Reframing Climate Change: Using Children’s Literature as a Residency Training Tool to Address Climate Anxiety and Model Innovation

To the Editor:

Given our burgeoning awareness of the profound effects of climate change on mental health, mental health professionals and trainees are challenged to find novel ways to address climate-related distress. For children, these difficulties may be compounded because their caregivers can themselves be at a loss for useful means of communication about climate change that are realistic, hopeful, and developmentally appropriate [1]. Therefore, here we report the creation of an evidence-based piece of children’s literature as an innovative public health intervention that psychiatry trainees can use therapeutically for children with clinical climate distress as well as to explore innovative ways to fulfill their public health role of protecting the mental health of children.

As a team of mental health professionals and environmental scientists, we wrote a children’s picture book that provides developmentally appropriate, psychologically grounded responses to climate-related thoughts and feelings to aid parents, teachers, and clinicians at all stages of training. We reviewed children’s books currently published on this topic and scholarly pieces about how best to discuss climate change and climate anxiety with children [2, 3]. From this review, we synthesized a six-step, psychologically grounded “Climate Talk”: (1) introduce the topic of climate change by finding out what children already know; (2) explain the science of climate change simply but completely; (3) describe the problem of climate change with hope but without sugar coating the ramifications; (4) discuss approachable ways to get involved in addressing climate change; (5) open the discussion for future conversations; and (6) conclude by inspiring a sense of wonder about the natural world in children. Embedded in this “Climate Talk,” in an effort to contrast the traditional tropes of discussing climate change that place the entire burden of “fixing our planet” on a younger generation, is an important introduction to the thriving community of scientists, activists, and politicians already working to address these issues and suggestions for how children can get involved.

In collaboration with the Group for the Advancement of Psychiatry – Climate Committee, a storyline centered around the components of this six-step “Climate Talk” was created, workshopped, and revised with input from child psychiatrists, psychologists, elementary school teachers, parents, and children. The final product, Coco’s Fire: Changing Climate Anxiety into Climate Action [4], is the story of a young squirrel’s quest to transform her climate-related worries into agency. Currently, educational curricula are being developed for teachers and students to use Coco’s Fire as a platform to start these conversations, and metrics to assess the effectiveness of these interventions will be critical in continued development of this material.

The book incorporates multiple psychologically grounded approaches to addressing climate anxiety. For example, to model how caretakers can help children with acute anxiety, age-appropriate grounding techniques are portrayed that young readers can practice along with Coco. Similarly, Coco’s father is portrayed using active listening and mirroring skills, which can reinforce secure attachment and a sense of safety. Additionally, appropriate to the concrete operational stage of cognitive development, Coco’s anxiety is represented in terms of a personified little fire creature (AKA “Coco’s Fire”) that Coco can interact with throughout the book. As Coco’s anxiety about climate change is transformed into engagement, the cognitive reframing process she is undergoing is depicted in the evolution of Coco’s fire creature from “scary red” to a “cool blue.” Finally, throughout the book, footnotes highlight where psychological content is being addressed and direct adult readers to the back of the book where they can find additional psychoeducational resources about these topics such as additional grounding techniques provided by the American Psychological Association [5].

Recently, training associations such as the Accreditation Council for Graduate Medical Education (ACGME) and the American Medical Association (AMA) have put together proposals for ways to increase training on climate change and health; however, the extent and speed of climate change as a public mental health threat also necessitate rapid innovation. In addition to its use as a teaching tool, this book, along with other public health innovations by psychiatrists, such as podcasts and twitter feeds, is an important way of exposing residents to the outside-the-box thinking that is now required of psychiatrists, who must also preserve academic rigor. It is therefore vital that mental health professionals be trained in addressing climate anxiety in their practice and that innovation be encouraged to create and use resources that frame this topic in new ways to aid young people and adults in cultivating hope and empowerment to address feelings of climate distress.