This programme is a treatment manual written for mental health professionals. It assumes clinical training, practical experience of cognitive behavioural therapy, and a supervision framework. It replaces neither your clinical judgement nor your professional responsibility. Diagnostic criteria are reformulated in our own words and never reproduced: refer to the original manuals for the wording itself. It is not written for the people concerned: if you are going through a crisis or thinking about suicide, contact your country's emergency services or a helpline.
1. The programme at a glance
Indication. Distress linked to the climate and environmental crisis that takes over life — time, sleep, work or studies, relationships, decisions —, in an adolescent from the age of fifteen or in an adult, with no diagnosable disorder that would explain it better. The programme is meant neither for proportionate worry, which does not call for treatment, nor for an established anxiety or depressive disorder, which falls under its own protocol (section 3).
Reference model. There is no reference treatment for eco-anxiety. At the time of writing this manual, we found only one controlled trial, a pilot one, of a psychotherapy for this distress in adults (Lindhe et al., 2023; section 11). The programme therefore assembles four components whose effectiveness is established in other indications, and it says so: cognitive and behavioural work on worry and rumination, taken from the treatment of generalised anxiety; acceptance of emotions and commitment in line with values, taken from acceptance and commitment therapy; behavioural activation, taken from the treatment of depression; and collective action, understood as a form of meaning-focused coping, that is, coping that draws on one's values and goals rather than on removing the problem (section 6).
Format. Ten weekly sessions, individual or in a group. Individually, they last 50 to 60 minutes. In a group of six to ten people, they last 90 minutes, and session 1 takes place as an individual interview with each participant before the first meeting. Three booster sessions follow, at one, three and six months. Section 14 justifies this total.
Mechanism targeted. Not making the concern disappear, since it has a real object, but four changes: that rumination and checking the news stop taking hours; that the emotions — fear, sadness, anger, guilt — can be felt without being fled or brooded over; that the person gets back the activities and relationships the distress has pushed aside; and that they act, if they choose to, in a way that has meaning for them and does not wear them out.
| Session |
Focus |
Session output |
| 1 |
Assess and situate |
Situation decided, risk assessed, baseline measures |
| 2 |
Understanding the circle |
Circle drawn, goals written |
| 3 |
Information |
Written information plan |
| 4 |
Worry and rumination |
Sorting done, fixed time chosen |
| 5 |
Making room for emotions |
One emotion gone through in session |
| 6 |
What matters |
Three values, one action for each |
| 7 |
Acting on one's own scale |
Activities and actions chosen, dated |
| 8 |
Acting with others |
A collective step chosen, or ruled out by decision |
| 9 |
The future and uncertainty |
A decision examined, a conversation prepared |
| 10 |
Review, plan, relapse |
Measures repeated, plan written |
What the person takes away. Nine printable worksheets, listed in section 35: my week with the climate, my circle and my emotions, my information, what depends on me, making room, what matters to me, the future and talking about it, the corner for those close to you, my plan for what comes next.
What sets this programme apart from the other manuals on this site. Three things. It begins by deciding whether treatment is needed: many people who are worried about the climate need no protocol at all, and others need a different manual. Unlike the treatment of generalised anxiety, it does not try to correct the worry, because its object is real; it treats the hold the worry has taken. And it makes action, individual or collective, part of the care, without ever turning it into a duty.
2. Before you begin
The four preliminary decisions
Is treatment needed? This is the most important decision in the manual, and it is made in session 1. A worry about the climate, even a strong one, is not a symptom: it becomes an indication when it takes over life (section 3). A person who worries, keeps informed, acts and sleeps does not need this programme.
Is there a diagnosable disorder? When the worry spills far beyond the climate, or when mood has collapsed beyond this theme, the picture falls under another manual (sections 3 and 8).
Is there a risk? Despair about the collective future is common in this indication; it can turn into personal despair, and this has to be looked for explicitly (section 9).
Has the person been directly affected? A flood, a fire, a drought that ruined a farm, a home lost: this is no longer the same suffering, and it is no longer the same programme (sections 3 and 30).
What this programme does not treat
It does not treat a proportionate worry. Treating it as a disorder would be a mistake, and sometimes a failing (section 34).
It does not, on its own, treat a diagnosable anxiety or depressive disorder. The disorder is treated with its own protocol: Treating generalised anxiety disorder in adults: a therapist's manual, Treating depression in adults: a therapist's manual, and, in adolescents, Treating anxiety in adolescents: a therapist's manual or Treating depression in children and adolescents: a therapist's manual. Some sessions of this programme can then be added to it (section 32).
It does not treat the trauma of a disaster lived through. That falls under Post-traumatic stress disorder in adults: a therapist's manual, or under Post-traumatic stress disorder in children and adolescents: a therapist's manual in young people.
It does not treat grief for a person. Ecological grief, which concerns landscapes, species or a future, is not prolonged grief disorder (section 4); the death of someone close, even one that occurred during a climate event, falls under Treating prolonged grief in adults: a therapist's manual.
It is not meant for children under fifteen. At that age, it is above all the adults around them, parents and teachers, who carry the work, and the few data available for this age group concern other formats (section 11).
How to use it
Read the whole manual before the first session, in particular sections 3, 6 and 14 — triage, the model and the therapist's stance —, then sections 26 to 28 before the sessions that draw on them. Each session is described with the same framework: the aim, the steps, what you say, the common errors, and the criterion for moving on.
Three warnings specific to this reason for consultation.
The drift that threatens most is debate. A session can pass very pleasantly in talking about the climate: the latest news, public policy, technologies, what other countries are doing. The person leaves stimulated, you leave with the feeling of having been useful, and nothing changes. Talking about the climate is not working on what the climate does to the person. The agenda is your protection (section 14).
The trap is symmetrical: reassuring or alarming. "It'll be fine" and "it's too late" are two opinions (section 14).
And your own relationship to the question matters. You yourself are worried, indifferent, committed or weary, and this colours what you hear and what you reply. The scoping review by Baudon and Jachens (2021), that is, a review that maps what has been published without assessing its effectiveness, makes the practitioner's work on themselves and their training one of the five themes shared by the approaches it lists (section 14).
3. Three situations not to confuse
The same words — "I'm eco-anxious", "the climate makes me anxious" — cover three situations that do not call for the same course of action. Most forms of eco-anxiety appear to be non-clinical (Pihkala, 2020), and Clayton (2020) insists on the need to distinguish an adaptive anxiety from one that no longer is. This manual sets out triage in three situations.
1. A proportionate worry
What you observe. The person worries when thinking about the climate crisis, is sad or angry about it, thinks about it often, keeps informed, has sometimes changed their habits, and talks about it with those around them. They sleep, work or study, see the people close to them, and have plans. The emotions are strong at times, then they subside.
What points the way. Preserved functioning and flexibility: the concern comes and goes, it does not organise the days, and it does not dictate decisions.
What research says about it. In one survey, habitual ecological worry had practically no correlation with pathological worry, and it was associated with pro-environmental attitudes and behaviours (Verplanken and Roy, 2013). A series of three studies reached a similar conclusion: for some people this worry can become unproductive, but for many others it is an adaptive response (Verplanken et al., 2020). Among 16- to 25-year-olds surveyed in ten countries, 84% said they were at least moderately worried (Hickman et al., 2021): in this age group, it is a majority reaction, not an oddity.
What this implies. No protocol. One session, sometimes two, to listen, to say that the worry is proportionate to a real threat, to look with the person at what they do with it, to point them, if they wish, to places where they can talk about it with others, and to leave the door open. Offering treatment would teach them that they are ill for caring about the world.
2. A distress that takes over life
What you observe. Hours a day spent thinking about it or reading the news, often in the evening and at night. Sleep that deteriorates, concentration that collapses. Pleasures given up because the person feels they no longer have the right to them. Guilt attached to every purchase, every journey, every meal. At times a paralysis — "nothing makes any difference" —, at times a commitment that leads to exhaustion. Conflicts with people close to them, decisions frozen: studies, career, having children. All this without the picture reaching that of an anxiety or depressive disorder, and with a concern that remains centred on the climate and the environment.
What points the way. The impact on functioning, which section 10 measures, the time taken each day, and rigidity: the concern no longer subsides, and it decides in the person's place.
What research says about it. In the international survey by Hickman and colleagues (2021), more than 45% of the young people surveyed said that their feelings about climate change negatively affected their daily life and functioning. Clayton and Karazsia (2020), in constructing their scale, concluded that worry can be distinguished from a more serious impact on life.
What this implies. This is the indication for this programme.
3. A diagnosable disorder
What you observe. In generalised anxiety, the climate is only one of the topics: health, money, work, the people close to them and being late all come up too, and have done for a long time, with constant tension and fatigue. In depression, mood is low and interest extinguished far beyond the ecological theme, self-esteem is damaged, and the slowing down affects everything.
What points the way. Extent and history. If you take away the climate, do the worry or the sadness remain? Were they there before the topic took up this place?
What this implies. The disorder is treated with its own manual (section 2). The climate theme is worked on there as one theme among others, with one precaution specific to this manual: the concern itself is not treated as irrational (section 26).
Other situations to rule out
Direct exposure to a disaster. A flood, a fire, a heatwave lived through in severe conditions, a home or a livelihood lost. The IPCC, the Intergovernmental Panel on Climate Change, associates climate extremes with trauma and mental health difficulties (Intergovernmental Panel on Climate Change, 2023). The course of action then follows section 30: practical needs first, then the trauma or the grief with their own manuals.
Obsessive-compulsive disorder with an ecological theme. The intrusion concerns a precise personal responsibility — having left a tap running, having sorted the rubbish wrongly, having polluted —, it is experienced as absurd or alien, and it is followed by rituals: checking, starting again, confessing. It is not a conviction about the world but a doubt about one's own acts, and it falls under Treating obsessive-compulsive disorder in adults: a therapist's manual.
Delusional apocalyptic content. A certainty of an imminent end, together with a personal mission, signs coming from elsewhere, and other psychotic features. This is rare, and it calls for a prompt psychiatric opinion.
The three triage questions
"If the climate were not a problem, what would you worry about?" It isolates generalised anxiety: the answer "about everything else" changes the protocol.
"What has this concern made you stop doing, or what does it prevent you from doing?" It isolates the impact on functioning, which makes the indication.
"How much time a day do you spend thinking about it without having decided to, or reading about it?" It measures the hold, in minutes rather than in impressions.
4. The dimensions of ecological distress
The vocabulary is abundant and poorly settled: eco-anxiety, climate anxiety, climate distress, ecological grief, solastalgia. There is no consensus definition (Ramsay et al., 2025). In his analysis of work from several disciplines, Pihkala (2020) notes that three factors seem to play an important role: uncertainty, unpredictability and lack of control. In practice, the distress breaks down into five dimensions, which have to be explored separately because they are not worked on in the same way.
Worry and rumination
What you observe. Two repetitive mental activities. Worry turns towards the future: "what if the harvests collapsed", "what if my children lived in an unliveable world". Rumination turns towards the past and towards the why: "how could we let this happen", "it's too late". One of the four dimensions of the Hogg scale (section 10) concerns rumination precisely.
What needs to be clarified. The difference between thinking about a problem in order to decide something and going round in circles. The first produces a decision in a few minutes; the second can last for hours without producing anything, and it is the second that is worked on (session 4).
Emotions
In the survey by Hickman and colleagues (2021), more than half of the young people surveyed reported each of the following emotions: sadness, anxiety, anger, powerlessness, helplessness and guilt. Each says something different.
Fear and anxiety concern what might happen, to oneself, to those close to one, to the world.
Sadness and ecological grief concern what is lost or being lost: a species, a glacier, a childhood landscape, a future one had imagined. Cunsolo and Ellis (2018), drawing on work carried out in the Canadian North and in a farming region of Australia, describe this grief as a natural response to ecological losses. Solastalgia is a particular form of it: the distress of seeing the environment one lives in change, without having left it (Albrecht et al., 2007). This grief is not prolonged grief disorder, which presupposes the death of a person.
Anger is directed at governments, companies, previous generations, inaction. In Hickman's survey, distress was correlated with the feeling that governments were not responding to the crisis and with the feeling of being betrayed.
Guilt concerns one's own contribution: a trip, a purchase, a meal. One of the dimensions of the Hogg scale measures anxiety about one's personal impact.
Powerlessness and despair — "nothing makes any difference", "humanity is doomed" — are often the heaviest. In the same survey, 55.7% of respondents agreed with the idea that humanity is doomed.
What matters in practice. These emotions do not have the same effects. In an Australian national survey, ecological anger was associated with better mental health and more engagement, whereas ecological anxiety and ecological depression were associated with lower well-being (Stanley et al., 2021). Naming the dominant emotion therefore guides the work (sessions 2 and 5).
Behaviours
Checking the news endlessly. Rereading the same news, scrolling through news feeds, searching "is it too late". This behaviour can take hours every day, and it is measured in minutes (section 10).
Or avoiding it entirely. No longer reading anything, changing the subject, minimising. This brings relief in the moment; in a study of twelve-year-old children, playing down the seriousness of the threat went with less negative affect, but also with a weaker sense of being able to act and fewer pro-environmental behaviours (Ojala, 2012b).
Monitoring oneself. Weighing every action, reproaching oneself for every lapse, aiming for an impossible purity.
Committing to the point of exhaustion, or staying frozen. The two sometimes coexist in the same person, a few weeks apart.
Depriving oneself. Giving up pleasures, outings, travel, sometimes plans, because enjoying them would seem indecent.
Asking for reassurance. "Tell me it's not too late." We will come back to this in session 3.
The future and life decisions
Going on to long studies, choosing a career, settling somewhere, having children: these questions really do arise, and they are legitimate. In Hickman's survey, 39.1% of the young people surveyed said they were hesitant to have children. The problem is not that the question arises; it is when the decision is made by the distress, or when it stays frozen indefinitely (session 9).
Relationships
The person may feel alone with their concern, or ignored and mocked when they talk about it: in Hickman's survey, among the young people who talked about the climate with those around them, 48% said they had been ignored or dismissed. They may also argue with people close to them who do not share their worry, or who share it to the point of amplifying it. In adolescents, these are often the parents; in adults, the partner or the family.
5. What maintains the distress
The mechanisms below are borrowed from models of worry, of depression and of emotional avoidance. Their role in eco-anxiety is plausible and consistent with the available cross-sectional data; it has not been demonstrated by longitudinal studies. The treatment targets all of them.
Continuous exposure to information
In a survey carried out in 32 countries, climate anxiety was higher the more people were exposed to information about the effects of climate change and the more attention they paid to it (Ogunbode et al., 2022). The study is cross-sectional: it does not say whether information maintains anxiety, whether anxiety drives people to seek information, or both.
The proposed mechanism, which remains a hypothesis, is as follows. Each piece of news sets off the alarm again, and news feeds are designed to hold attention. Above all, keeping informed gives the feeling of being responsible, of not looking away: the relief of having "done something" reinforces the behaviour, even though no action has followed.
Abstract rumination
Verbal and abstract worry keeps the person in words and distances them from action as well as from emotion; the mechanism is detailed in Treating generalised anxiety disorder in adults: a therapist's manual, section 3. Applied to a global problem, on which no individual decision can settle anything, it never reaches a stopping point. And it has the appearance of seriousness: continuing to think about it seems more responsible than stopping.
All-or-nothing responsibility
Two opposite positions lead to the same result. Either the person holds themselves responsible for everything, and every action becomes a possible fault. Or nothing they do counts, "a drop in the ocean", and action loses its meaning. In the free-text answers of a study of young adults, some described precisely this feeling that their actions were insignificant in the face of the scale of the problem (Schwartz et al., 2023). The first position wears people out, the second paralyses them.
Emotional avoidance, and its opposite
Not thinking about it any more, minimising, distracting oneself brings relief in the short term. In twelve-year-old children, playing down the seriousness of the threat went with less negative affect, but also with a weaker sense of being able to act and fewer pro-environmental behaviours (Ojala, 2012b). Acceptance and commitment therapy calls experiential avoidance the tendency to do anything not to feel a painful emotion or thought, even when it is costly, and it sees in it one of the sources of the psychological rigidity it seeks to reduce (Hayes et al., 2012). Conversely, being overwhelmed without ever letting the emotion run its course — brooding over it rather than feeling it — also maintains it. Both slopes are dealt with in session 5.
Withdrawal from life
Giving up pleasures, plans and relationships, because "what's the point" or because enjoying them would seem indecent, deprives the person of what used to support them. Mood drops, rumination fills the space that has been freed, and the withdrawal deepens. This is the circle that behavioural activation treats in depression (Treating depression in adults: a therapist's manual, section 4).
Isolation
The person feels alone with their concern, or shares it only with people who amplify it. Among young people, being ignored or dismissed when talking about it is a common experience (Hickman et al., 2021; section 4). The less they talk about it, the less they hear other ways of living with the same worry, and the more room solitary rumination takes.
The complete circle
A piece of news arrives. The person ruminates, often in the evening. Fear, sadness or guilt rise. They withdraw from what used to do them good, or they throw themselves into frantic action. They wear themselves out or blame themselves for not doing enough. And they go back to the news, to find out, or to punish themselves. This is the pattern you draw with them in session 2.