Upward and Downward Counterfactual Thought After Loss: A Multiwave Controlled Longitudinal Study

Counterfactual thoughts, mental simulations about how a situation may have turned out differently (i.e., “if only …, then …”), can reduce health after stressful life-events. However, specific counterfactual thought types relate to post-loss problems is unclear. We hypothesized that self-referenced upward counterfactuals “If I had done the current would be better”) serve as cognitive avoidance, thereby perpetuating loss-related distress. Conversely, downward … happened, could been [even] worse”) facilitate benefit finding, reducing In longitudinal survey, self-referent, other-referent, and nonreferent counterfactuals, were assessed at baseline. Prolonged grief depression symptoms baseline, 6- 12-month follow-ups. Multiple regression analyses associations between thoughts symptom levels in 65 recently bereaved people who generated loss-event. Moderator unicity of significant effects previous step, by comparing these 59 generating with those propensity-score matched participants other negative Multivariate showed uniquely strongly positively associated prolonged concurrently. Self-referent longitudinally. confirmed thinking one’s (in)actions prevent death exacerbated severity. treatment improved targeting self-blame guilt.