In this section:
This expertise is provided by Elissa Epel, PhD, and Elena Fromer.
In the Bay Area and elsewhere, we are now living in an unprecedented period of extreme unpredictability with climate change, resulting in wildfires and smoke, poor air quality, and extreme temperature changes. These require a new mindset—one where we are prepared for these events as much as we can be. This also requires actual preparation ahead of time getting the resources we need and to cope well with them, if and when they arrive. Living in the Bay Area, we are used to earthquake preparedness. This entails having an emergency kit and "go-bag" ready. We don’t know when it will happen, but it could happen. We can adopt a similar strategy for other natural disasters. In this section, we address both psychological and practical preparation, and they go hand in hand. Understanding how the risks work, and what we can do, are now part of our ability to be prepared and cultivate a more relaxed mental stance.
The more prepared we are, the less anxiety we will feel before and during the next challenge.
We must realize that for some, a climate event can cause extreme psychological stress, depending on how impacted the person is. The novelty and unpredictability of these events alone make them stressful. With wildfires, there can be a true threat to our lives, to our homes and businesses. Regardless of how close the fires are, there is also the threat to our health, from the smoke, for sensitive people. For people who have been through this before, to have evacuations happen again, can re-trigger post traumatic stress reactions. Lastly, for people with low income or precarious housing, they may not have the protections that are easy to take for granted — air conditioning, air filters, and homes that are easily sealed up. These are now critical issues that will need to be improved and addressed in our communities together.
When the specific disaster we are coping with has ended, psychological consequences may persist, as well as the fear of recurrence. It is important to seek support right afterwards, from people who understand what you have experienced — others in similar situations or mental health professionals.
As a community, we have experienced heat waves, rampant fires and evacuations, and smoke, all on top of ongoing stressors. The confluence of events is enough to make anyone feel overwhelmed and naturally ask, “When will this end? What’s next? Should I move?” There are no easy answers to these questions. In the short run, we need to focus on our own safety and well being, and help those around us. We will get through this current crisis, together! This too shall pass.
Dealing with uncertainty requires embracing a “new world” mindset
It is clear we are living in a challenging period ahead. When unpredictable terrible things happen, it violates our expectations. We may feel shocked or victimized. Our natural bias is to think the future is reliable but in reality it has always been unpredictable and now in this era of climate crises, it is very unpredictable. So we need new coping strategies. Part of resilience today is embracing a new world mindset in three ways:
- Expect the unexpected: Do not assume we know the future — but still work to create the best future. Not knowing what tomorrow or next month will bring is inherently hard for us. We like to plan ahead and feel ease about the future. Unpredictability can create anxiety.
While we can have a relaxed grip on the future and write our plans in pencil, we can also help stay grounded in the present and the certainty of our present moment. Notice and fee ease and joy when you can! It is thus important to notice the moments today, when things are certain, when we feel safe, and let ourselves feel at ease. You might try brief belly breathing or three-part breathing at least once a day, taking a brief mindfulness break, or one of the mindfulness apps. You can also try exercises from UC Berkeley's Greater Good in Action that help us feel appreciation, joy, and social connection.
- Control the things we can control: That includes right now, plans for today, and the near future. When we feel overwhelmed by thoughts about the future, it helps to take things moment by moment, day by day. Having a balanced daily routine with enough self care, sleep, movement, and social connection is especially important right now.
- Stay positive and take action: It may seem that the glass is half empty these days. If we see the glass as half empty we make that true. “If you think you can, or you think you can’t, it’s true.” Our hopeful attitude and proactive actions are critical to building a better future—we can mitigate climate damage, both in personal actions and in who we elect and influence. If we don’t stay positive, we cannot be part of the solution.
Climate distress and grief
We live in the larger context of a climate crisis that is now here to stay and could get worse. This is an existential and spiritual crisis that many have been dealing with already. But now, seeing the impact of climate change at such a personal level can deepen climate distress, also called eco-anxiety. Climate distress describes negative emotions about climate changes — there can be a wide range of feelings such as sadness, hopelessness, anger, grief, and loss at various times.
To maintain well being during this era of climate crisis takes extraordinary coping on our part to stay hopeful and do our part so things don not get worse. Our wide range of feelings are normal and fitting, and important to talk and even write about. Remember that feelings are contagious, and hopelessness and pessimism are especially catchy. Climate changes are here, and thus so is climate distress. We can use our negative feelings to motivate us to make changes on a personal level or through activism.
Taking action is the best way to manage our distress! Part of dealing with climate distress is not pushing it away and ignoring the problem, but rather doing something active about it. Below is a UCSF webinar with experts suggesting what healthcare professionals — and also the public — can do. Some of the high impact actions are advocacy, voting for climate friendly policies and politicians, and making changes in your personal or larger environments. Finding a way to share concern and awareness, and take some action about climate, is something that we all can do. This might be reducing red meat, using less carbon such as walking instead of driving, and making changes to home and workplaces. These changes add up.
It is also helpful to read about positive changes being made and to be part of these changes, such as in Christiana Figueras’ book “The Future We Choose.” Thus a new mindset involves embracing the fact that the world is indeed different — and in some ways changed forever — but there are many actions we can take now to prevent worsening and to find new possibilities: This crisis has led to opportunities for societal growth and new ways of constructing our daily lives, businesses, and economy. We have an opportunity to thrive socially and live in better harmony with our ecosystem in ways that we were not on track for!
Global warming has lead to droughts, heatwaves, and wildfires — all tightly interrelated events. In the Northern California, we are experiencing all of these at once. The heat alone can cause a lot of mental health symptoms such as poor sleep and irritability, and for people with mental health disorders, it can trigger episodes like aggression, suicidality, and other crises. In fact, the admissions for psychiatric emergencies go up at emergency rooms during heat waves. The effects of heat, and how to cope with the heat, are described in our UCSF recent webinar “Sizzling Hot.” Additional tips can be found below in the “Protecting yourself and vulnerable people from extreme heat” section.
When we witness natural disasters, even if they are not near our home, we may feel distress or vulnerability. The media shows images and stories of disasters over and over, and this fuels ongoing anxiety and vigilance. It is critical to find only reliable sources, to limit the news, and to reach out to others in need. The American Psychological Association offers the tips below for managing distress related to wildfires:
- Take frequent breaks from watching the news.
- Be kind to yourself and the emotions you may be experiencing.
- Keep your perspective on life positive and focus on the good things around you.
- Find productive ways to help in your community by making donations or volunteering your time.
- Recovering from wildfires: Wildfires can be particularly stressful because the factors that influence their strength and direction can change at any moment. It is common for people who have lived through these circumstances to experience strong emotions. This tip sheet from the American Psychological Association lists several good strategies for trying to regain stability in your and your children's lives.
- National Child Traumatic Stress Network
- Parent Guidelines for Helping Children Impacted by Wildfires: Lists common reactions parents may see in their children after a wildfire and how to help their children deal with this distress.
- Wildfires: Tips for Parents on Media Coverage: How to help children understand media coverage while limiting their exposure to distressing images.
When do you need extra support?
- The Substance Abuse and Mental Health Services Administration (SAMHSA) offers lists of warning signs for emotional distress for children and teens, older adults, first responders, and recovery workers who may be at greater risk for emotional distress during this time.
- If you or someone you know shows any signs of emotional distress for two weeks or more, call the Disaster Distress Helpline at 1-800-985-5990 or text TalkWithUs to 66746 for support and counseling. The Disaster Distress Helpline is a national hotline that provides 24/7, year-round crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. Spanish-speakers should text "Hablanos" to 66746. Calls and texts are answered by trained, caring counselors from crisis call centers located throughout the United States.
- In addition, we have put together resources for COVID-19 and pandemic-related distress. If you are experiencing significant distress, there are warm lines and hot lines, as well as counseling for UCSF employees.
When wildfires burn near you, smoke can reach your community even if you don’t smell it. Wildfire smoke is a mix of gases and fine particles from burning trees and plants, buildings, and other material. Wildfire smoke can make anyone sick, but people with asthma, chronic obstructive pulmonary disease (COPD), or heart disease, as well as children, pregnant women, and responders are particularly at risk. The Centers for Disease Control and Prevention (CDC) has a list of useful resources for protecting yourself from wildfire smoke, and SafeHome.org has created a guide to staying safe during a wildfire.
Breathing in smoke can affect you right away, causing many symptoms:
- Scratchy or sore throat
- Runny nose
- Irritated sinuses
- Trouble with breathing or wheezing
- Asthma attacks
You might not realize that breathing in smoke can also cause symptoms other than respiratory-related symptoms:
- Tiredness and fatigue
- Chest pain
- Fast heartbeat
- Stinging eyes
These symptoms are common when the air quality is poor, but also suggest you should try to improve your air—do not stay outside except for short periods, get to a building or room with better air (such as a sealed up room with an air purifier). If you are in a vulnerable group, see the special instructions below and consider your options for temporarily relocating to an area with better air quality if possible.
Smoke, air pollution, and our skin
The skin is our largest organ and it is permeable, meaning that some environmental exposures can literally get through our skin. It makes sense to think of ways to protect it during this time of pervasive air pollution. UCSF researcher Thea Mauro and colleagues have shown that applying daily body lotion for a month reduces blood inflammation levels in people over 50 years old, reducing it to levels in much younger people. The smoke and pollution mostly enters our blood through the lungs. However, it is possible it also impacts us through skin contact and permeability.
While no studies have been done with smoke, it is logical to use body lotion during this time on top of clean skin. When living in poor air quality, it is also wise to shower daily with gentle soap and wash clothes if you have been outside.
We already know that air pollution can lead to inflammation and impair our immune function. Air pollution contains both solid particles and gas particles. Wildfire smoke includes small particles (particulate matter or PM < 2.5 microns) that are easily absorbed into the lungs, leading to oxidative stress and inflammation, especially for those with respiratory issues already. Our first line of immune defense in the lungs against both inhaled particles and microbes of our immune system involves alveolar macrophages, cells that ingest both small particles and microbes, and when they get overloaded with toxic particles from long term exposure to air pollution, they are not as effective in preventing infection and may even promote susceptibility to COVID-19.
It is likely that exposure to wildfire smoke can increase risk of COVID, as described by the CDC. The best way to prevent adverse health effects from wildfire smoke is to reduce exposure by staying indoors with the windows closed and creating a cleaner air space through the use of increased ventilation and filtration (e.g., portable HEPA air cleaners), especially if you are high risk due to health conditions or pregnancy. If you have to go outside, refrain from exercise and wear an N95 or KN95 mask. A study by Harvard researchers examined daily fluctuations in PM 2.5 during the 2020 wildfire season in the Western U.S., and found it was linked to an increased number of COVID cases. UCSF’s Dr. John Balmes has reviewed the evidence of smoke exposure and COVID cases and warns about the risk of air pollution on respiratory infections. “We really need to double down on policies to get to clean transportation and get to clean energy,” he said. “We’re doing this in California, but we need the rest of the world to join us.”
Be ready to protect yourself against smoke and ash before, during, and after a wildfire:
- Prepare for Wildfires: Emergency supplies, evacuation plans, and current conditions
- Actions to Take During Wildfires: How to protect yourself from smoke and what to do during power outages
- Easy steps to take at home to protect yourself from smoke:
- Check local air quality reports by searching for your ZIP code on the CDC’s Air Now website, which has the most reliable sensors. However, you might also check PurpleAir—which uses information from individual’s sensors, giving you more geographically sensitive information—or the AirCare app.
- Keep indoor air clean by keeping all windows closed, especially if you do not have air conditioning. If you do have an air conditioner, make sure to keep the fresh-air intake closed to prevent outdoor smoke from infiltrating inside.
- Avoid activities that increase indoor pollution, such as burning candles, cooking on gas stoves and vacuuming.
- Wash your nose out and gargle with clean water. You can do this five times a day until the smoke subsides.
- Take a shower and wash your clothing after being outside to remove particulates.
- N95 respirator masks can be helpful to project yourself by filtering out fine particles when it is absolutely necessary to go outside. If you are unable to find one, you might get a KN95 mask instead. See mask fitting guide below. However, public safety officials recommend that spending as much time indoors is the best way to protect yourself. Note that a cloth mask, such as those often used to prevent the spread of COVID-19, will not adequately protect lungs from particles found in wildfire smoke.
The CDC also offers a list of what to do after you’ve been close to a wildfire containing measures to protect yourself from ash and other health hazards.
The CDC offers helpful guides for vulnerable groups:
- Wildfire Smoke and Pregnancy
- Wildfire Smoke and Children
- Wildfire Smoke and Chronic Conditions: Asthma, COPD, and Heart Disease
- Wildfire Resources and Guidance for Health Officials and Professionals
The Climate Psychiatry Alliance (CPA) provides professionals with resources on the mental health effects of climate change. People with mental illness are particularly vulnerable to heat. CPA member and UCSF volunteer clinical professor Robin Cooper, MD, has developed downloadable toolkits to help us deal with extreme heat (for patients, providers, and caregivers.
These toolkits include tips for staying cool and avoiding overheating, such as:
- Drink lots of water. Staying well-hydrated is key to avoiding overheating. Do not wait until you are thirsty! By the time you are thirsty, you may already be dehydrated. If your urine is dark or if you are not urinating, you are becoming dehydrated.
- Keep out of the heat. Know cool places to go.
- Libraries, malls, movie theaters, and air-conditioned coffee shops may be good places.
- Your community may have cooling centers. Contact your public health department or ask your provider for resources.
- Do not stay in overheated apartments or rooms with no ventilation. In very severe heat, fans blow hot air and may make things worse.
- Wear light, loose clothing. Do not wear jackets or layers.
- Take showers or keep your face and arms wet with water.
- Find shade and wear a wide-brimmed hat if possible.
- Stay informed by listing to radio or TV about warnings and ways to cope.
- Avoid alcohol and recreational drugs. Alcohol increases dehydration. Drugs—particularly MDMA, cocaine, and methamphetamine—reduce your ability to stay cool and release heat.
- Do not stop taking medication or change your dose unless a provider tells you to. Before the summer months, discuss safe use of medications with your provider.