Upward and Downward Counterfactual Thought After Loss: A Multiwave Controlled Longitudinal Study
Open accessAbstract
Counterfactual thoughts, mental simulations about how a situation may have turned out differently (i.e., "if only …, then …"), can reduce mental health after stressful life-events. However, how specific counterfactual thought types relate to post-loss mental health problems is unclear. We hypothesized that self-referenced upward counterfactuals (i.e., "If only I had done …, then the current situation would be better") may serve as cognitive avoidance, thereby perpetuating loss-related distress. Conversely, downward counterfactuals (i.e., "If … had happened, then the current situation could have been [even] worse") may facilitate benefit finding, thereby reducing distress. In a longitudinal survey, self-referent, other-referent, and nonreferent upward counterfactuals, and nonreferent downward counterfactuals were assessed at baseline. Prolonged grief and depression symptoms were assessed at baseline, and 6- and 12-month follow-ups. Multiple regression analyses assessed associations between counterfactual thoughts and symptom levels in 65 recently bereaved people who generated counterfactual thoughts about the loss-event. Moderator analyses assessed the unicity of significant effects in the previous step, by comparing these effects in 59 people generating loss-related counterfactuals with those in 59 propensity-score matched participants generating counterfactuals about other negative life-events. Multivariate analyses showed that nonreferent upward counterfactuals were uniquely strongly positively associated with prolonged grief and depression symptoms concurrently. Self-referent upward counterfactuals were uniquely positively associated with prolonged grief and depression symptoms longitudinally. Moderator analyses confirmed that thinking about how one's (in)actions could prevent a death uniquely exacerbated prolonged grief and depression severity. Prolonged grief treatment may be improved by targeting self-blame and guilt.
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Counter-factual thinking is associated with more severe prolonged grief symptoms.
“Relatedly, engaging in counter-factual thinking, in which people imagine that if they had behaved differently the situation would have turned out better, is associated with more severe prolonged grief symptoms 114 .”
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References 58 · Cited by 29
- Authors
- Eisma, M. C., Epstude, K., Schut, H. A. W., Stroebe, M. S., Simion, A., & Boelen, P. A.
- Affiliations
- University of Groningen (NL)
- Utrecht University (NL)
- Corresponding author
- Eisma, Maarten C.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 52
- Issue
- 3
- Pages
- 577-593
- ISSN
- 0005-7894 (ISSN-L)
- OpenAlex
- W3046784692
- Cited by
- 29
- References
- 58
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 2 · 2020: 1
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- ZonMw
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (veni195.113, 91208009)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- counterfactual reasoning, upward counterfactuals, downward counterfactuals, bereavement, prolonged grief disorder, depression, loss, cognitive avoidance, benefit finding, guilt, self-blame, grief therapy
- MeSH terms
- Grief, Humans, Longitudinal Studies, Mental Health, Regression Analysis
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