my placard (which read ‘The climate crisis is a mental health crisis’), two members of the public asked about me about my activism whilst on the train and thanked me for taking part. Back home, friends wanted to talk about it, and express gratitude for my actions. Progress indeed! I don’t have all the answers and I am just doing the best I can with the resources I have.
As a therapist, I know the importance of leaving personal opinions to one side as I sit with my clients offering unconditional positive regard. Of course it is all about the client’s agenda, not mine. However, I now question where we sit in terms of collusion with denial if we do not acknowledge the threat humanity faces.20 We are trained to sit with views different from our own and to get alongside the client and meet them where they are. This often leaves no space within the therapy room to address these issues (unless of course the client raises them), so what can we do as health professionals to make a difference? Recently, there has been an increase in calls for health professionals to engage in climate action as part of our professional practice, including guidance from the Office for Health Improvement & Disparities (2022), not least because the climate crisis is a health crisis. I note also that the Law Society has issued a powerful statement in support of lawyers who do not wish to represent those who harm the climate (Law Gazette, 2023). These questions inspired me to become a founding member of the recently established Climate Change Special Interest Group (CCSIG) here at the BABCP. These are problems we need to work through together.21
Professional and collective action
19 Claire’s climate activism continues to evolve but the role of climate conversations remains central in both her personal and professional lives. Allowing or explicitly enabling these is consistent with the development of empathic attunement and the guiding principles of SP/SR. Among their 10 principles for effective communication, Sippel et al. (Reference Sippel, Shaw and Marshall2022) include providing spaces for interaction, offering possibilities for meaningful personal action, and interestingly making climate action an issue of social belonging.
20 The connection to social belonging leads also to Claire’s own question to herself about collusion and denial. Henritze et al. (Reference Henritze, Goldman, Simon and Brown2023) offer a helpful framing and forcefully argue that a moral injury perspective frames the debate in terms of justice, social position, and ethics. It thereby supports clinicians by ‘delineating both the psychological and structural elements that determine the possibilities (and limits) of individual and community agency (p. 328)’.
21 This framing of the climate emergency as having an impact on individuals but requiring a societal framing runs through the aims of the Special Interest Group (SIG), and the role of CBT in the area of climate change.
The aims of the SIG are:
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(1) To apply Cognitive Behavioural Science and Practice to the challenge of climate change, and contribute to the development of new models and protocols;
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(2) To bring together BABCP members with concern for this, so that they can act as ambassadors and pool their expertise and resources;
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(3) To support members in CBT research, training, and therapy, both clinically and in the workplace, to work with the challenges of climate change and promote sustainable practices;
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(4) To contribute to national and international debate where CBT might assist with meeting the challenges of the climate emergency, through engagement with the media, government and public.
Recently, members of the Climate Change SIG together with board members developed a statement on the climate and ecological emergency, eco-distress, and made four commitments in the areas of normalising climate concern as a normal psychological reaction to drastic changes, promoting research, committing the association to sustainability and Carbon Zero goals, and working with other organisations in these areas. The statement was adopted by the Board of the BABCP in 2024: BABCP | British Association for Behavioural & Cognitive Psychotherapies > About > Climate and Ecological Emergency..
Some questions
I imagine that people who have taken the time to read this article already have an interest in the topic, but we are all at different places on our journey. In keeping with my quest for reflection, I leave you with questions to consider. I would encourage you to take time and reflect on what emotions you have experienced when you read this. Do you empathise with the feelings raised, or do you think it’s catastrophising? Or would you rather not think about it? Whatever the answer, I hope you can be curious about what you are experiencing and your own ecological identity. How does eco-identity intersect with our sense of self and identity? What social norms influence our reactions to the climate crisis, and to our clients? Not all clients with climate anxiety will have a sense of where they see themselves in the ecological world. I do not think I had a sense of my eco-identity when I started this journey, but I definitely experienced eco-distress. As always, we need to understand where our clients are, what they are experiencing, and to be aware of our own reactions to best serve our clients. It is important to ask ourselves: would you feel confident treating a client who presented with climate anxiety?22 Do you think there is enough training and support available for working with eco-distress?23 What more help and support would you want? As a therapist and a person with lived experience I am excited to see what the future holds for CBT and eco-anxiety. As a CBT community, we have a fundamental role to play in mitigating the impact of this unfolding climate and mental health crisis.24 Although this has been a challenging journey, knowing the severity of the crisis we face and taking time and space to reflect on my reactions to it, has helped me to better serve my clients. Driven by the desire to tell my children I have done all I can to mitigate the climate crisis, this journey has empowered me to reflect on my personal and professional selves and how they sit together.
Skill development, training needs, and the role of professional associations
Claire raises the question about feeling confident and I would add competent enough to provide treatment for climate change distress.
22 In a clinical guidance article addressing skill deficits for working with service users from minoritised ethnicities, Churchard (Reference Churchard2022) uses an established model of therapist skill development to understand deficits in declarative knowledge, procedural skills, reflection (cognitive, emotional, and situational barriers), and challenges with the personal self. Importantly, he outlines general and specific ways of addressing them in a summary table. It would be relatively straightforward to adapt the model to working with service users with climate and ecological distress. An adapted model would have implications for individual practitioners as well as supporting supervisors, trainers and those involved in curriculum development.
23 In the UK context, Milton et al. (Reference Milton, Gimalova and Simmons2020) conducted a survey of the members of the Division of Counselling Psychology (part of the British Psychological Society) in February 2020, just before the pandemic. While the survey was small (closed 5 March 2020, n=40), it raises some interesting issues. While just over half of those involved in clinical practice had experience of clients bringing climate issues to therapy (55%), in many cases this was secondary to other presenting concerns, including the effects of natural disasters. The need for training and in multiple forms was also noted: core training, CPD, short courses, etc. Participants also expressed views that the Division should support members involved in non-violent protest and that arrest should not be the basis for fitness to practise investigation. An older study (Seaman, Reference Seaman2016) surveyed 160 therapists of different professions working in different settings from across the USA. Although climate change was not a frequent focus of work, it was more frequently mentioned in passing, and evoked a range of emotions among therapists. Most therapists relied on generic principles to manage their own responses and respond to clients, although a small minority had sought out training.
If you would like to find out more about working with climate anxiety or join a supportive group to work through your own feelings around the issues, please do consider joining the Climate Change SIG or attending one of our events ( https://babcp.com/Climate-Change-SIG).
24 While other professional organisations in mental health have made high profile statements about their role in addressing climate change that are easily accessible to the public (e.g. American Psychological Association), until very recently it has been difficult to find something similar for any of the listed member organisations of the World Confederation of Cognitive and Behavioural Therapies. Individual member organisations below the listed members may have done so, and some individual and umbrella organisations have climate change or similar SIGs or working groups, or represent views of members in newsletters, etc. The BABCP appears to be leading through its official statement described earlier. There is still much to do. For example, the APA has gone beyond a statement and formally adopted a strategic plan to address climate change (American Psychological Association, APA Task Force on Climate Change, 2022): ‘Although the severity and urgency of the crisis should not be understated, it remains within the capacity of society to reduce its most adverse effects and to promote health, well-being, and justice for all people. Psychologists have the knowledge and skills to design and implement strategies that will help realize these aims (p. 3)’. If the APA can claim this for psychology, so can CBT.
Discussion
This has been a challenging journey. Writing this article has added another level to my (Claire’s) understanding of how climate change has taken me beyond my previous experience of the interaction and tensions between my personal and professional selves. Despite the initial and ongoing disruption, knowing the severity of the crisis we face and taking time and space to reflect on my reactions to it, has helped me to better serve my clients. From the personal desire to tell my children I have done all I can to mitigate the climate crisis, my journey has empowered me to reflect on my personal and professional selves and how they may sit, sometimes uncomfortably, together. This is not resolved in any final sense; it is still my reality and will continue to be so.
The literature cited does not represent a systematic search as it has been a response to the primary narrative, and a different process to my (M.F.’s) standard approach to writing an article. It has drawn on up-to-date reviews and primary data articles wherever possible, but through both scarcity and curiosity I have also explored philosophical and conceptual accounts and sources from other therapeutic traditions that in my earlier career I may not have accessed. I have sought to make connections rather than ‘stack up’ a weight of evidence that simply does not yet exist. However, although CBT is evidence-based in a narrow sense (i.e. based on treatment outcome literature), much of the practice of CBT does not have a large evidence base, including many key components. For example, Clark and Egan (Reference Clark and Egan2015), review the scant evidence in support of Socratic dialogue or guided discovery. Although central in the curriculum of almost all CBT training and part of CBT for 40 years, it would be hard to claim that its use is evidence based. Evidence for climate-change practice will develop, but we can also usefully apply what is known from other relevant areas where practice is more established. While the psychological and mental health challenges may be specific to what seems an overwhelming global threat, so were the psychological and mental health challenges of the COVID-19 pandemic. CBT mobilised in many different ways, adapting, innovating, and even revolutionising approaches to mental healthcare.
We believe that these two separate threads come together. The personal experiences reported illustrate the complexity of personal and professional responses to climate change and how reflection is essential to manage the tensions and interactions between the two. The commentary reflects both the individuality and universality of the experience, and that these will be life-long challenges for our generations and, we hope, future generations. For practitioners, self-development, perhaps through self-practice/self-reflection or other forms of continuing professional development will be essential. There are also clear implications for supervisors, trainers, and ultimately curriculum developers and accreditors.
Conclusion
CBT has been in constant evolution since its inception over 50 years ago and has survived and even thrived in the crisis of a global pandemic; CBT led by practitioners was an important part of the response. If we can mobilise the collective knowledge, experience, and resources within CBT to engage with anthropogenic climate change and its multiple ramifications for individuals, society, the global community and the biosphere, there may be reason to hope.
Key practice points
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(1) Research the topic: educate yourself about the science of climate change and about climate change distress.
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(2) Self-practice/self-reflection: understand and acknowledge how you feel about the crisis we are in, and how are your actions helping or hindering your functioning.
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(3) Self-care: make time for meditation, peer support, processing of own emotions, the need to get in touch with nature, and to have time away from focus on the crisis.
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(4) Work with the client to establish whether the client has a realistic perspective. Validate their emotions if they are indeed an understandable reaction to the crisis we are in.
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(5) Empower client to focus on what they can control, and let go of what they cannot, and to live a life in line with values and beliefs.
Data availability statement
No data are used in this study.
Acknowledgements
I (Claire Willsher) would like to acknowledge the climate scientists and the climate activists I have met over the last four years. I recognise their hard work and often personal sacrifice to bring these issues into the public awareness.
I (Mark Freeston) acknowledge my grandchildren. Because of them, I now look at the world and to the future in a different way.
Author contributions
Claire Willsher: Conceptualization (equal), Methodology (equal), Visualization (equal), Writing – original draft (equal), Writing – review & editing (equal); Mark Freeston: Conceptualization (equal), Methodology (equal), Visualization (equal), Writing – original draft (equal), Writing – review & editing (equal).
Financial support
None.
Competing interests
Claire Willsher works in private practice, providing CBT to adolescents and adults with anxiety and depression, including clients with climate anxiety. Claire Willsher is also a member of Extinction Rebellion. Mark Freeston receives royalties for books and honoraria for training on anxiety-related topics, including the understanding of uncertainty in mental health.
Ethical standards
Not applicable.
Open access
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