MARA GOVERMAN: More teens are saying they can't sleep because they're worried about the environment. Today, we're asking how do we respond to climate anxiety without pathologizing it?

JOSH FEDER: I'm Dr. Josh Feder, the editor-in-chief of The Carlat Child Psychiatry Report and co-author of The Child Medication Fact Book for Psychiatric Practice, second edition 2023, and our other book, Prescribing Psychotropics.

MARA GOVERMAN: And I’m Mara Goverman, a licensed clinical social worker in Southern California with a private practice and an avid reader of The Carlat Psychiatry Reports. Today, we're talking about climate anxiety, how it's showing up in young people, and how we can support them in session.

JOSH FEDER: We're basing this conversation on an interview we did with Dr. Laelia Benoit, who highlights that climate anxiety isn't like a typical anxiety disorder. Instead, it often stems from grief, grief about environmental loss.

MARA GOVERMAN: She calls it environmental grief, and that's a useful distinction. It's not about distorted thinking. It's a grounded emotional response to something real.

JOSH FEDER: She encourages us to meet kids where they are emotionally, not to minimize or distract from what they're feeling.

MARA GOVERMAN: And unlike general anxiety that might be disproportionate to the situation, this one often makes sense. When teens say they're afraid the world is falling apart, they're not exaggerating; they're responding to what they see and hear every day.

JOSH FEDER: They see it in their own environment. It's not like just echo chambers in the news. Let's talk about numbers for a minute, though. According to recent surveys, 75 to 80% of 15 to 25-year-olds are worried that climate change will affect their generation. Around 17% of teens say they've lost sleep over it (http://www.tinyurl.com/52cu4f3m). And I see that in my clinical practice, right? I mean, we in San Diego have had more heat; we can tell that our microclimate here at the coast in Southern California is changing; our wildfires are becoming more problematic; our air quality is worse. I mean, here's a lot of changes that we're just seeing, and of course, we're trying to help our patients to be able to meet the moment that they are presented with by our generation and the generations before us.

MARA GOVERMAN: For some patients, the sense of hopelessness or paralysis often comes from a lack of action or a feeling that individual efforts don't matter.

JOSH FEDER: And that's often reinforced at home. As Dr. Benoit points out, even though many adults say they're worried about climate change, they rarely talk about it with their kids. That silence can make kids feel dismissed or unsupported.

MARA GOVERMAN: Since COVID and the economic challenges that people face, it's a lot harder to volunteer and commit to climate change activities and committees.

JOSH FEDER: So parents might not really be getting engaged, how they otherwise might have been previously.

MARA GOVERMAN: And kids are not going to do that on their own.

JOSH FEDER: Right? Yeah, some will, yes. You have some kids who kind of rail against the machine, and we're going to do it differently. But here we're talking about them being kind of overwhelmed.

MARA GOVERMAN: It can also block action. If parents are invalidating the concern, the child may freeze or feel ashamed or feel like it's all on them to fix the problem.

JOSH FEDER: And we've seen that. Think about those PSAs with polar bears stranded on melting ice. They stir emotion, but then what do you do with that feeling?

MARA GOVERMAN: So what do we recommend in session? Dr. Benoit suggests promoting community-based action. Something as small as planting trees or insulating school buildings can help restore a sense of agency.

JOSH FEDER: Yeah, and we have to kind of do these things in a developmental way. So for a little kid, planting trees is hands-on and makes a lot of sense. For an older kid or maybe a teenager, it might be more political action, right? Advocacy, with your city, or your county, or your state, or even at the federal level.

MARA GOVERMAN: Or writing to your representatives in government. 

JOSH FEDER: Writing, marching, things like that. Getting people active so that they can be  more involved in the solutions. And, you know, I have this happen all the time, right? I've got patients who come in, and they're anxious about whatever's going on in the world, and I tell them. Let's think about what you can do to actually do something to be active so that you feel like you're working on this and part of the solution. And it does feel overwhelming, but there's really not a choice other than to kind of get engaged and work on these things. So my hope is always that they do this, and occasionally they get involved, but not always; and part of that is like what we were talking about earlier, will their parents have the bandwidth to help support them doing it, or to get involved themselves? You know the operating principle here is that action improves mood, and there's data to back that up. Studies show that young people who engage in climate advocacy report better well-being overall (Schwartz SEO et al, Curr Psych 2023;42(20):16708–16721).  

MARA GOVERMAN: There's also a developmental angle to this. Kids under five don't grasp the science, but they understand emotions. For them, it's about modeling calm, honest conversations. You can say, yes, the world is changing, and we can take care of it together.

JOSH FEDER: Yeah, you don't want to just put it on them alone, right? From five to twelve, kids begin to grasp cause and effect. They might start to recycle or want to reduce waste. Negative messages at this age can lead to sleep issues or rumination. So we frame things with possibilities and small steps.

MARA GOVERMAN: Adolescents, on the other hand, can think more abstractly. They see the global picture and often want to work on bigger projects: solar panels, climate marches, and environmental clubs.

JOSH FEDER: And they may need help navigating feelings that might overwhelm them. One tool is to ask, What can I do on my own that helps the planet and makes me feel better? What can I do with others?

MARA GOVERMAN: And they don't need to be perfect solutions; they need connection. Even just hearing I see what you're doing, and I admire it can shift the tone in a session.

JOSH FEDER: When I became co-chair of The Trauma and Disaster Committee of The American Academy of Child Adolescent Psychiatry, I had previously been serving as the international liaison to that committee, doing a lot of work with peace building with young children who are impacted by climate change and war all at the same time, and climate change that makes wars worse; all those kinds of things. One of my thoughts was, well, if I'm going to do this, I'd like to really focus on climate change as one of the things our trauma disaster committee could work on, because we're getting all these disasters, and then wars, and conflicts that are driven partly by climate change and things like that. And so I thought that would be my heavy lift, and what turned out to occur is that a lot of younger colleagues, mostly younger colleagues, took it upon themselves to create a climate committee, which we were able to support as part of our process in trauma and disaster, and they eventually, just last year, and in record speed, went from an interest group to a committee at The American Academy of Child Adolescent Psychiatry. So on the one hand, I really wanted this to happen. On the other hand, here were younger colleagues really taking the ball and running with it, doing all kinds of things, including testifying, and I say younger, they're not all younger. There are a few that are my age, older. But, it's just so gratifying to see them do that, and to see how their actions are effective and helpful, and also helping all of us to feel like we're doing something that's useful. And I think that kind of comes down to a principle of how do we stay calm to help families stay calm, so those families can help their kids stay calm, and part of that is getting involved ourselves in advocacy, so that we feel like we're doing something effective and meaningful.

MARA GOVERMAN: Another thing I was thinking about is, when is the appropriate time to explore those issues in session? And I guess if you come with a bio-psychosocial framework within the social framework, it's just asking, and in being curious with your client, what are some of the social action issues that give them anxiety, and how do we deal with that?

JOSH FEDER: I think you're right. And I'm thinking about colleagues who are like in their car listening to this and thinking, like, I have time to, right? Ask about that stuff. But I have to tell you two things. One is it comes up because kids bring it up a lot of times. But the other is that it's kind of on us to be touching base on, if you're only using like the heads, mnemonic: Home, Education, Activities, Drugs, and Sex/intimate relationships...

MARA GOVERMAN: And suicidality.

JOSH FEDER: Even suicidality? No. Well, that's a different mnemonic for a different part of the visit. But for the heads mnemonic, one of the things that comes in is, what are your activities? What's happening? Your interaction and relationship to the world around you? What are you seeing? And it's kind of open-ended, and then you can sort of see from there what's popping up on their radar to share with you. And it might be something about friends, it might be something about, you know, there was a flood in SE San Diego, world events, things like that. Every day there's something, and the question is, what are they looking at? What are they doomscrolling? And are they, are they going to talk a little bit about it?

MARA GOVERMAN: And that just opens up the discussion for skill building and coping skills and managing anxiety, and how they're doing with that. So it's just a different way of seeing what's happening underneath, and how they manage all of the background noise.

JOSH FEDER: Right. And from your perspective as a therapist, you can lie back and kind of explore that and pick it apart. If I'm doing a med check, I can at least tag it and talk to the therapist about it. If I'm doing therapy, which I do a lot of, I can lie back and talk about it and think about it. And if I'm somewhere in between, usually there are things, and we have to have them in our back pocket to think about, well, what does this mean to you? And let's write this down as one of the things that you're concerned about, and we want to get a plan around how we address whatever that is. So, let's talk about assessing for climate anxiety. Dr. Benoit mentions asking teens how they picture their future, if they struggle to imagine one, or if climate fears dominate the picture; that's worth exploring.

MARA GOVERMAN: It also brings up the feeling of solastalgia. The sense of homesickness without leaving home. Some youth don't feel that personally, but their parents might. It's helpful to explore those family dynamics.

JOSH FEDER: So that's the idea that you once lived in a place where, well, here we are, where it was lush and now it's dry. Right? And you can't grow things as well. We're more of a desert in some partsof our country, and we worry more about water, things like that, and you think about the good old days when you could water your lawn and it would grow. Now you don't want to have a lawn because it'll burn up in the next fire and maybe take your house with it. So that's what solastalgia is. But I think this idea of asking people about how they picture their future fits in beautifully with our own favorite model of developmental relationship-based approaches that use functional, emotional, developmental capacities, meaning in any interaction, we're thinking about is the person calm enough to interact, and how do we co-regulate them? Are they connecting with us in a meaningful way? And is there a flow of interaction? And once that flow is going in, in any interaction, we're talking about including a med check, we're thinking about problem-solving the problem of the moment. And the med check goes How are things going for you? How are your medicines working for you? Do you have side effects? How's life going? But within that, there are different levels of functional, emotional, and developmental capacities, and as you move forward towards problem solving and logical problem solving, using symbolic thinking about the past and what happened, thinking about the future, how you'll do it differently, those kinds of things. Well, then it comes into these ideas about what that future looks like for me? Right. I can imagine, especially like teenagers, you think about what I want to be doing in a few years. Are you thinking about what happens after high school, for instance, or things like that? So that future thinking, ideally, is built into how we're thinking about kids in the moment anyway, and it'll naturally lead to the idea of climate anxiety, if that's part of what's going on. There was one example that Dr. Benoit gave of an autistic teen who became hyper-focused on reducing their family's carbon footprint. So he stopped using appliances and refused to go on vacation, and the parents thought it was obsessive, but it was kind of value-driven, right? It was in context, it worked out okay. So rather than seeing it as a symptom to treat, Dr. Benoit joined the teen's values, right? And the alliance opened the door to working on other, less adaptive behaviors that the team was engaging in.

MARA GOVERMAN: The takeaway: support what works, reduce what doesn't, and don't label every strong climate response as disordered or pathological.

JOSH FEDER: The bigger picture here is systemic. As adults, we need to stop treating youth concerns as something to be cured. The better response is to help them channel it, and to do our own part to reduce the actual problem.

MARA GOVERMAN: And that means clinicians, too. When we stay engaged and show up for the topic, we model resilience and we support kids, not just emotionally, but socially and ecologically. You can read more from Dr. Benoit in our April/May/June 2024 newsletter. We'll link it in the show notes. And if you found this episode valuable, which we hope you did, please share it with others who need to hear this message.

JOSH FEDER: Everything from Carlat Publishing is independently researched and produced.There's no funding from the pharmaceutical industry.

MARA GOVERMAN: The newsletters and books we produce depend entirely on reader support. There are no ads, and our authors don't receive industry funding, which helps us to bring you unbiased information that you can trust.

JOSH FEDER: Thanks to all of you for tuning into this episode. Again, like Mara said, if you found this discussion helpful, subscribe to more episodes on mental health and psychiatric care and tell your friends. Until next time, take care!