Blog 2/2 A practical approach to treatment

In the first of these two extended blogs (Eco-anxiety: what’s in a name?), I noted that the way we define emotional responses to environmental change makes a difference to how we might view ourselves and our approach to treatment.  Perhaps in contrast to some other therapists, I approach eco-distress as a manifestation of anxiety, anger, sadness etc in a particular context, rather than as something that is exceptional, unusual etc. Some might even say treatment is not appropriate given anxiety and anger are quite rational responses to the climate emergency. While that may be true, it is problematic, and therefore worthy of ‘treatment,’ when the emotional responses lead to such distress that life loses its meaning, that there is no joy in life any more, and that everything that once seemed important has faded from perception.  I’ve spent much of my adult career in service of the environment, in various capacities (academic, consultant, campaigner), but I have learned through experience to find a way to have perspective – in fact it is because I have spent so long in the environmental policy space that I have that perspective; I am only too well aware of how policy making works and the tension between the desire for urgent action and the realities of securing and implementing policy change, especially at international level when you are trying to get nearly 200 countries to act in concert.

For some, behavioural action - engagement in positive action – is the most constructive way to turn anxiety and anger into something more helpful, and hopeful.  That may work to some extent, but also can come with some risks as we shall see, if it serves to maintain undue focus of attention and/or may result in action that runs in conflict with other personal values.

Purpose of treatment

In seeking to ‘treat’ eco-anxiety or eco-distress the aim is not to eradicate the emotional response of anxiety/sadness/anger or whatever else is experienced, but to be able to shift or gain perspective, accepting that these emotional responses are normal human responses but that in extreme forms are deeply distressing and paralysing.  A common desire is ‘to find joy in life again’ and that often involves (re)connecting to one’s personal values – the things/domains in life that are important to you.  You may be unaware that might even be the issue as the environment has become so dominant it is all that seems important. In reconnecting to values, that entails being more present, aware of the here and now in order to:

• be more psychologically flexible in response to the changing environment, to uncertainty; and

• be able to act in the present in service of values.

My own approach to treating eco-anxiety and eco-distress has evolved out of the transdiagnostic[1] model of Cognitive Behavioural Hypnotherapy (Hypno-CBT®), which draws heavily in my application on Acceptance and Commitment Therapy (ACT) and Metacognitive Therapy (MCT) and utilises hypnosis primarily for reinforcement of mindfulness-based techniques and action, for relaxation, and for imagining more positive futures where the client has greater self-efficacy and long-term resilience.

For me, eco-anxiety/distress involves a collaborative conceptualisation with the client around ACT and MCT models (as well as CBT), from which emerge the main approaches to treatment, and techniques and resilience building skills. Collaboration is key as the approach depends upon the client willingly engaging in the practice of techniques and alternative behaviours.  By the time a client reaches out for therapy, however, there is often motivation for change. 

Eco-anxiety/distress often presents as a ‘stuck’ focus of attention, where thoughts are dominated by the past or the future, where experiential avoidance is prevalent along with fusion about the meaning of the negative autosuggestions (negative automatic thoughts) you might be giving yourself, along with a range of cognitive distortions. You may find it difficult to observe your own thoughts and feelings, and consequently tend to become attached to your own conceptualisation of yourself based on your ‘stuck’ focus (I’m an eco-anxious person; I’m scared, I’m a worrier etc) – and so you increasingly associate with the content of your thoughts and feelings. Consequently, it’s difficult to have any real clarity about what is important to you – your values – and therefore it is difficult to act in service of those values.  What often happens is that the environment becomes either the dominant value or pervades all other values to the extent that it becomes paralysing and you may find you are unable to actively engage with other values. Ironically, through avoidant behaviour you may even stop engaging with the very thing you value most highly – nature and the environment.

The dominance often of future thinking, and fear of the future, while not an unnatural response to climate change, is not very helpful if it results in excessive worry. The extent of worry is such that it often manifests itself through metacognitions (thoughts about thoughts; beliefs about beliefs). You may, for example, find yourself getting anxious about being anxious (which feeds into experiential avoidance as a coping strategy). Metacognitive therapeutic approaches, notably detached mindfulness and attention training, overlap helpfully with and complement ACT mindfulness and values techniques in this context.

Intolerance of uncertainty frequently manifests as a stuck focus of attention on the emotional response being experienced (anxious, angry….), and the uncertainty inherent in the consequences of climate change for the world and individually. The resulting lack of psychological flexibility makes it increasingly difficult to switch attention away from this and to the present moment and more helpful action.  In fact, an unconscious metacognitive belief in the power of thinking (and of checking/monitoring) often leads into excessive worry and ‘doomscrolling’ through social media and newsfeeds for negative news, reinforcing anxiety, anger, and/or sadness and creating excessive vicious cycles/spirals.

What to expect with treatment…

In my approach I draw upon three main components:

• ACT[2]– conceptualisation, values, committed action and simple informal mindfulness techniques for present moment awareness, acceptance, defusion and being an observer of self (including self-compassion)

• MCT[3] – conceptualisation, attention training to ‘unstick’ and reinforce switching of attention; detached mindfulness to let go of negative thoughts; and ability to be more mindful

• Hypnosis for confidence in one’s own ability to be more mindful, to do committed action in service of values (includes environment, but not the only thing that’s important)

So, for me, the focus for treatment is not primarily on channelling the negative emotion into positive action for the environment, positive though that can be. There are some potential benefits to be found in acting individually and collectively in pro-environmental behaviour and campaigns to further climate change action.  However, one potential problem with that is that it may not help gain sufficient perspective, and may even serve to exacerbate the focus of attention on the single value and the struggle.  And it may be that in trying out forms of action that are not consistent with other personal values, e.g. confrontational demonstrations/campaigns, especially for someone who is more pacifist in their approach, may cause a spiral of helplessness and hopelessness, despair and depression. 

Action for the environment can, however, fit as part of wider committed action in service of multiple values (e.g. connecting with friends, community, nature), e.g. volunteering at a nature reserve or animal sanctuary, doing practical action that makes a tangible and visible difference on the ground and is situated within the new-found perspective.

Finding hope….

This approach has been developed with clients and has had real beneficial effects with those I’ve worked with, many of whom have been able to gain perspective and find joy in life again, while still caring passionately about the environment and climate change. For those suffering with eco-distress, there is hope in seeking treatment, and it can make a real difference over quite a short period of time. A typical treatment programme for eco-distress with me is likely to occur over 6-10 sessions (sometimes fewer, sometimes more and spread out over several months), to help build greater resilience and psychological flexibility.  Rest assured, concern for the environment and climate change won’t go away – nor should it.  But it can be held more kindly in a broader perspective of values, alongside other things that are important to you in life, for life to be meaningful.

If any of this resonates with you, then do reach out and get in touch – it can make all the difference.

by Bill Sheate, 17 April 2024

Endnotes

[1] Transdiagnostic refers to a mechanism which is present across ‘disorders’, and which is either a risk factor or a maintaining factor for the ‘disorder’. Transdiagnostic processes are found in the domains of attention, memory/imagery, thinking, reasoning, and behaviour (Psychology Tools, n.d. Information Handout). By focusing on transdiagnostic processes we can seek to address the underlying causes rather than being overly focused on ‘disordered’ experiences (see Labelling Issues: the Pros and Cons blog post).

[2] Acceptance and Commitment Therapy

[3] Metacognitive Therapy