Imagining What Could Have Happened: Types and Vividness of Counterfactual Thoughts and the Relationship With Post-traumatic Stress Reactions.

Ines Blix,Marianne Skogbrott Birkeland,Alf Børre Kanten,Siri Thoresen

doi:10.3389/fpsyg.2018.00515

Abstract

A growing body of research suggests that counterfactual thinking after traumatic events is associated with post-traumatic stress reactions. In this study we explored frequency of upward and downward counterfactuals in trauma-exposed individuals, and how trauma-related counterfactuals were represented in terms of vividness. We examined the relationships between vividness and frequency of counterfactual thoughts and post-traumatic stress reactions in two groups who had experienced different types of traumatic exposure, namely survivors and bereaved from the fire on the ferry Scandinavian Star in 1990. Even after 26 years, both survivors and bereaved reported that they currently entertained thoughts about what could have happened during the fire on Scandinavian Star. Survivors reported more downward counterfactuals than the bereaved, whereas the bereaved reported more upward counterfactuals than the survivors did. Vividness of counterfactual thoughts, as well as reported frequency of upward and downward counterfactuals, were associated with post-traumatic stress reactions. Our results suggest that both upward and downward counterfactuals can be harmful, and that vivid counterfactuals about a traumatic event might play a similar role in post-traumatic stress as trauma memories. Therefore, traumatized individuals who entertain counterfactual thoughts may benefit from interventions that target these thoughts specifically.

Highlights

Common reactions to traumatic events are intrusive memories or thoughts, numbing, hyperarousal and avoidance of trauma reminders, trauma-related thoughts and memories
A growing body of research suggests that thoughts about counterfactual outcomes play a key role in the experience of psychological distress and symptoms of post-traumatic stress disorder (PTSD) (El Leithy et al, 2006; Blix et al, 2016; Mitchell et al, 2016)
Our goal was to describe the frequency of type, and vividness of trauma-related Counterfactual thinking (CFT), and to examine the relationships with post-traumatic stress reactions after exposure to a real-life traumatic event. We explored these relationships in two groups with different kinds of traumatic exposure, namely survivors and bereaved from the fire on the ferry Scandinavian Star in 1990

Summary

Introduction

Common reactions to traumatic events are intrusive memories or thoughts, numbing, hyperarousal and avoidance of trauma reminders, trauma-related thoughts and memories These responses can be understood as normal responses to an abnormal event, and they subside for most individuals during the following days or weeks. According to theories on post-traumatic stress, patterns of cognitive processing of the traumatic event influence the development and maintenance of post-traumatic stress symptoms (Brewin et al, 1996; Ehlers and Clark, 2000) Along these lines, Counterfactual Thinking and Post-traumatic Stress Reactions trauma has been associated with rumination and intrusive vivid memories (Ehlers and Clark, 2000; Berntsen et al, 2003; Michael et al, 2007). A growing body of research suggests that thoughts about counterfactual outcomes play a key role in the experience of psychological distress and symptoms of PTSD (El Leithy et al, 2006; Blix et al, 2016; Mitchell et al, 2016)

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