Climate Change‐Related Thoughts and Cognitive Styles in Psychotherapy : A Qualitative Analysis of Therapists' Reports

Kurzfassung/Abstract

Background
Although several studies have examined climate change‐related concerns affecting mental health, it remains unclear what specific cognitions are present in clinical samples. The present study examines (1) the thought content of patients with climate change‐related concerns and (2) their cognitive styles, as reported by therapists.

Methods
This study is a secondary analysis of a nationwide survey of German therapists on climate change‐related concerns in their patients. We qualitatively analysed reports from a subgroup of N = 214 therapists regarding patients' thought content and cognitive styles with structural content analysis.

Results
Therapists' reports revealed diverse themes of thought content as outlined in the literature, with the most prevalent categories reported by approximately half of therapists being the deadly threat posed by climate change (54.2%) and helplessness in face of collective inaction and individual inability (52.8%) as well as the paralysis and disengagement from life goals (48.1%) and the immediacy, celerity, and irreversibility of climate change (46.7%). The most commonly identified cognitive styles in the therapists' reports were rumination (50.0%), catastrophising (44.9%), and self‐ and other‐blame (32.2%).

Conclusions
The findings indicate that recurring climate change‐related cognitions in therapy correspond with established cognitive patterns and overarching themes such as loss and danger, commonly linked to depression and generalised anxiety. Preliminary associations with disorders like panic and adjustment disorder require further empirical validation. Clinically, assessing these cognitions may guide intervention adaptation and inform targeted psychotherapist training using relevant cognitive content.

Implications for Practice and Policy
Integration into clinical assessment: The results of the study suggest that recurring content can be classified into overarching themes, such as loss and threat. According to the theory of content specificity, these themes are related to depressive and anxiety symptoms. Climate change‐related cognitions should be systematically assessed as a diagnostic tool to identify clinically relevant content and refine diagnostic accuracy.

Adaptation of existing therapeutic approaches:
Given the overlap between climate change‐related cognitions and established psychopathological patterns, existing therapeutic techniques—such as cognitive restructuring, emotion regulation, and meaning‐focused techniques—could be effectively adapted to address climate‐specific thought patterns.
Development of standardised patient scenarios for therapists' training:
The results of the study can inform the development of climate change‐aware training modules for therapists, given the validation of the identified climate change‐related cognitions based on relevant literature. Such recurring climate change‐related cognitions could inform different standardised patient scenarios. These training modules could improve clinicians' skills and readiness to effectively treat climate change‐related distress.
Societal and political engagement:
The study identified a broad range of climate change‐related themes. As climate change progresses, such worries are likely to affect an increasing number of people. This underscores the urgent need for prompt and effective action by policymakers to address the psychological burden associated with climate change.