What might not have been: an investigation of the nature of counterfactual thinking in survivors of trauma

Abstract

Background. Counterfactual thinking (CFT) refers to the process of reflecting on an event and changing aspects of it so as to alter the eventual outcome. Such thinking appears frequent in survivors of trauma (e.g. ‘If only I had stayed at home then I wouldn't have had the accident’), but has received little systematic empirical investigation. Four studies examined the nature of CFT in both trauma survivors and non-traumatized controls.

Method. Participants generated CFT to their own trauma or to written scenarios.

Results. Three key findings emerged. Firstly, trauma survivors overwhelmingly produced CFT that mutated aspects of their own behaviour during the traumatic event (self-referent CFT) and that improved the event's outcome (upward CFT; Studies 1 and 2). Secondly, self-referent CFT style in trauma survivors was generalized to non-autobiographical scenarios and was independent of how much control the protagonist in the scenarios had over the outcome. In contrast, never-traumatized controls tended to generate more self-referent CFT to scenarios where the protagonists had some control than to scenarios where the protagonist had little control (Study 3). Thirdly, this self-referent, upward CFT style of trauma survivors was not related to frequency of post-traumatic stress symptoms (Studies 1 and 3) or Posttraumatic Stress Disorder (PTSD) caseness (Study 2).

Conclusions. These results are interpreted in terms of a self-referent, upward CFT style that is normative following trauma for all survivors, regardless of levels of trauma-related distress, and that is applied to any negative events that are encountered.