As climate change worsens and public awareness of its grave impact increases, individuals are increasingly experiencing distressing mental health symptoms which are often grouped under the umbrella term of eco-anxiety. Interventions for the treatment of eco-anxiety are proposed.
eco-anxiety;climate anxiety;climate change;therapeutic approaches;psychological interventions
The impact of climate change, the “unfamiliar, human-induced changes in atmosphere and depletion in biodiversity and other natural systems” 
(p. 27) manifesting through significant changes in the planet’s temperature, wind patterns, rainfall, and other measures of climate 
, is becoming more and more apparent. This impact is both actual and predicted [3,4]
. Indeed, current scientific consensus states that global warming is occurring and will continue to occur, with profound effects on public and environmental health 
. Individuals increasingly wrestle with visions of a future life with more extreme weather events, higher temperatures, increased respiratory illness, changes in water and food availability, mass displacement of populations, and the pain of imagining the devastation and loss of familiar environments [5,6,7]
. In fact, the 2019 United Nations Climate Summit in New York named climate change as the defining issue of our time 
Public awareness of the effects of climate change is rising due to growing media coverage and the release of alarming reports and warnings by major organizations like the United Nations and the World Health Organization [6,9]
. The Yale Program on Climate Change Communication found in 2018 that “69% of Americans worry about global warming, and 49% believe it will harm them personally” 
(p. 13). Across the world, survey data from the Australian youth mental health organization ReachOut revealed that four out of five students felt somewhat or very anxious about climate change. Half of the students further reported that they experienced these emotions on a weekly basis 
Research confirms that our collective sense of a looming climate change-related threat is taking a significant toll on our mental health 
. Recent studies [12,13]
point to a surge in the psychological distress associated with “awareness of the overarching problem humans face as a result of global climate change” 
(p. 7) 
. The International Psychoanalytical Association now names climate change as the greatest global health threat of the 21st century 
. Though research on this specific form of distress is still in its infancy, the umbrella term of eco-anxiety, which is not yet listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), is emerging as a key term.
The term is used to describe the emotional and mental states associated with heightened awareness of climate change and concurrent distress in the face of its threatening implications for the future 
. The American Psychological Association describes it as a “chronic fear of environmental doom” 
(p. 68). Psychologist Renee Lertzman refers to the experience as “environmental melancholia- a combined sense of primal loss and paralyzing powerlessness” (as quoted by Dockett 
, (p. 11)) while environmental philosopher and professor of sustainability Glenn Albrecht 
categorizes it as a form of “psychoterratic illness…(an) earth-related mental illness where people’s mental wellbeing… is threatened by the severing of ‘healthy’ links between themselves and their home” (p. 95).
Though the term eco-anxiety certainly implies the presence of anxiety as a key symptom, individuals who suffer from it experience a constellation of emotions 
including fear, anger, exhaustion, powerlessness, feelings of loss, helplessness [19,20]
, and even phobia and despair 
. Lise Van Susteren, a psychiatrist specialized in the psychological effects of climate change, sees eco-anxiety as a form of “pre-traumatic stress disorder” (as cited in Kerecman Myers 
, (p. 3)), in which traumatic consequences are anticipated and felt before the event even takes place. Kaplan 
has similarly explored the traumatizing power of anticipation in relation to climate change and the possibility of an emerging “Pre-Traumatic Stress Syndrome” (p. 81), including symptoms like flash-forwards, fear-induced dissociation, and nightmares.
The need for informed professionals certainly seems more pressing than ever, as the prevalence of eco-anxiety and demand for its treatment are on the incline. The UK-based Climate Psychology Alliance reported in 2019 that it was “inundated with requests for therapeutic support” 
while US-based grief support organization The Good Grief Network, which coordinates support groups for eco-anxiety, reported that the last 6 months of 2019 saw a surge of interest in their activities “with branches popping up in half a dozen states” 
Many mental health professionals have called for an increase in awareness of and training for eco-anxiety [5,15,25,26]
. Despite the apparent and increasing demand for therapeutic support and the projection that climate change will only continue to loom larger and larger in collective awareness, very little existing literature seems to address relevant and specific therapeutic interventions for eco-anxiety. It is therefore key to start assembling a clear picture of appropriate interventions and approaches to enable these professionals to make informed choices in their eco-anxiety treatment plans.
2. Current Insights on Interventions for Treatment of Eco-Anxiety
The entry identified interventions for the treatment of eco-anxiety and found the fields of psychoanalysis, ecotherapy, and Jungian depth psychology to be the most prevalent psychological approaches. Only two studies evaluating some of these interventions were available.
These results seem to suggest that treatment for eco-anxiety could embrace a holistic model, reliant on two facets: firstly, evenly addressing different elements and layers of the client’s inner experience and secondly, creating connections between client, practitioner, groups, and nature. In fact, the egalitarian spread of proposed interventions across different microsystems (client and their inner selves, practitioner and their inner selves, client and practitioner, practitioner and professional groups, client and groups, client and nature) mirrors the message contained in many of the papers reviewed, namely that healing both our natural environment and our eco-anxiety must involve a shift away from human and individual-centeredness towards the balanced spreading out of power and attention between the individual, community, and the natural world. Moreover, many of the interventions put forth in this entry do not merely focus on helping clients manage their distress but also encourage them to get in touch with something greater than themselves, to access a numinous experience of the world. This is evidenced by the repeated appearance of mindfulness, grief rituals, creative expression, and encouragements to connect with art and literature and to commune with nature [7,12,13,26,37,45,51,52,53]
. These are all types of interventions that can bring individuals into deep experiences of grace and stretch the notions of individuality into one of greater systems of connection and healing. It is notable that, interventions focused solely on connecting clients with nature were present in a quarter of papers (26%), staking nature’s claim as a solid participant in the healing of people.
The high number of proposed interventions centered on the professional’s own reflection on climate change and on adequate training (34%) similarly conveys an important message. It suggests that much like ecologically-oriented action asks every member of the collective to take on their share of responsibility, treatment for eco-anxiety should be democratic and place the practitioner face to face with their own “social and environmental embeddedness” (as cited in Stewart 
, (p. 78)). Seaman’s study 
further reports that the “therapists’ own emotional reactions to climate change may impact how they receive and respond to clients who discuss climate change during therapy” (p. 46). Many authors emphasize the need for practitioners to make their practice a space in which eco-anxiety can truly be welcomed and not minimized, explained away as a distraction from personal themes, or blocked off because of the professional’s own anxieties [30,32,33,44,45,53]
. With regards to training, many papers push for practitioners to acquire more familiarity and skills with regards to both the impacts of climate change and the eco-anxiety process [7,16,26,30,33,42,44,45,53]
. Doherty and Clayton 
postulate that mental health professionals “have an ethical obligation to take immediate steps to minimize harm, reduce disparities in climate impacts, and continually improve their climate-related interventions” 
(p. 266). Practitioners themselves support this view, as 50% of the therapists interviewed felt that they were not adequately prepared to deal with eco-anxiety, even though 37.3% felt that climate change was relevant both to their work and their field 
The entry found a high number of proposed interventions involving groups. Unsurprisingly, since mental health interventions often involve connecting the client with inner resources, most records (89%) stressed interventions focused on fostering clients’ inner resilience. However, the degree of presence (62%) of interventions aimed at connecting clients with groups—specifically those groups intent on providing social connection and emotional support rather than groups oriented towards action—is perhaps more surprising. Many group endeavors and organizations focused on actively mitigating climate change have bloomed as public awareness of its consequences has increased (Extinction Rebellion, Plastic Pollution Coalition, among others) but these groups are mostly focused on helping individuals take action. This usually involves making lifestyle changes, engaging politically, or spreading an ecological message. These groups seem to place little emphasis on the emotional experience of feeling distress over our changing climate.
However, this entry’s findings reflect a strong theme present across many papers namely that, in order to engage with eco-anxiety, it is just as vital to provide a space for the expression of emotion as it is to act [13,16,26,32,33,37,39,41,45,49,50,55]
. The authors cited above seem to concur on a treatment process for eco-anxiety whereby practitioners first provide clients with a safe, containing space in individual or group treatment models in which distressing, and sometimes paradoxical emotions and ideas can be felt and thought through, after which clients can naturally flow into actions that align with their values. Climate anxiety researcher Pikhala 
and psychoanalyst Randall 
particularly draw attention to the misguidedness of pushing clients too quickly into action. Pihkala 
bemoans the oft-adopted model that “the antidote to anxiety is action” (p. 11) and Randall explains that a focus on guiding clients towards ecological lifestyles changes without first addressing the immense losses and attacks on identity those changes will catalyze is doomed to fail 
According to this entry, established groups and organizations have a crucial role to play in providing this supportive collective environment. Randall’s Carbon Conversations group model and Joanna Macy’s The Work that Reconnects are appraised in consistently laudatory terms by authors [13,26,33,37,42,50,55]
and by participants, in great part because of their capacity to provide an emotional safe space for participants. These two models could therefore function as blueprints for group treatment of eco-anxiety.
These 14 records also highlight the need for mental health professionals treating eco-anxiety to be familiar with the general process of grief, with authors especially concurring on the value of Worden’s model of the tasks of grief. The Good Grief Network 
and Randall 
also offer their own multi-step blueprints for moving through the experience. The presence of these models seems to cement the conceptualization of eco-anxiety as a process through which an individual can be accompanied.
The 14 records equally point to the importance of understanding the specific kinds of grief underlying eco-anxiety. Two authors [10,13]
notably offer their proposal that eco-anxiety is a form of disenfranchised grief, thus requiring both that practitioners be familiar with the concept and that they be prepared to offer the required heightened level of support that must accompany a grief that is deemed not socially acceptable. Fittingly, three authors recommend group mourning rituals [7,45,53]
in an effort to spread the weight of the grief process and to provide participants with the experience of being seen and validated by the collective in their pain. The literature identified in this entry repeatedly highlights the tension between the individual and the collective, namely the line betweenwhat is personal pain and responsibility, and what can and should be shouldered by a greater group of peers.
Four authors identified in the entry [13,16,42,53]
refer to the traumatic component of eco-anxiety, with Bednarek 
and Pihkala 
specifically confirming Van Susteren (as cited in Kerecman Myers 
) and Kaplan’s 
conceptualization of eco-anxiety as a form of anticipatory trauma. However, these authors focus on the need for practitioners to familiarize themselves with this kind of trauma rather than proposing specific, trauma-informed interventions. This illustrates a larger finding of the entry, namely a great disparity in the level of specificity of interventions proposed across the records reviewed. Some interventions are highly targeted, for example Randall’s recommendation that mental health professionals provide psychoeducation on the dynamics of unconscious collective guilt 
or Hasbach’s ecotherapy intervention whereby clients identify a space in nature that they like and visit it regularly to build a nurturing relationship with it 
. Other interventions are far more general, as evidenced by Davenport’s recommendation that clients should be encouraged to cultivate community connection 
or the Good Grief Network’s vague exhortation to eco-anxious individuals that they “do inner work” 
(p. 3). This disparity could be due to two factors. First, more than half of the records reviewed take a holistic approach to eco-anxiety, proposing many interventions that address the subject from a variety of different angles rather than exploring a few interventions in depth. Second, most of the records identified in the entry are reflections on the general subject of eco-anxiety which happen to mention interventions rather than papers or studies pointedly addressing or measuring treatment interventions for eco-anxiety.
The dearth of studies evaluating any of the proposed interventions highlights a major gap in the literature. Only two studies were identified that evaluated interventions. Gillespie’s 
study evaluated a dreamwork-oriented group process and Büchs et al.’s 
study assessed the effects of participating in Carbon Conversations groups. The encouraging results of these studies reaffirm the value of some of the interventions proposed by authors, most of all the power of groupwork, and make a strong case for increasing the evaluation of other, yet-unassessed treatment possibilities to create a strong, evidence-based foundation. These two studies also shared a compelling finding. Aside from helping participants to process complex and sometimes contradictory emotions and to gain insight and grounding from others’ perspectives, both Gillespie’s group and Büchs, Hinton and Smith’s Carbon Conversation sample found that the group process had positively affected participants’ ability and willingness to take tangible, ecologically-minded action. Indeed, Gillespie 
explains that “as a result (of the group process) we felt better equipped and more motivated to work with others to engage with global warming issues” (p. 353). Büchs et al. 
“found evidence that …Carbon Conversations…has helped many participants to engage with these issues more deeply and take- sometimes quite radical- carbon reducing actions in multiple areas” (p. 636) and that “several participants also report that taking part made them feel more confident in talking to and encouraging people in their personal networks to reduce their emissions, indicating that the impact of Carbon Conversations may extend beyond the direct participants” (p. 636). This shared finding could indicate that treating eco-anxiety through providing its sufferers with shared emotional space may have far greater impacts than merely helping individuals better tolerate their distress. It could also be an important part of helping people change their lives in a way that goes beyond the scope of mere treatment and shifts their relationship with the world. A wealth of literature is available on the complex topic of getting people to change their habits in line with sustainability goals, and studies like these could act as the bridge between strict behavioral conceptions of change and deeper, more holistic, and emotion-embracing approaches.
The entry identified a variety of interventions for both individual and group treatment. These interventions targeted many layers of individuals’ wellbeing, from inner experiences such as thought processes to connecting with others through sharing and rituals and to communing with the natural world. Recommendations for treatment plans are to focus on holistic, multi-pronged, and grief-informed approaches that include eco-anxiety-focused group work.