Eco-Anxiety and Morita Therapy—A Review and Illustrative Case Report
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis manuscript focuses on a very important topic, eco-anxiety and climate anxiety. There is a demand for applying various kinds of therapeutic approaches to the topic, and this is the first manuscript that I know of which applies Morita therapy to the issue. Fundamentally, the manuscript is useful, but it needs major revisions before publication. The biggest issue is: what is exactly the special contribution of Morita therapy here? The original phases of Morita therapy are quite different from this application. Furthermore, the things that the author writes are coming from Morita therapy here – focusing on doable actions and not ruminating extensively on emotions – are proposed by many, many therapies. The manuscript should change its framing to argue that this case study shows that an application of Morita therapy was useful in this case, but the methods used are ones which are used in a number of other therapies, too. Some examples of those should be mentioned. I’m thinking of CBT and Emotion-Focused Therapy, for example; there are differences between those and what is discussed here, but also profound similarities. These changes should be made to the Introduction and especially to the Discussion.
Several other recommendations and needs for modifications are discussed below.
Keywords: add ’distress’ and/or ‘eco-distress’
The names of concepts should not be written with capital letters in English (contrary to German).
37 I would recommend: instead of “not fully…” -> “capturing climate change -related affects, while the concept of eco-anxiety can encompass an even wider range of concerns.”
48-49 Rephrase. “notable gaps in literature related to many forms of therapy, including…”
50-55 stylish corrections needed.
84 Qualification needed. ‘always’ or ‘usually’?
85 (see also 111): Please clarify a bit what is meant with “neurotic” here. In what sense is Morita using the concept? And is that the same as a general contemporary understanding of what a “neurotic” person is like?
84-90 This sounds like a quite basic point, but perhaps Morita had a certain depth here which is now not shown. Please consider adding a bit of nuance.
97 falls-> fall
107 “reality” instead of “nature” here? That would avoid misinterpretations.
108 + “carefully” consider? Otherwise, quite a basic point.
115-118 Please clarify the difference between points 3 and 4. “continuous simulation with varied sensations”?
125-6 Is this method the same for everyone, or only for people suffering heavily? And, relatedly: are there different ways to apply the method? This seems to require a clinical setting, or a retreat center.
I would move much of the content in 174-188 here, to give an introduction and a frame to the reader.
141 The list of leisure activities is a bit curious (e.g. whistling as a common activity; but perhaps it was, then). Please consider rephrasing.
145 Does looking up to the sky really require “significant muscle movement”?
163-5 “detaching from all fixations” and “returning to a natural rhythm of activities” seem to contradict each other. Please explain / reformulate: what is “natural” here?
177 edit the language.
178-9 You need to explain this more. Who gave this criticism? Or where do the implications about Morita therapy come from?
189-190 rephrase: “has been linked to eco-anxiety in some public comments” (not any whole “popular discourse”)
190-4 Please clarify this. “Morita therapy is mentioned on the British website…”
209 have –> has
210-11 correct the language.
211-12 who “their”? Rephrase and clarify.
218 change 3 into 4
219-21 repetition with 215-7. Reformulate.
229-230 How much of her climate worries are the result of heightened climate awareness and what exactly is the role of the F4F demonstration experiences? Please clarify. Now it sounds like the F4F demonstration is a major cause.
241 and 245: reformulate to avoid repetition.
247-51 This needs reformulation. “Overthinking” and “allowing her emotions to overwhelm” are not the same thing. What is the specialty of Morita therapy here, compared to for example CBT, or is there any?
A side note: “Acting” could be misinterpreted (cf. actor in a theatre).
255-6 It can be a different thing to have wishful thinking about reality than to wish that climate crisis would not exist. Please clarify whether there was actual wishful thinking, or simply deep hopes that the crisis would be solved.
266-7 and 274-5: I am not convinced that her actions are somehow fully separate from her (climate) emotions. Are there truly no emotions guiding her decisions to cut climate emissions?
296 Can we really be sure that her actions and efficacy buffer against any strong distress? In other words, is she truly able “to fully experience these emotions”? Or just better able to cope?
310 Can we really know that her climate anxiety will “eventually subside on its own”?
314 Change into 5
357-362 repetition
Author Response
Dear Reviewer #1,
thank you very much for your valuable time and comments. I have incorporated them into the manuscript. I added two paragraphs in the introduction (section 2, Morita Therapy) and the discussion, where I address the similarities and differences between Morita Therapy, CBT, and EFT. Additionally, I have carefully read and implemented the many valuable comments throughout the manuscript. Numerous formulations have been adjusted, statements have been clarified, and a few words have been specified or removed. In some cases, the comments overlapped with those of other reviewers, resulting in more extensive changes than suggested in a single comment. The quality of the manuscript has significantly improved thanks to the numerous remarks, for which I would like to express my gratitude!
Reviewer 2 Report
Comments and Suggestions for AuthorsThank you for the opportunity to serve as reviewer of the manuscript entitled “Eco-Anxiety and Morita Therapy – A Case Study”. The manuscript discusses an interesting topic focusing on the Eco-Anxiety together with the Morita Therapy.
Author presented a single case study describing the therapeutic intervention and concluding that Morita Therapy “proved beneficial in managing participant’s Eco-Anxiety by facilitating a shift from passive worry to active engagement with life’s challenges”…..providing “significant insights into the adaptability and effectiveness of this therapeutic approach beyond its traditional contexts".
My sense is that these topics could be of potential interest to the CHALLENGES readership but, unfortunately, there are several conceptual, methodological, and procedural problems that prevent a positive evaluation.
First, at the conceptual level, Author considered eco-anxiety as a mono-dimensional construct while recent research demonstrated its multidimensionality.
Concerning Morita Therapy, Author described its origins and some concepts, but I feel with some misunderstanding (ex.: the use of “pain” to intend “suffering” lines 100, 131, 134, 137) and several misleading affirmations (lines 101-106) without any consideration to current refinements in which a standard training system for therapists was established, adaptations to modern conditions were made and expanded.
Furthermore, a comparison and distinction with other psychotherapeutic concepts should be urgent together with a description of the fundamental theory that has not changed – such as Human nature understanding based on Oriental theory, Desire to live and fear of death, Vicious cycle theory, Contradiction by ideas, Therapeutic goal; arugamama state.
For example, the similarities between mindfulness and the idea of arugamama has been discussed in the literature but in this paper, it is not considered, as would have been appropriate throughout the article distinguishing the therapeutic indications that come from the Treatment-Expanding Psychotherapeutic Science (TEP) framework (used by the Author) and those that are specific to the Morita Therapy.
Second, following the reasoning described by the authors in his/her proposal, to make this aim potentially falsifiable, almost a single-subject design with some control is suitable. I feel important suggest single-subject study and not a case study. A case study is a specific description of an individual, which can include both qualitative and quantitative analyses. In the current manuscript, only qualitative analyses are included. The history of psychology is filled with influential cases studies, such as Freud’s case of “Anna O.” or Watson & Rayner’s case of Little Albert, but case studies can be appropriate for indicating new research questions (only when the topic is new). They can also support researchers understand rare phenomena, such as the effects of amnesia.
However, case studies cannot replace single-subject research. One reason is that case studies usually do not allow researchers to determine whether specific events are causally related, or even related at all.
A comparison would be needed where a second subject do not receive the treatment or using a single-subject procedure with specific measures/variables whose progress can be observed over time (ex.: eco-anxiety should be measured with questionnaires or psycho-physiological markers).
Furthermore, no correct diagnosis of the case study based on DSM-5 TR or ICD 10 was reported.
A further motivation is that a single case can always be unrepresentative of people more generally. Moreover, case studies have serious problems with both internal and external validity. Synthetically, methodological question is quite complex, and I don't believe that the methodology of the present case is sufficiently precise to answer the research question unambiguously supporting conclusion.
Furthermore, Author uses lexical terminology not more in use (ex.: “neurotics” see lines 85, 111).
Other concern is that the procedures used in this research may not have achieved the goal. That is, I feel that the way the methodological framework was done and the way the questions were posed may have produced a situation in which (methodologically) is difficult evaluate if there is a relation between treatment and outcome.
Consequently, I suggest that the author use this experience as the foundation for further work. However, I hope you will find my questions and suggestions helpful to you in your future research in this area.
Author Response
Dear Reviewer #2,
Thank you very much for your valuable comments, which I would like to address below.
Regarding the unidimensionality: It is clear that eco-anxiety is a multifaceted phenomenon that must be considered on multiple levels. The single case study is primarily intended for scientifically interested practicing psychotherapists, which is why eco-anxiety is presented in a simplified manner for the sake of complexity reduction (and due to space constraints).
This is also the reason why no "control study" was conducted, as such a study would not be meaningful. A hypothetical second person with the same symptoms might react very differently to the same therapy or no therapy at all compared to Waltraud M. In the discussion, I have clarified that the generalizability of a single case study is not given, and I have added in the revised version that while Morita Therapy appears promising for treatment, further research (and practice) is necessary. (Another reviewer commented that I should emphasize the promising approach of Morita Therapy more strongly.)
No ICD-10, ICD-11, or DSM-5 diagnosis was made, as the therapy was not billed through health insurance. Eco-anxiety is also not a diagnosis, as the fear of the impacts of climate change is not inherently pathological and does not receive a diagnosis. It would most likely be classified as an unspecified anxiety disorder, which, however, could be misleading for the treatment of eco-anxiety in this case. Additionally, no psychometric procedures, inventories, or other questionnaires were conducted or evaluated. Conclusions were drawn based on the anamnesis, which I have appropriately indicated in the revised manuscript.
The comment that a comparison with other psychotherapeutic concepts is useful was also mentioned in other reviews, particularly in relation to CBT and EFT. I have added two such paragraphs in the theoretical section on Morita Therapy and in the discussion.
Yes, I deliberately used outdated terminology, as the theoretical foundation is several decades old and the terms used at that time are reflected. To avoid misunderstandings, I have explained the term "neurotic," which is mentioned only once.
Finally: "Other concern is that the procedures used in this research may not have achieved the goal. That is, I feel that the way the methodological framework was done and the way the questions were posed may have produced a situation in which (methodologically) is difficult evaluate if there is a relation between treatment and outcome."
To my understanding, it is invariably the case in psychotherapeutic treatment that one cannot know whether the outcome results from the treatment or whether other factors had a much more significant influence. In a single case study, it is also impossible to make a clear assignment, in my opinion, which is why one can only present an approach and leave it to the readers to judge whether it could be effective or not. Additionally, other psychotherapists who apply exactly the same form of treatment may achieve different results because they are different individuals with different personalities, and so are their patients. In my opinion, comparability between different therapeutic situations is not feasible. Only with a very high number of treatments involving a very narrowly defined therapeutic intervention can a certain probability be calculated for its effectiveness in a patient. However, nothing can be said about the individual case.
I hope that my responses are satisfactory and thank you very much for your valuable time and comments, Reviewer #2.
Reviewer 3 Report
Comments and Suggestions for AuthorsThank you for the opportunity to read your article based on the treatment of eco-anxiety in a single case design. I agree that such a design is limiting with respect to the ability to generalise the findings and that insights to be gained are not enriched through the application of objective measures. However, I believe there is scope to accommodate such niche research into the literature to foster curiosity and exploration.
According to the aims of the journal: “All submissions to Challenges are expected to highlight how the work is relevant to planetary health and how the findings directly impact the flourishing of humans and/or the environments on which we depend.” The concluding paragraph focuses very appropriately on the various shortcomings of the study, but it seems that there should also be some emphasis on how Morita Therapy shows some promise to help people adapt to our changing environment and climate.
I noted some typographic and/or grammatical errors in the manuscript as well as some statements that require clarification. I have listed these as follows:
Ll 33-34 (and elsewhere). I query the use of title case for these various forms of anxiety or fear.
L 50. Challenges; title case for journal title
L 97. “Many falls into…”. Many fall…
L 107. ‘nature’ has many meanings and referents. When therapists urge patients to ‘observe nature’, what is it they expect patients to observe? Some examples?
L 119 (and elsewhere). Morita himself uses lowercase in reference to shinkeishitsu, yet you use title case.
L 171. Erythrophobia – define for those unfamiliar with the term. “managed to shop in work clothes without feeling anticipatory anxiety”. What does shopping in work clothes have to do with fear of blushing?
L 177. “discusses the therapy's dissemination post-founder's death”. Do you mean to say that LiVine discusses the dissemination of Morita therapy in the years following the founder’s (i.e., Morita’s) death? “post-founder’s death” doesn’t fit the context here.
Ll 178-179. “criticizing the false dichotomy between Eastern and Western methods which labels Morita Therapy as unscientific and ineffective for Westerners.” A dichotomy doesn’t label anything.
L 194. There is reference to a brief quote but no accompanying quotation marks to indicate the specifics of the quote.
L 208-210. Firstly, the paragraph appears to begin with reference to the current study, but the third sentence is not aligned with the current study as described in the abstract with reference to a female patient (her/she). Secondly, the sentence doesn’t follow grammatical rules. Finally, you make general reference to a case study method for which a patient provides informed consent for use of their data. It would be useful to have a concrete affirmation that the patient in question for the current case study gave her informed consent for the use of her data/experiences in this way.
Ll 219-220. Repeats previous paragraph ending.
Ll227-230. “Additionally, she has been experiencing increasing fears about the climate crisis and its consequences, which have significantly intensified in the past two years since she participated in a Fridays-For-Future demonstration, affecting her daily life.” What affected her daily life? Participating in the demonstration? Or fears about the climate crisis and its consequences?
L 286. Reference “to her lawyer” is ambiguous because in the previous sentence there is reference to “the lawyer she works for”. In that sense, the person is not her lawyer but rather her employer.
Ll 309-310. “She still feels anxious about the climate, but she accepts its presence, knowing it will eventually subside on its own.” Accepts the presence of the climate? Knowing that climate will subside? I assume you mean to refer to the presence of anxiety, and knowing that the anxiety will subside – needs to be articulated more clearly.
Comments on the Quality of English LanguageSome revision is required for clarity and to correct errors of grammar.
Author Response
Thank you very much for the valuable and detailed comments, which significantly contribute to improving the quality of the manuscript and the clarity of individual statements. I have incorporated each comment and made the changes in the text using track changes in Word. I hope the passages now clearly express what is meant. I have also added a few sentences at the end of the last paragraph about the contribution of Morita Therapy to current challenges and thank you for these comments as well. Finally, I would like to thank you for your valuable time spent on the review.
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThe author has read my comments carefully and made many improvements to the paper. The most important thing is that now the application of Morita Therapy is situated in the context of other methods (namely CBT and EFT), and both its special elements and interconnections are discussed. Many smaller, good edits have been made, such as better explaining of what is meant with neuroticism in this context. I think that the flow of English should be checked once more, but that can be done in the production process.
Author Response
Thank you very much for your kind reply, and again for you valuable comments in the first review!
Reviewer 2 Report
Comments and Suggestions for AuthorsThe Author tried to replay to the requested revision changing some points in the manuscript without producing a rebuttal letter which is necessary to justify changes together with the choice do not conside some requests at all, as in the case of my revision. Unfortunately, in the current version of the manuscript, most of my comments are unaddressed.
Author addedd some information about my first concern (lines 38-53) regarding the construct multidimensionality but, in the rest of the manuscript he continued to speak about a neurotic subject without considering the requested classification based on DSM 5 TR.
Concerning Morita Therapy Author addedd (lines 216-233; 400-417) some comparisons with other psychoterapic approaches but the manuscript remain unchanged regarding my request to propose and discuss the current refinements of the Morita therapy in which a standard training system for therapists was established, adaptations to modern conditions were made and expanded.
The description of the fundamental theory that has not changed – such as Human nature understanding based on Oriental theory, Desire to live and fear of death, Vicious cycle theory, Contradiction by ideas, Therapeutic goal; arugamama state. For example, the similarities between mindfulness and the idea of arugamama has been discussed in the literature but in this paper, it is not considered, as would have been appropriate throughout the article distinguish the therapeutic indications that come from the Treatment-Expanding Psychotherapeutic Science (TEP) framework and those that are specific to the Morita Therapy.
Finally, following the reasoning described by the author in his/her proposal, to make this aim potentially falsifiable, almost a single-subject design with some control is suitable. I feel important suggest single-subject study and not a case study. A case study is a specific description of an individual, which can include both qualitative and quantitative analyses. In the current manuscript, only qualitative analyses are included. The history of psychology is filled with influential cases studies, such as Freud’s case of “Anna O.” or Watson & Rayner’s case of Little Albert, but case studies can be appropriate for suggesting new research questions (when the topic is new). They can also support researchers understand rare phenomena, such as the effects of amnesia. However, case studies cannot replace single-subject research. One reason is that case studies usually do not allow researchers to determine whether specific events are causally related, or even related at all.
A comparison would be needed where a second subject do not receive the treatment or using a single-subject procedure with specific measures/variables whose progress can be observed over time (ex.: eco-anxiety should be measured with questionnaires or psycho-physiological markers). Not having used an objective method or the clinical observation based on DSM 5 manual to formulate his diagnosis, we cannot know whether the described subject actually had eco-anxiety or perhaps some personality disorde, so author's conclusions are not reliable or teneable.
Author uses lexical terminology not more in use.
Consequently, I suggest that the author use this experience as the foundation for further work. However, I hope you will find my questions and suggestions helpful in future research in this area.
Author Response
Thank you for your insightful comments regarding the manuscript. I appreciate the opportunity to clarify and address your concerns about the suitability of a single case study and the need for a potentially falsifiable design.
Firstly, while I understand the preference for a single-subject design with control measures to enhance the robustness and falsifiability of the findings, it is important to recognize the specific context and objectives of this study. The primary aim of this single case study was to provide an in-depth exploration of eco-anxiety within a real-world context, where detailed qualitative insights can offer valuable contributions to understanding this emerging phenomenon. Unlike single-subject designs, which typically require manipulation and control of variables, case studies allow for a more holistic and nuanced examination of individual experiences in their natural settings.
Historically, case studies have been instrumental in advancing psychological knowledge, particularly in areas where phenomena are not yet well understood or are difficult to quantify. As you mentioned, seminal case studies such as Freud's "Anna O." and Watson & Rayner's "Little Albert" have significantly influenced the field by highlighting new research questions and providing a foundation for future empirical studies. In this vein, our case study aims to shed light on the complex interplay of factors contributing to eco-anxiety, thus laying the groundwork for more controlled studies in the future.
Regarding the absence of quantitative measures and the reliance on qualitative analysis, it is important to note that the richness and depth of qualitative data can capture the intricacies of eco-anxiety that might be overlooked by standardized measures. While it is true that case studies do not establish causality in the same way experimental designs do, they can offer critical insights into the lived experiences of individuals, which are essential for developing hypotheses and informing subsequent research.
But of course, I not only carefully read your valuable comments, I also added two paragraphs and deleted an important word to change the manuscript in a way you suggested. I deleted the word "neurotics" in the case study. Now, it is only used in the historical context of Morita, but not in the context of Waltraud. I replaced it with "people with anxieties". Furthermore, I added a paragraph about the diagnostics. Although, I didn't run any diagnostical tests or surveys, I now write about the diagnosis, I would have given her regarding her symptoms. And last but not least, I added a long paragraph about the changes in Morita therapy in the last decade(s).
Thank you again for your time and your comments!
