CBT and responses to extreme weather events: A commentary on current knowledge and future directions
Professor Mark Freeston
7 April 2026
Anthropogenic climate change has profound consequences for both physical health (Romanello et al., 2025) and mental health (Lawrence et al., 2022; World Health Organization, 2022). Mental health impacts may arise from acute extreme weather events such as floods, heatwaves, storms and wildfires; from chronic extreme climate events such as prolonged droughts; or gradual changes in average climatic conditions such as rising sea levels (Lawrence et al., 2022). Although many regard the climate and ecological emergency as a humanitarian, biospheric and/or planetary crisis, this short commentary, marking World CBT Day 2026, focuses more narrowly on extreme weather events that may be experienced as “natural disasters” their impacts, relevant interventions, and the potential role of CBT.
Both the frequency of and exposure to extreme weather events are increasing, including floods (e.g., Liu et al., 2022), heatwaves (e.g., Yin et al., 2022), storm events such as cyclones (e.g., Kossin et al., 2020) and wildfires (e.g., Cunningham et al., 2024). Their associated impacts are growing as well. Confidence in attributing these increases in extreme weather events and their impact to climate change, as opposed to other factors such as urbanization or population growth in the case of floods, is also strengthening (Clarke et al., 2022), at least for some event types (Otto et al., 2020).
A recent review by Mishu et al. (2025) identified 26 studies evaluating interventions intended to support mental health among those affected by climate change and related extreme weather events. All but one intervention targeted people affected by a specific type of event, namely fires, floods or storms. Study designs varied considerably, and only seven were randomized controlled trials. Overall, the interventions were effective in improving mental health outcomes, and most were CBT-based, although formats differed widely. The majority of studies were conducted in Higher Income Countries (HICs) and delivered through established services or schools, while only a minority were community based.
One notable community-based intervention is Cognitive Behavioural Therapy for Post-Disaster Distress (CBT-PD), which has been used following the 9/11 terrorist attacks (Hamblen et al., 2006), earthquakes in Chile (Leiva-Bianchi et al., 2018) and New Zealand (Woods et al., 2025), and in response to hurricanes Katrina and Sandy (Hamblen et al., 2017). CBT-PD is an 8 to 12 session transdiagnostic intervention with four components comprising psychoeducation, breathing retraining, behavioral activation, and cognitive restructuring. In the post-Sandy study, eight community-based professionals, primarily social workers trained specifically for the intervention, treated 342 adults between 10 and 26 months after the hurricane. Large reductions in distress were reported (ES = 1.41), with gains maintained at five-month follow-up. Although “promising”, as rightly described by the authors, the intervention has yet to be replicated or evaluated using more rigorous designs in the context of extreme weather.
A more tailored, therapist-guided, online self-help treatment (RESILIENT) was developed in response to the evacuation of an entire town and surrounds (approximately 88,000 people) due to wildfires in Fort McMurray in 2016 (Belleville et al., 2023). An initial survey found that evacuees reported symptoms of PTSD, insomnia and depression one year after the disaster (Belleville et al., 2021). The self-paced programme contains 12 evidence-based modules covering “psychoeducation for PTSD, sleep and depression, gradual and prolonged exposure to avoided situations and memories, CBT for insomnia, behavioral activation, diaphragmatic breathing, problem-solving strategies, cognitive restructuring, imagery rehearsal therapy for nightmares, mindfulness-based strategies, and strategies to promote self-compassion and acceptance (p. 235)”. Participants were offered up to twelve 30-minute guided support sessions delivered by supervised psychology students in what appears to be a coaching model. Randomized to treatment or waitlist control (each N = 67), more than half of the intention-to-treat sample and 82% of the completer sample (N = 17) showed minimal clinically important improvement on at least one of PTSD, depression or insomnia symptoms. Large effect sizes (> .8) were reported by those who completed more than half the treatment. This intervention is notable for being tailored to the specific needs identified in the affected population, delivered remotely across a distance of roughly 4,000 km, implemented in a low-intensity model of guided self-help by non-licensed coaches (although Mishu et al., 2025 describe it as a specialized service), and is a modular treatment designed specifically for the evacuees by an established team of treatment developers with collective expertise in insomnia, depression, PTSD and anxiety disorders as well as online treatment delivery. As with CBT-PD, replication has yet to occur.
A central challenge for such interventions is dissemination. The BABCP has recently published an open-access collection of short chapters, led and edited by members of the BABCP Climate Change Special Interest Group, which addresses a range of applications of CBT and related approaches for climate and eco-distress more broadly, with potential relevance for those affected by extreme weather events. However, to address the psychosocial consequences of extreme weather events in both community and individual contexts, further interventions will be required. The Mental Health and Climate Change Alliance, a Canadian not-for-profit organisation, provides open-access materials for twelve interventions, many CBT-based, that may be applicable to extreme weather contexts, including resources for CBT-PD. These may be found at Therapeutic Approaches for Post-Disaster Mental Health Recovery and Resilience — Mental Health and Climate Change. Thus, there are accessible English language resources available of interventions that in some cases may be pragmatically applied and in others have been thoughtfully adapted. It remains that there are few that have an evidence base for their application to climate and eco-distress more broadly or more narrowly to the impact of extreme weather events.
Given that this is World CBT Day, it is important to widen the perspective. Most of the resources described above originate from HICs such as the UK, the US and Canada. A recent review focusing on extreme weather events in predominantly Low and Lower-Middle Income Countries (L/LMICs) identified evidence of displacement and disruption to communities, vulnerability and disruption of healthcare systems due mainly to storms, as well as examples of resilience (Brainard et al., 2026). As mental healthcare resources may already be limited in L/LMICs, there is a need for accessible, transferable, culturally appropriate, and scalable interventions.
Since 2015, the World Health Organization has programmatically developed open-access materials for six CBT-based mental health interventions in multiple languages, including guidance, self-help booklets and audio files such as Doing What Matters in Times of Stress. Although not specific to climate change or extreme weather, these programmes exemplify scalable, culturally adaptable, community-delivered interventions. They are also supported by an expanding evidence base from RCTs conducted in diverse settings (see the WCCBT webinar Global Guide to Implementing WHO Evidence-Based Psychological Interventions). As understanding of the consequences of extreme weather grows, and as interventions such as the RESILIENT programme continue to be refined and evaluated, there may be potential for such approaches to be incorporated into WHO-supported dissemination frameworks as accessible, transferable, culturally appropriate and scalable treatments.
Professor Mark Freeston is a clinical researcher with over 30 years experience developing and testing models and treatment for OCD, anxiety disorders, and more recently, adjustment disorders. His recent research is on climate and eco-distress with a focus on how the experience of extreme weather contributes to perceptions of climate change and climate and eco-distress.
Declaration: I am a member of the BABCP Climate Change Special Interest Group, the Group of Trainers in Clinical Psychology Planetary Health Subgroup, and Climate Psychology Alliance. While I have written this as a contribution to World CBT Day on behalf of the BABCP Climate Change SIG. The views expressed here are my own.
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