Counterfactual thinking and functional differences in depression

Effects of subclinical depression on prefrontal-striatal model-based and model-free learning

Depression is characterized by deficits in the reinforcement learning (RL) process. Although many computational and neural studies have extended our knowledge of the impact of depression on RL, most focus on habitual control (model-free RL), yielding a relatively poor understanding of goal-directed control (model-based RL) and arbitration control to find a balance between the two. We investigated the effects of subclinical depression on model-based and model-free learning in the prefrontal-striatal circuitry. First, we found that subclinical depression is associated with the attenuated state and reward prediction error representation in the insula and caudate. Critically, we found that it accompanies the disrupted arbitration control between model-based and model-free learning in the predominantly inferior lateral prefrontal cortex and frontopolar cortex. We also found that depression undermines the ability to exploit viable options, called exploitation sensitivity. These findings characterize how subclinical depression influences different levels of the decision-making hierarchy, advancing previous conflicting views that depression simply influences either habitual or goal-directed control. Our study creates possibilities for various clinical applications, such as early diagnosis and behavioral therapy design.

Counterfactual thinking in psychiatric and neurological diseases: A scoping review

BACKGROUND

The ability to simulate alternatives to factual events is called counterfactual thinking (CFT) and it is involved both in emotional and behavioral regulation. CFT deficits have been reported in psychiatric and neurological conditions, possibly contributing to patients' difficulties in modulating behaviors and affections. Thus, acknowledging the presence and possible consequences of CFT impairments might be essential for optimal clinical management.

OBJECTIVES

This scoping review aims to summarize the previous evidence about CFT in psychiatric and neurological diseases to determine the extent of the previous research and what has been discovered so far, the variety of clinical conditions considered, the methodologies adopted, and the relevant issues to be addressed by future investigations.

METHODS

PsycInfo, PubMed, Scopus, and Web of Science were searched to identify articles published up to January 2020, written in English and focused on CFT in adults affected by psychiatric or neurological conditions.

RESULTS

Twenty-nine studies have been included; most of them focused on psychiatric conditions, a minority considered neurological diseases. The generation of counterfactual thoughts related to a negative real-life or a fictional event and the counterfactual inference test were the most popular tasks adopted. CFT impairments were reported in both psychiatric and neurological conditions, likely associated with a fronto-executive dysfunction.

CONCLUSIONS

Future research might further explore CFT in those psychiatric and neurological conditions in which CFT difficulties have been preliminary reported. Furthermore, it would be recommendable to extend this investigation to all the clinical conditions possibly at risk of fronto-executive dysfunction. In the end, we speculate that since CFT plays a role in driving everyday behaviors, it might be crucial also when medical decisions are involved; thus, future research might extend the investigation of CFT especially to those populations that implicate complex clinical management.

Counterfactual Thinking-Related Emotional Responses in Patients With Major Depressive Disorder

Objective: To explore the emotional characteristics of counterfactual thinking (CT)-related emotion responses in patients with major depressive disorder (MDD) via the "counterfactual thinking gambling task (CTGT)." Method: Twenty-five patients with MDD (the MDD group) and twenty-five healthy controls (the HC group) with matched demographic features were included. The 17-item Hamilton Depression Scale (HAMD) and the 14-item Hamilton Anxiety Rating Scale (HAMA) were used to assess the severity of depression and anxiety symptoms. The counterfactual thinking gambling task was applied to assess the situation-focused- and behavior-focused-CT-related emotion responses in the MDD group and the HC group. Results: There was no significant difference in general demographic data between the two groups (p > 0.05). Compared with the HC group, the MDD group experienced higher levels of "disappointment" and lower levels of "joy" in the situation-focused CT paradigm (p < 0.05). However, the experience of "regret" and "relief" in the behavior-focused CT paradigm were not significantly different between the two groups (p > 0.05). Conclusions: MDD is associated with an impaired situation-focused-CT-related emotion responses, and is often accompanied by increased disappointment and decreased joy; however, behavior-focused-CT-related emotion responses are not significantly affected in MDD. This pattern may represent the characteristic CT-related emotion responses of MDD.

Cognições sobre Eventos Passados: uma Revisão da Literatura

El presente estudio tuvo como fin reunir y sintetizar resultados de múltiples artículos del área del pensamiento contrafactual, entre los años 2005 y 2015. Se obtuvieron 99 artículos en las bases de datos PsycInfo, Web of Science y SciELO, con la palabra clave “pensamiento contrafactual” y su correspondiente en lengua inglesa counterfactual thinking. La multiplicidad de publicaciones y áreas relacionadas se discuten haciendo énfasis en el rol del pensamiento contrafactual en distintas vertientes de procesos neurológicos, psicológicos y sociales.

Upward counterfactual thinking and depression: A meta-analysis

This meta-analysis examined the strength of association between upward counterfactual thinking and depressive symptoms. Forty-two effect sizes from a pooled sample of 13,168 respondents produced a weighted average effect size of r=.26, p<.001. Moderator analyses using an expanded set of 96 effect sizes indicated that upward counterfactuals and regret produced significant positive effects that were similar in strength. Effects also did not vary as a function of the theme of the counterfactual-inducing situation or study design (cross-sectional versus longitudinal). Significant effect size heterogeneity was observed across sample types, methods of assessing upward counterfactual thinking, and types of depression scale. Significant positive effects were found in studies that employed samples of bereaved individuals, older adults, terminally ill patients, or university students, but not adolescent mothers or mixed samples. Both number-based and Likert-based upward counterfactual thinking assessments produced significant positive effects, with the latter generating a larger effect. All depression scales produced significant positive effects, except for the Psychiatric Epidemiology Research Interview. Research and theoretical implications are discussed in relation to cognitive theories of depression and the functional theory of upward counterfactual thinking, and important gaps in the extant research literature are identified.

Understanding Counterfactuality: A Review of Experimental Evidence for the Dual Meaning of Counterfactuals

Cognitive and linguistic theories of counterfactual language comprehension assume that counterfactuals convey a dual meaning. Subjunctive-counterfactual conditionals (e.g., 'If Tom had studied hard, he would have passed the test') express a supposition while implying the factual state of affairs (Tom has not studied hard and failed). The question of how counterfactual dual meaning plays out during language processing is currently gaining interest in psycholinguistics. Whereas numerous studies using offline measures of language processing consistently support counterfactual dual meaning, evidence coming from online studies is less conclusive. Here, we review the available studies that examine online counterfactual language comprehension through behavioural measurement (self-paced reading times, eye-tracking) and neuroimaging (electroencephalography, functional magnetic resonance imaging). While we argue that these studies do not offer direct evidence for the online computation of counterfactual dual meaning, they provide valuable information about the way counterfactual meaning unfolds in time and influences successive information processing. Further advances in research on counterfactual comprehension require more specific predictions about how counterfactual dual meaning impacts incremental sentence processing.

Styles of Counterfactual Thoughts in People with and without Signs of Depression

People in a depressive state frequently believe that things could have happened differently in their lives, which is regarded as counterfactual thought. This study aimed to investigate whether the styles of counterfactual thought shown by people with indicating signs of depression and by people without any of those signs are different. Study participants were 42 adults divided into two groups: those with signs of depression and those without signs of depression. Five stories taken from newspapers and magazines and fictional scenarios were presented to the participants. After reading such stories, participants had to answer questions about how the narrated facts could have been different from what they actually were. Results indicated similar counterfactual thought styles in both groups (with and without depression signs). Most of the thoughts found were categorized as upward, subtractive, self-referent and that modified an aspect referred to action/inaction. A few significant differences between groups were observed, and most of them were obtained through directed modifications, in the last three stories. Some tendencies were shown in the group of people with signs of depression, such as those found for the subtractive category, t(40) = 2.33, p < .05, which can indicate a trend of possible failure in the preparatory function of CT, and in the hetero-referral function, t(40) = 1.97, p < .05, indicating a difficulty in thinking of different forms of action in the future. The removal of negative events may indicate that these experiences are not beneficial to people's survival. These results may indicate some tendencies about how people in depressive states think about past events.

Cognitive neuroscience of human counterfactual reasoning

Counterfactual reasoning is a hallmark of human thought, enabling the capacity to shift from perceiving the immediate environment to an alternative, imagined perspective. Mental representations of counterfactual possibilities (e.g., imagined past events or future outcomes not yet at hand) provide the basis for learning from past experience, enable planning and prediction, support creativity and insight, and give rise to emotions and social attributions (e.g., regret and blame). Yet remarkably little is known about the psychological and neural foundations of counterfactual reasoning. In this review, we survey recent findings from psychology and neuroscience indicating that counterfactual thought depends on an integrative network of systems for affective processing, mental simulation, and cognitive control. We review evidence to elucidate how these mechanisms are systematically altered through psychiatric illness and neurological disease. We propose that counterfactual thinking depends on the coordination of multiple information processing systems that together enable adaptive behavior and goal-directed decision making and make recommendations for the study of counterfactual inference in health, aging, and disease.

Reinforcement learning in depression: A review of computational research

Despite being considered primarily a mood disorder, major depressive disorder (MDD) is characterized by cognitive and decision making deficits. Recent research has employed computational models of reinforcement learning (RL) to address these deficits. The computational approach has the advantage in making explicit predictions about learning and behavior, specifying the process parameters of RL, differentiating between model-free and model-based RL, and the computational model-based functional magnetic resonance imaging and electroencephalography. With these merits there has been an emerging field of computational psychiatry and here we review specific studies that focused on MDD. Considerable evidence suggests that MDD is associated with impaired brain signals of reward prediction error and expected value ('wanting'), decreased reward sensitivity ('liking') and/or learning (be it model-free or model-based), etc., although the causality remains unclear. These parameters may serve as valuable intermediate phenotypes of MDD, linking general clinical symptoms to underlying molecular dysfunctions. We believe future computational research at clinical, systems, and cellular/molecular/genetic levels will propel us toward a better understanding of the disease.

Depressive states amplify both upward and downward counterfactual thinking

Depression has been linked to counterfactual thinking in many behavioral studies, but the direction of this effect remains disputed. In the current study, the relationship between depression and counterfactual thinking was examined using the event-related potential (ERP) technique. In a binary choice gambling task, outcome feedback of the chosen option and that of the alternative option were both provided, so as to elicit the process of counterfactual comparison. By investigating ERP signals in response to outcome presentation, we discovered that when the fictive outcome was better or worse than the factual outcome, the amplitude of the P3 component was positively correlated with individual levels of depression, but not levels of anxiety. These results indicate that depression strengthens both upward counterfactual thinking and downward counterfactual thinking. The implication of this finding to clinical research is discussed.

Effect of Motivational Goals on the Causal Realism of Counterfactual Thoughts

Counterfactual thinking refers to mental comparisons of reality with imagined alternatives of it. The "functional view" of counterfactual thinking suggests that upward counterfactuals (which improve on reality) serve a preparative function and downward counterfactuals (which worsen reality) serve an affective function. This view presumes that people generate counterfactuals that focus on cause(s) that have actually produced the negative outcomes. The two experiments reported here demonstrate that people spontaneously manipulate the causal content of their counterfactuals, depending on their motivational goals. Specifically, it was found that when people aim to feel better about a poor decision they generate less realistic (upward) counterfactuals, experience less negative affect and tend to attribute the outcome to less controllable causes than when they aim to learn from their experience. The theoretical and practical implications of these findings are discussed.

Counterfactual processing of economic action-outcome alternatives in obsessive-compulsive disorder: further evidence of impaired goal-directed behavior

BACKGROUND

Obsessive-compulsive disorder (OCD) is a disorder of automatic, uncontrollable behaviors and obsessive rumination. There is evidence that OCD patients have difficulties performing goal-directed actions, instead exhibiting repetitive stimulus-response habit behaviors. This might result from the excessive formation of stimulus-response habit associations or from an impairment in the ability to use outcome value to guide behavior. We investigated the latter by examining counterfactual decision making, which is the ability to use comparisons of prospective action-outcome scenarios to guide economic choice.

METHODS

We tested decision making (forward counterfactual) and affective responses (backward counterfactual) in 20 OCD patients and 20 matched healthy control subjects using an economic choice paradigm that previously revealed attenuation of both the experience and avoidance of counterfactual emotion in schizophrenia patients and patients with orbitofrontal cortex lesions.

RESULTS

The use of counterfactual comparison to guide decision making was diminished in OCD patients, who relied primarily on expected value. Unlike the apathetic affective responses previously shown to accompany this decision style, OCD patients reported increased emotional responsivity to the outcomes of their choices and to the counterfactual comparisons that typify regret and relief.

CONCLUSIONS

Obsessive-compulsive disorder patients exhibit a pattern of decision making consistent with a disruption in goal-directed forward modeling, basing decisions instead on the temporally present (and more rational) calculation of expected value. In contrast to this style of decision making, emotional responses in OCD were more extreme and reactive than control subjects. These results are in line with an account of disrupted goal-directed cognitive control in OCD.

How reason for surgery and patient weight affect verdicts and perceptions in medical malpractice trials: a comparison of students and jurors

Jurors' decision-making processes are often influenced by extra-legal factors, including judgments of defendants and plaintiffs. Two studies comparing the decisions of university students with those of community jurors sought to determine if extra-legal factors such as individual differences (including identity as a student or juror participant), the reason for surgery (medically necessary vs. elective), the type of surgery (e.g., gastric bypass, nasal reconstruction) or weight of the patient influenced jurors' decisions and perceptions in medical malpractice suits, such that participants would hold negative perceptions of overweight patients or patients who undergo elective surgeries. Results indicate that students and jurors differ in perceptions of the patient's injury and perceptions of risk, which explains some of the variance in liability verdicts. Students were more likely to find doctors liable, but also were more likely to assign responsibility to patients than were jurors. Patients who had undergone elective surgery were seen as more responsible for their situation - and their doctors were assigned less responsibility - than those who had undergone a medically necessary surgery. Tests of weight bias showed that jurors found overweight patients less responsible for their situation than patients of normal weight, but students showed the opposite pattern. Theoretical explanations are explored and implications discussed.

"If only I had done better": Perfectionism and the functionality of counterfactual thinking

Although a recent update on the functional theory of counterfactual thinking suggests that counterfactuals are important for behavior regulation, there is some evidence that counterfactuals may not be functional for everyone. Two studies found differences between maladaptive and high personal standards perfectionism in the functionality of counterfactuals and variables relevant to behavior regulation. Maladaptive but not personal standards perfectionism predicted making more upward counterfactuals after recalling a negative event and was linked to a variety of negative markers of achievement. Maladaptive perfectionism was associated with making controllable, subtractive, and less specific counterfactuals. High personal standards perfectionism moderated the effects of maladaptive perfectionism on counterfactual controllability. Generating counterfactuals increased motivation for personal standards perfectionists relative to a noncounterfactual control group but had no effect on motivation for maladaptive perfectionists. The findings suggest a continuum of counterfactual functionality for perfectionists and highlight the importance of considering counterfactual specificity and structure.