In this episode, Steph interviews Liz Marks about the upcoming special issue on climate change in the Cognitive Behaviour Therapist.

They discuss the origins of the special issue and chat a bit about the Climate Change Special Interest Group (SIG) within the BABCP. Liz also gives an overview of all papers in the special issue, covering topics such as eco distress, transdiagnostic approaches, compassion-focused therapy, acceptance and commitment therapy, environmental identity, active hope, and climate cafes.

Useful links:

tCBT Special Issue - CBT in a Time of Climate and Biodiversity Crises

Liz is part of the Bath Centre for Mindfulness and Community mission and an affiliate of CAST- The Centre for Climate and Social Transformations

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Transcript:

Hello. I welcome to let's talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT.

Today, I'm talking to Dr Liz Marks. Liz is a Guest Editor for our upcoming special issue “CBT in a time of climate and biodiversity crises”, which will be published later this summer in the Cognitive Behaviour Therapist.

Steph: Hi, Liz, welcome to the podcast.

Liz: Hi Steph. Thank you so much for having me on your podcast today.

Steph: You're welcome. So, before we get into the episode, would you tell us a bit about who you are and the work that you do?

Liz: Yeah, sure. So, I'm a senior lecturer at the University of Bath and I'm also a clinical psychologist, so I teach clinical psychology, but I also do a lot of research into relevant aspects of psychology and particularly CBT. So I'm also an accredited CBT therapist, I'm an MBCT trained mindfulness teacher and my work sort of covers all of those different aspects, both clinically and in terms of research.

Steph: So we're talking today, not just about one paper, but we're actually talking about several papers, which make the upcoming special issue in the Cognitive Behaviour Therapist. So this is a special issue on climate change, which you guest edit alongside Mandy Cole. Can you tell me a little bit about how the idea for the special issue came around?

Liz: Yeah, it's, it's really, interesting journey. I guess it sort of started in 2022, at the London conference. I don't know if you were there or your listeners were there, it was in the middle of that blistering heat wave. I had put in a symposium about climate change with Mark Williams at Cardiff and some others. And Mandy, who I didn't know at this point, had put in a request to run an interactive table. BABCP suggested we link up and have a round table, which is what we did. And that's where I met Mandy and also Claire Willsher who had been looking for some guidance from the organization around activism so Mandy and Claire were engaged in a consultation, with the BABCP members at the conference about what they wanted in relation to climate change and so that was all going on. And one of the things that happened was, Richard, Thwaites, who's the editor in chief at tCBT, spoke to Mandy there and asked if she might be interested in guest editing a special issue on climate change and me and Mandy, who had, who'd been talking at the conference, talked about that, and she asked me to join her, and that's kind of where it started.

Steph: Brilliant. Thank you. And did you want to talk a little bit about the climate change SIG? How many members do you have? What kind of goes on in the climate change SIG?

Liz: Yeah, okay. So the, the, climate change SIG was another outcome from this conference in 2022. And Mandy put in an application for the SIG at that point. It hadn't been successful previously, but it was accepted then. And, we were a temporary committee until 2023 when we had our first AGM and that was a conference in Cardiff. And now we've got over a hundred people.

Steph: Oh, wow.

Liz: and we, yeah, it's great. It's really exciting. It's building. And, so they, the SIG supported this special issue and we also are running various events. So we are running an event on eco therapy and CBT in September, we're supporting that and we're also going to be supporting the running of some climate cafes, which I can talk about a bit later as well.

One of the other really important things that came out of the conference and that goes beyond the SIG, in fact, is the climate statement that the BABCP have made about the organization's aspirations and guidance around climate change as a whole. I think it's really important to mention this. I'm not sure if your listeners will all be aware, but they made it really clear there that BABCP recognizes we're in a climate and ecological emergency and that we all need to take action on climate change, regardless of what our roles are. And recognizing that CBT has the tools to alleviate suffering, but that we also need to develop new ways of working. So I think that's really important and also is well aligned to what we're doing with the special issue.

And one last thing that SIG has done that's really interesting that your listeners might be interested in is that people in the Climate SIG have been interviewing the leaders of the organization about what they think is important about climate change. So President Saiqa Naz, President Elect Stirling Moorey, and the CEO, Tommy McIllravey, and they all talk about feeling passionately about climate change as individuals, as well as for the organization. So there's a real energy around this at the moment.

Steph: Okay. Brilliant. Thank you. So, if we get into talking about the special issue, then it's full title is CBT In A Time Of Climate And Biodiversity Crises. So it has eight papers in the issue, and it also starts with a really lovely introduction from yourself and Mandy, which really sets the context of the issue and how all the papers fit within it. Do you want to start talking a bit about some of the papers and why they're significant.

Liz: If I could just start by setting all of the papers in a particular context, which is the recognition that we are living at a time where we're facing significant threats and losses from climate change and the biodiversity crisis. And we wanted these papers to drive forward our understanding, offering original and pioneering ideas about what CBT can do in this context. And I think we, we talk about the distress that people might experience when aware or experiencing the impacts of climate change and related issues, which I will probably refer to as eco distress as we go through. but I, I think it's really important that this isn't some sort of diagnosis. It's referring to the experience of challenging thoughts and feelings in response to what is really happening, so just as we might have an emotional response when we are living with a chronic or terminal illness, and reality cognitions about that, we see that we're living with a, in a planet, who is also facing a chronic health condition, a sort of planetary health crisis and it's really important I think that we recognize that the thoughts and feelings that people have aren't pathological. They're actually showing a real awareness of what we're all facing.

Steph: The first paper that we were going to talk about was the paper with Mark Freeston and Claire Willsher. And this is quite an unusual paper in that it doesn't read as a research paper, but it is Claire's experiences as a climate change activist, and then Mark’s responses to her with the kind of academic evidence backing up her kind of personal insights. Do you want to talk a bit more about that and start us off?

Liz: Yeah, this is a really unique paper. And I think it's really helpful to set the scene as well because it ties our understanding of people's emotional responses to climate change. And so something I think that we can all relate to as kind of a citizen of the world of somebody who is aware about what's going on. But Claire brings to it the perspective of somebody both with the lived experience and with a psychological understanding as a CBT therapist, so she's able to reflect on her thoughts and feelings about climate change and how that shaped her decisions to engage with activism as well. She's very brave and open about her personal journey with difficult eco emotions and I think what, what Mark does really well is to show how and why these experiences might arise by linking them to different aspects of the evidence base and it's, it's really clearly shows how therapists are not going to be immune to climate change or the emotions that they elicit. And I think something that's maybe really relevant to a lot of CBT practitioners and more broadly to therapists around the world is, many of us go into this because we're tuned into suffering. And we, we wish to alleviate that suffering in some way we wish to show compassion and care for others. And something that climate change does is it, it threatens people's health and wellbeing, particularly people who are more vulnerable. So it may well be that people who are working in this area could even be particularly tuned into the painful emotions that elicits for themselves as well as others. And I think what this paper really beautifully shows is how important it is to make sure that therapists have the support that they need, and that the tools they could use for that around self-reflection, self-practice, supervision, personal and community support are all going to help them navigate their own eco emotions.

Steph: Brilliant. Thank you. So that's actually quite a hard paper to follow then, because as you say, it brings out a lot and will probably bring up quite a lot of personal feelings for CBT therapists too. So do you want to talk about some of the other papers in the issue now and kind of what comes up after this one?

Liz: Yeah, absolutely. And I guess just to speak to that point, Steph, I think what this paper really shows and maybe one of the key take home points from the whole special issue is that if therapists are going to be working with people who are reporting painful ecological emotions, then they are going to need to understand what their own response to the climate crisis is. If you're going to have the capacity to validate and, work with a patient on something really difficult, if that elicits something in you and you're not familiar with it, that's going to be really difficult for you. So there's this sense in which it's really important for all of us to know and understand how we're feeling.

Steph: Yeah, what a great point, thank you.

Liz: yeah, so the papers do cover a wide range of things. I think to, to start from sort of looking at this transdiagnostic perspective. So, moving away from this idea that maybe we need a, a new model or a new way of diagnosing eco distress, which I don't think is appropriate is that actually we can use existing ways of understanding distress, in different contexts and trans diagnostic processes are one of those. And Mark Freeston, has, has, with other colleagues, written a paper that looks at uncertainty intolerance and its relationship to eco distress, using empirical work and a statistical approach called network analysis- which I won't go into, but if you're interested, it is well explained in the paper. One of the things that's really interesting here is that although uncertainty can often be associated with more distress in certain conditions like anxiety problems, in terms of people who are experiencing eco distress, uncertainty actually seems to be associated with less distress. Which makes sense in a way, because if you're able to think, oh, maybe climate change isn't happening, maybe the worst outcomes are really uncertain, then you're going to feel less scared and less distressed. And I think that finding, which is different from what one might expect in other aspects of clinical research, emphasizes why it's important to do empirical work in this area and not just assume that things will translate directly. And the other thing that Mark's paper does is it replicates a lot of work that's been done elsewhere, that eco distress is quite strongly correlated with pro environmental behaviour. That is the behaviour that we all need to be adopting in order to see the social transitions that we need to see to reduce carbon emissions, so that really highlights why eco distress is perhaps motivating and important, and so we don't really…what we need to think about is not necessarily about getting rid of it, but rather navigating it, learning to relate to it differently.

Steph: Okay. So thank you for summing up Mark's papers so succinctly. How did these findings relate to any of the other papers that are in the special issue?

Liz: I think this idea around eco distress being not pathological, being understandable and potentially really important in terms of motivating pro environmental behaviour is really drawn out in a couple of papers that talk about third wave approaches and how we might adapt those, for working with eco emotions.

So Mark Williams and colleagues talk about compassion focused therapy and they focus interestingly on a group of people that maybe we don't normally think about as, as needing support, which is climate scientists. But just as healthcare workers were at the sharp end of working with the COVID pandemic, climate scientists are now on the front line of the climate crisis. They are the ones that are reading probably the scariest scientific findings and recent reports have shown that this is having an effect on, on their health and wellbeing. So CFT here is offered as a framework to help understand how this group of people might be feeling and how they can relate more kindly to their experiences, without, without necessarily saying that they shouldn't be feeling that way. And another, model that's quite useful about thinking about how we relate to emotions and distress is of course ACT, Acceptance And Commitment Therapy, and Mark and Victoria Samuels then explore adapting ACT for eco distress, and how it could be used to increase flexibility, openness, and a more aware relationship with experience and also how that pertains to the values that people hold. And I think understanding values and meaning is so essential to understanding eco distress, because often people will feel distressed because they recognize that the things that they hold dear the things that they really value, like, fairness in society or protecting the natural world, are really threatened by climate change and its drivers. And, and I suppose building on that is a paper by Ines Zevallos Labarthe and myself, where we explore this idea of moral injury or moral distress. I don't know how familiar your listeners will be with that. It may have, they may have come across it in work with veterans or again, healthcare workers, but it's where we either witness or even perpetrate something that violates our core values, our core moral codes and the findings from this paper suggests that, at least some aspects, and for some people, a lot of the experience of eco distress is driven by this sense of relational betrayal and moral distress because governments and those in power are failing to act in line with science. And that is causing them distress and anguish. And again, that perhaps is particularly interesting because it has ramifications for what we do as CBT therapists in the room and how we understand the distress, but actually beyond that. So, you know, some might argue that by not acting in line with the science, governments and people in power are failing to protect human rights. You know, the right to safe life, and an argument that was actually mentioned in a recent legal case is the right not to be subjected to cruel, inhuman, or degrading treatment that causes anguish, and one could potentially argue that moral injury is a form of anguish. So these are some of these new ideas that I think need drawing out and further investigation, but it's sort of pointing the way towards why this area of research is so important beyond CBT as well.

Steph: one thing struck me when you were talking about one of the papers there about the climate scientists was not just that they must be reading really the scariest facts and figures and having the knowledge about what is going to happen to the world, but also the backlash that they must face against that as well and so many people telling them that they're wrong or that they don't believe them. That must be really difficult.

Liz: Yeah, I think that must be very difficult and I think there is a real challenge in this area about how we communicate and what we communicate to people, you know, as I said, right at the start, becoming aware of this stuff can be really scary and it can feel extremely overwhelming. So to expect people to turn towards and absorb all of the information that's being given to them may be a really big ask. As the science seems to suggest that people who are more aware and have greater proximity to climate change, both cognitively and experientially tend to report higher levels of distress. And that's why it's so important to, you know, outside of the therapy room. Think, okay, well, this is going to be happening more and more, how can we support this? This distress. So people feel able to turn towards this and make the changes that we need to see. It's, it's a really, really, really important issue.

Steph: And were there any kind of surprise findings or insights that emerged from contributions to this issue that you maybe hadn't expected?

Liz: Yeah, I think there are, there are three other papers that offer some really interesting new perspectives that I think some listeners may not have come across. And these are ideas around environmental identity, a type of eco therapy known as active hope and climate cafes. I'll just talk about them each briefly cause, cause they're related, but they're a bit different.

So Thomas Doherty and colleagues describe a case study where they talk about environmental identity which means how people see themselves in relation to the world. It's akin to this idea of nature connectedness, and how much part of nature you feel, how important the natural world has been in your upbringing, in your daily life. It isn't relevant for everyone. I think that's important, but for some people, it's actually a really big driver of their distress and also perhaps their motivation and inspiration to be involved or get active or be an activist. And he explains ways in which you can bring environmental identity into the awareness of someone and use it as part of formulation and use it to support your therapy in really helpful ways, that can actually mitigate the distress by again aligning values and action. So that was really interesting. And then Rosie Jones and Chris Johnston describe a methodology that that already exists called active hope, and it involves cognitive work, but also, systems thinking ecology, wisdom traditions, and things that may seem really far out there for CBT therapists, but what they do beautifully is they align the processes and proposed mechanisms of active hope with CBT. And you can see there are really strong resonances between the two. And by doing this, they show kind of skills and ideas for bringing nature into therapy in a way that's consistent with CBT and also offer new ways of working with eco distress, some of which may actually feel like they could fit in quite well with your standard process. And both of these, I think point to why CBT perhaps needs to start to learn a bit more about the profound relationship between human and planetary health.

And then the last, the last paper is one that I wrote with, Luis Calabria. And this is about, again, taking these ideas outside of the therapy room and into the community. So if this distress is going to be something that isn't necessarily clinical, but it's widespread because it's something we're all facing, we need to find ways of helping people to navigate their emotions, perhaps in new and more accessible ways. And climate cafes are a space that are held in a non-clinical setting, lightly facilitated where people come and just talk about how they feel about climate change. So it's not an action space, it's a feeling space and this research was qualitative and looked at people's experiences. And what it showed is that just by sharing how you feel with a group of people who, perhaps feel similarly, could really normalize the distress and, and build a sense of community. So moving away from a lot of the isolation that people often feel when they're worried about climate change. But it also seemed to help people build a sense of compassion for themselves and for others. And even for others who maybe don't believe in climate change or have a different point of view and that really alleviated some of the most distressing aspects of what they were experiencing. But none of these things will cure eco distress because that's really not what we can do. The only thing that cures eco distress is going to be if we stop climate change, which means we stop burning fossil fuels and that we protect the natural world. That's, that's the cure for eco distress, but we can find ways to live well with it and we can find a way to be resilient in the face of these challenges and we can find a way to actually use it to motivate us to move towards the kind of changes we probably all want to see regardless of who we are.

Steph: great. Thank you. Well, in the special issue, there are so many great papers that have come out of that, and they cover such a wide range of topics and let you say some surprising ones, some maybe slightly left field ones and some kind of really empirical evidence as well. So it's a great issue and I really, really recommend that people go and read everything in the special issue, not just the ones that they might pique their interest because there are some really, really good bits of information in there. so I was just going to ask you, what was it like being the guest editor of a special issue? How did you and Mandy commission the papers you wanted to include? How did you find the experience?

Liz: it was really fun and, and exciting and hard work, but good hard work.so Mandy and I met quite a few times over a few months to identify people working in the area, who might have, have, some, some work or some ideas that they would like to publish with us. and we, planned a sort of two-phase approach. And one was to invite people that we had identified as doing really relevant work. and then to put out a call for papers. but we had an overwhelmingly positive response from everyone that we invited. So, we ended up with these eight papers, without needing to go to a call for papers. So that's what we have in the special issue now and with incredible support from you in particular, Steph, helping us navigate the whole thing and, and also from Richard, which really allowed us to kind of do everything smoothly. So if anyone's got an idea or is thinking about it, I'd really recommend it. Cause, it was a really interesting, and exciting thing to do.

Steph: Great. It's great to hear that you really enjoyed it cause we love doing special issues at tCBT cause they're just a really great way to get really good ideas together in a really nice, coherent way. And I'm glad that this issue really came together really well.

Liz: I think it works for these kind of areas which are new and emerging, and you can sort of start to pull things together and start to kind of get a bit of a map of the landscape and all of the places in the landscape that definitely need more research, which is most of this landscape, I would say.

Steph: And this leads quite nicely into my next question then, which I think we've touched on already. What's the impact that you hope that the special issue will have on the world of CBT? What do you think CBT therapists can learn from this?

Liz: Yeah, I mean, I'll go back to my first point, which is, I really hope that what people will take away from this is that the reality upon which the distress about climate change and ecological degradation is happening is terrifying. People are suffering. There, there is, there's already been a great amount of loss. Vulnerable and more marginalized people are suffering the worst impacts already. And this is going to get worse. These are the predictions and that that's scary. And so feeling scared, feeling anxious, feeling grief about what has been lost, feeling angry about inaction, even feeling guilty or ashamed yourself. I mean, living in the Western world, it's, it's quite difficult not to have a carbon footprint, all of these are really understandable and rational feelings, and I, I really hope that that is what people will, will take away. And I think it may be going, you know, beyond, or outside of climate change is maybe this speaks to a wider issue in CBT, where perhaps it's thinking about moving a little bit away from a medical model of distress that has its place. It's really useful and it's very familiar. So it's not about getting rid of that, but it's about perhaps bringing in a new perspective as well. And we see that in transdiagnostic approaches, versus disorder specific models. And that it's possible to understand and respond to distress without medicalizing it and that's important when we're thinking about, like I said, maybe there are plenty of ordinary people who won't meet any kind of clinical criteria, but who are distressed and might benefit from new ways of thinking about this. So it brings up some interesting ideas about what the role of a scientist practitioner is and what CBT is for and what it can look like.

And that isn't about reinventing the wheel, we've got incredible models and skills and techniques, but it's about maybe using them in slightly different ways. I guess, I hope that the data driven technical papers will appeal to those who are interested in the technical aspects of CBT that's there for, for them, shows it's grounded in a scientific basis and I hope for practitioners, it'll help them see why it's relevant, what they might need to take care of themselves, maybe to think about asking about it when they meet a client who's in distress, particularly younger people, it seems to be more relevant to them. And yeah, so to start to integrate some of those ideas in, in formulation assessment and practice. And then maybe it's relevant outside of the world of CBT, outside of the world of therapists, to people who are involved in working in climate change, charities, scientists, the wider world thinking about maybe we need a bit more emotional literacy to support our resilience in the face of climate change, to think about how we communicate what's going on and how we support the, the people that, that are distressed about it and that it's not just a negative thing, that eco distress may well be a guiding light that can help us move towards living in a way that supports our values and supports a kind of just and sustainable world.

 Steph: what do you see as the next steps or future directions for research in this area?

Liz: I think it's wide open and I think that's really exciting. I think we need an army of people to start working on this. So we've got lots of theoretical papers suggesting the types of mechanisms and processes that, that might be helpful and that needs testing. We've got ideas about interventions that might help. And that needs testing too. I think we need more clarity around what eco distress is, when eco emotions turn into something that's more debilitating and why I think we need to consider what a good outcome might be for someone who's eco distressed. If it's not about getting rid of all of the emotions or even the distress itself. And I think thinking about the importance of the relationship with the natural world, there's loads to do.

Steph: Yeah, that's like a whole other special issue, isn't it, on future research and things we can do.

Liz: Yeah. Yeah, maybe, maybe.

Steph: Well, maybe we'll be back here in a few years’ time building on what you've done before and what's come next. That would be really exciting if we could get together again to talk about different changes that have happened in CBT since this special issue.

Liz: Yeah. I'd love that.

Steph: Yeah.

Liz: that'd be great.

Steph: and so very finally, do you have any further work coming up that you'd like to talk about anything you want to plug while we're here?

Liz: I'm working with a colleague in the States at the moment, Susan Clayton, and we're developing a way of measuring moral injury in relation to climate change. So we're hoping to get that out in the next few months. I'm thinking about developing some work around enhancing resilience in young people with eco distress, particularly based on third wave CBT type approaches and I'm working on a grant at the moment with people at the University of Bath, looking at how young people, and their shared values are related to their wellbeing for environmental behaviour and ecological emotions. So those are things that are in the pipeline at the moment.

Steph: Great. And I'd also really recommend anyone who is interested in the climate change to come seek you out and have a chat to you at the conference as well which is coming up next week in Manchester.

Liz: yeah, absolutely. So we will have a climate change table and, Mandy and I will be there and lots of other members of the SIG will be on the table. And we've also got a symposium there on the Wednesday, so please come along. yeah, the more members, the merrier. We're very friendly.

Steph: Brilliant. So Liz, thank you so much for talking to me today. This has been brilliant.

Liz: Ah, thank you. It's been a real pleasure, Steph, and, and thank you very much for, supporting this, this special issue and bringing climate change into greater awareness of the BABCP and its membership.

Steph: No problem.

Thanks so much for listening. If you enjoyed this episode, then please rate, review and subscribe wherever you get your podcasts. And you can follow us on Twitter @BABCPpodcasts.

If you have any feedback or suggestions for future episodes, then I'd love to hear from you. Email us at [email protected]. And why not check out our sister podcast, Let's talk about CBT- Practice Matters. This is hosted by the lovely Rachel Handley. And it's the perfect podcast for clinicians working in CBT. Thanks for tuning again, and I'll see you next time on research matters. Bye.