If only… a systematic review and meta-analysis of social, temporal and counterfactual comparative thinking in PTSD

Associations among posttraumatic stress disorder symptoms, life satisfaction, and well-being comparisons: A longitudinal investigation

Many individuals who encounter potentially traumatic events go on to develop symptoms of posttraumatic stress disorder (PTSD). Research suggests that survivors of traumatic events frequently compare their current well-being to different standards; yet, knowledge regarding the role of comparative thinking in well-being is limited to a few cross-sectional studies. We therefore examined the temporal associations among aversive well-being comparisons (i.e., comparisons threatening self-motives), PTSD symptoms, and life satisfaction in individuals exposed to traumatic events. Participants (N = 518) with a trauma history completed measures of PTSD symptoms and life satisfaction, as well as the Comparison Standards Scale for Well-being (CSS-W), at assessment points 3 months apart. The CSS-W assesses the frequency, perceived discrepancy, and affective impact of aversive social, temporal, counterfactual, and criteria-based comparisons related to well-being. All participants reported having engaged in aversive well-being comparisons during the last 3 weeks. Comparison frequency emerged as a significant predictor of PTSD symptoms, β = .24, beyond baseline PTSD symptom severity. Life satisfaction contributed unique variance to the comparison process by predicting comparison frequency, β = -.18; discrepancy, β = -.24; and affective impact, β = .20. The findings suggest that frequent aversive comparisons may lead to a persistent focus on negative aspects of well-being, thereby exacerbating PTSD symptoms, and further indicate that comparison frequency, discrepancy, and affective impact are significantly influenced by life satisfaction. Taken together, the findings support the need for a thorough examination of the role of comparative thinking in clinical populations, which may ultimately help improve clinical care.

'My child could have died': counterfactual thoughts and psychological distress in parents of trauma survivors

Background: After exposure to a potentially traumatic event, survivors may experience thoughts about 'what could have happened', referred to as counterfactual thoughts (CFTs). CFTs have been found to have a negative impact on survivors' mental health. This is the first study to investigate whether parents of trauma survivors experience CFTs and the association with psychological distress in this group.Objective: The main aim of the present study is to investigate CFTs in parents of trauma survivors and the relationship between the frequency and vividness of CFTs and psychological distress.Method: The participants (N = 310, 191 females) were parents of the youths targeted in the terror attack on Utøya island, Norway, in 2011. Frequency and vividness of CFTs, posttraumatic stress reactions (PTSR), and symptoms of anxiety and depression were measured 8.5-9 years post-terror.Results: The majority of the parents (74%) reported having experienced CFTs at some time point since the attack. For almost one-third of the parents, CFTs were still present more than eight years after the attack. Higher frequency and vividness of CFTs were uniquely associated with higher levels of PTSR, anxiety, and depression.Conclusion: The present findings suggest that frequent and vivid CFTs may contribute to mental health problems in parents of trauma survivors and should be addressed in therapy.

Comparison standards shape everyday judgments of low and high wellbeing in individuals with and without psychopathology: a diary-based investigation

People can easily rate and express their current levels of wellbeing, but the cognitive foundations for such judgments are poorly understood. We examined whether comparisons to varying standards underlie fluctuating wellbeing judgments within-person (i.e., throughout daily episodes) and between-person (i.e., high vs. low levels of psychopathology). Clinical and non-clinical participants recorded subjective affect for each distinct episode for one week. Participants briefly described current, best, and worst daily episodes, which we coded for presence and type of comparison standard (social, past temporal, criteria-based, counterfactual, prospective temporal, and dimensional). Participants also rated their engagement with these standards and the respective affective impact. During best episodes, participants reported more downward (vs. upward) comparisons that resulted in positive affective impact. In worst episodes, upward (vs. downward) comparisons were more frequent. In best and worst episodes, we most frequently identified past-temporal and criteria-based comparisons, respectively. The clinical group engaged more often with all potential standard types during worst daily episodes and was more negatively affected by comparative thoughts, amid consistently more negative affect levels across all episode types. Our data suggest that judgments of affect and wellbeing may indeed rely on comparative thinking, whereby certain standards may characterize states of negative affect and poor mental health.

Cognitive factors underlying the impact of postmigration stressors on subjective well-being: Well-being comparisons and self-efficacy

BACKGROUND

Migration and the resulting challenges in the host country can have a profound impact on the mental health of refugees and intensify preoccupation with one's own well-being. Yet, cognitive factors underlying the adverse impact of postmigration stressors are poorly understood.

OBJECTIVE

We aimed at exploring the frequency and nature of well-being comparisons in the context of flight and migration using the Comparison Standards Scale for Well-being (CSS-W), which assesses well-being related social, temporal, counterfactual, criteria-based and dimensional aversive and appetitive comparisons. We further aimed at examining the mediating role of well-being comparisons and general self-efficacy in the relationship between postmigration stressors and psychological well-being.

METHODS

We conducted a survey with 1070 Arabic speaking forcibly displaced people in Germany assessing well-being comparisons, general self-efficacy, postmigration stressors, subjective well-being and social media engagement.

RESULTS

Factor analysis of the CSS-W yielded a theoretically grounded two-factor structure proposing an aversive (mostly upward) and an appetitive (mostly downward) comparison factor. Aversive and appetitive comparisons were reported by more than 99% of participants, with temporal comparisons being reported by 98.7% of participants. Postmigration stressors were significantly related to subjective well-being and aversive well-being comparisons and general self-efficacy partially mediated this relationship. Appetitive well-being comparisons, however, were not significantly related to neither postmigration stressors nor general self-efficacy.

CONCLUSION

Aversive well-being comparisons and general self-efficacy seem to play a significant role in the adverse effects of postmigration stressors on subjective well-being. Longitudinal research is needed to examine the directional dynamics between general self-efficacy, well-being comparisons and postmigration stressors.

Crying over spilled milk? A network analysis of aversive well-being comparison, brooding rumination and depressive symptoms

BACKGROUND

Comparative thinking about one's well-being is ubiquitous. Comparisons that threaten an individual's self-motives are aversive and interact with rumination and depression. Aversive well-being comparisons include upward social, past temporal, counterfactual, and criteria-based comparisons, as well as downward prospective temporal comparisons. Although the frequency, discrepancy, and affective impact of aversive comparison total scores have been associated with brooding rumination and depression, no study has investigated the interaction of specific comparison standards (e.g., social or counterfactual) with symptom cascades of brooding and depressive symptoms.

METHODS

To examine this interaction, we conducted network analyses on the interplay between aversive well-being comparisons, brooding rumination, and depression. Specifically, we conducted a cross-sectional study in N = 500 dysphoric individuals and a longitudinal study in N = 921 participants at two timepoints, three months apart. Participants completed measures of depression, brooding, and the Comparison Standards Scale for Well-being, which assessed the frequency, perceived discrepancy, and affective impact of aversive well-being comparisons.

RESULTS

Feelings of worthlessness emerged as the most central attribute in the networks of the dysphoric sample. Longitudinally, brooding and depressive symptoms predicted aversive comparisons, but not the other way around, which accounted for social and other-referent counterfactual comparisons to a greater degree than for other comparison types.

LIMITATIONS

We used nonclinical samples.

CONCLUSIONS

The findings highlight the critical role of comparison standards in depression. Further research is warranted to detect potential intervention targets for mitigating negative effects of negative self-evaluation.

Individual differences in the frequency of voluntary & involuntary episodic memories, future thoughts, and counterfactual thoughts

Voluntary and involuntary mental time travel can take the form of episodic memory, episodic future thinking, and episodic counterfactual thinking. This study uses an individual-differences approach to understand why people engage in these forms of mental time travel. The individual-differences variables include trait-level personality, boredom proneness, depression, anxiety, stress, emotion regulation, mindfulness, mind-wandering, positive and negative affect, rumination, optimism, thinking styles, and time perspective. Across two studies, our results indicate that individual differences underlie these forms of mental time travel. The most unique, episodic counterfactual thinking, was alone positively correlated with negative emotionality and negatively correlated with optimism. We also observe differences as a function of voluntariness and discuss these findings in relation to the cognitively demanding nature of constructing future and counterfactual thoughts. We discuss the importance of distinguishing voluntary from involuntary thinking and assessing episodic counterfactual thinking in relation to episodic memory and episodic future thinking.

Aversive well-being comparisons in dysphoria and the role of brooding rumination

OBJECTIVES

Individuals frequently engage in comparisons on how they are doing relative to different standards. According to the general comparative-processing model, comparisons can be perceived as aversive (appraised as threatening the motives of the comparer) or appetitive (appraised as consonant with, or positively challenging the motives). Research indicates that aversive comparisons are associated with depression. We hypothesize that aversive comparisons play a significant role in the relationship between brooding rumination and depression. Drawing on central propositions of control theory that discrepancies instigate rumination, we investigated the mediating role of brooding rumination in this relationship. Reflecting the different directionality, we also examined whether well-being comparisons mediate the relationship between brooding rumination and depression.

METHODS

Dysphoric participants (N = 500) were administered measures of depression and brooding rumination, and the Comparison Standards Scale for Well-being. The latter assesses aversive social, temporal, counterfactual, and criteria-based comparisons regarding their (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective valence.

RESULTS

The relationship between the frequency of aversive comparisons with depression was partially accounted for by comparison discrepancy and engendered affective valence and brooding rumination. The relationship between rumination and depression was partially mediated by sequential comparison processes.

CONCLUSIONS

Longitudinal research needs to unravel the underlying directionality of the relationship between depression, brooding, and comparison. Relevant clinical implications of well-being comparison are discussed.

Using Analogies to Help Adolescents Unlearn Self-Blame

One of the changes included in DSM-5 to the diagnosis of posttraumatic stress disorder (PTSD) was the inclusion of negative cognitions and emotions related to the trauma, including distorted self-blame for the trauma.¹ Studies show that many young people experience self-blame after experiencing various types of trauma,^2-4 that self-blame from trauma is a key mediating factor in internalizing symptoms in adolescents,² and that self-blame is tied to higher levels of trauma symptoms.³ However, studies have also suggested that young people develop self-blame when they do not directly experience PTSD from trauma, such as maternal depression, parental divorce or separation, bullying, and general negative events.⁵ There appear to be multiple pathways in which young people learn self-blame, and self-blame should be assessed on an individualized level. It has been suggested that psychotherapy with children and adolescents should involve translating the goals of treatment into simple concrete concepts, such as "a simple situation that is familiar to them from day-to-day life."⁶ In addition to evidence-based psychotherapeutic interventions that target symptoms of self-blame resulting from trauma, analogies may serve as potential intervention tools to translate the goal of unlearning self-blame relevant to the individual, situational, and cultural contexts.

Habitual aversive and appetitive well-being comparisons in dysphoria: Introducing the Comparison Standards Scale for well-being

BACKGROUND

People are constantly preoccupied with how they are doing compared to different standards. This preoccupation influences judgments of well-being, including depression. However, research on well-being comparisons is scarce, also due to a lack of a measure of multi-standard comparisons.

METHODS

Our research goals were twofold. First, we validated the Comparison Standards Scale for well-being (CSS-W). Second, by drawing on central propositions of the general comparative-processing model, we examined the association of habitual well-being comparisons, their perceived discrepancies with the standard, and engendered affect with depressive symptoms and psychological well-being in dysphoric participants (N = 500). The CSS-W assesses habitual social, temporal, counterfactual, and criteria-based upward and downward comparisons regarding their a) frequency, b) perceived discrepancy, and c) engendered affect.

RESULTS

The findings confirmed the theoretically expected two-factor solution representing aversive (mostly upward) and appetitive (mostly downward) comparisons. Comparison frequency, discrepancy, and engendered affect were associated with depression and well-being. Yet, aversive comparisons displayed higher associations with the outcomes than appetitive comparisons. In particular, frequency of appetitive comparisons was not significantly correlated to depression. In line with our central theory-driven hypothesis, the relationship between frequency of aversive comparisons with depression was partially mediated by serial effects of comparison discrepancy and affect, whereas the relationship with well-being was fully mediated by comparison discrepancy and affect.

LIMITATIONS

The cross-sectional design of the study does not allow for conclusions of causal relations between the measured variables.

CONCLUSIONS

The presented framework proves useful in examining significant comparison processes in well-being and depression.

Counterfactual comparisons and affective styles in the aftermath of traumatic events

Traumatic events often lead to counterfactual comparison (CFC), defined as comparing one’s current attributes to that of a hypothetical mentally simulated alternative that might have occurred but is counter to the facts. CFC can differ in its direction and in terms of the referent of action. The mentally simulated alternative may be evaluated as more favorable (upward CFC) or less favorable (downward CFC) and the counterfactual alteration (e.g., preventing the event) may have been performed by oneself (self-referent) or others (other-referent). The frequency and engendered affective valence of CFC differ between trauma survivors and correlate with PTSD symptoms. However, knowledge about the mechanism involved is lacking. Individuals differ in how they regulate the engendered affective valence following CFC, suggesting that dispositional affect regulation styles may be implicated in this relationship. We therefore examined the affective styles of adjusting, concealing, and tolerating and their relationship with CFC frequency and engendered affective valence. In 556 individuals who had encountered at least one traumatic event, we examined this question separately for (1) upward self-referent CFC, (2) upward other-referent CFC, (3) downward self-referent CFC and (4) downward other-referent CFC. Most effects were found for upward (rather than downward) CFC and particularly for upward self-referent CFC. The frequency of engaging in upward self-referent CFC was associated with all three affective styles and with engendered affective valence. Different emotion regulation processes appear to be associated with more frequent engagement in upward self-referent CFC and more negative engendered affective valence. Theoretical and clinical implications are discussed.

Measuring Appearance-Related Comparisons: Validation of the Comparison Standards Scale for Appearance

Background

Humans constantly compare their attributes to different reference frames. According to the theoretical framework of the general comparative-processing model, such comparisons may be perceived as aversive (i.e., appraised as threatening the motives of the comparer) or appetitive (i.e., appraised as consonant with, or positively challenging the motives). However, we lack a measure that adequately captures multi-standard comparisons.

Methods

Considering appearance-related comparisons as a relevant comparison domain, we introduce the Comparison Standards Scale for Appearance (CSS-A) that assesses appearance-related social, temporal, counterfactual, criteria-based, and dimensional upward and downward comparisons regarding their (a) frequency, (b) perceived discrepancy, and (c) engendered affect. We administered the CSS-A to 1121 participants, along with measures of appearance social comparison, body satisfaction, physical self-concept, self-esteem, well-being, and depression.

Results

A two-factor model (aversive and appetitive comparisons) fit the data better than a bifactor model with an additional general domain-factor (comparative thinking). The validity of the CSS-A was supported by correlations with external validators beyond appearance, social comparison, and body satisfaction. Aversive comparisons displayed higher associations with most outcomes than appetitive comparisons.

Conclusions

Overall, the CSS-A offers a psychometrically sound and useful measure of multi-standard comparisons.

How do I know how I am doing? Use of different types of comparison in judgment of well-being in patients seeking psychological treatment and healthy controls

Judgment of well-being is formed on the spot, and we know little about its foundations. We aimed at examining the role of comparison standards in informing evaluations of well-being in a clinical and a nonclinical sample. In a semi-structured face-to-face interview, individuals seeking psychological treatment and healthy control individuals rated how they have been feeling in general and relative to specific comparison standards and were each time invited to substantiate their ratings. Independent coders assessed number, type, direction, and specificity of reported comparisons. When asked to explain why they chose a particular rating of their well-being, 93% of clinical participants and 61% of nonclinical participants spontaneously reported some type of comparison standard. Both groups reported highest well-being ratings relative to social and past temporal comparisons and lowest relative to prospective temporal comparison. Furthermore, clinical participants engaged in more upward than downward comparisons, whereas this was not the case for healthy control participants. Our findings suggest that evaluations of well-being are informed by different comparison types and that individuals with clinical complaints use more comparisons when evaluating their well-being. The results encourage further investigation of comparative thinking as an underlying mechanism of judgment of well-being and ill-being.

Comparisons Inform Me Who I Am: A General Comparative-Processing Model of Self-Perception

People's self-concept contributes to their sense of identity over time. Yet self-perception is motivated and serves survival and thus does not reflect stable inner states or accurate biographical accounts. Research indicates that different types of comparison standards act as reference frames in evaluating attributes that constitute the self. However, the role of comparisons in self-perception has been underestimated, arguably because of lack of a guiding framework that takes into account relevant aspects of comparison processes and their interdependence. I propose a general comparative model of self-perception that consists of a basic comparison process involving the individual's prior mental representation of the target dimension, the construal of the comparison standard, and the comparison outcome representing the posterior representation of the target dimension. The generated dimensional construal is then appraised with respect to one's motives and controllability and goes on to shape emotional, cognitive, and behavioral responses. Contextual and personal factors influence the comparison process. This model may be informative in better understanding comparison processes in people's everyday lives and their role in shaping self-perception and in designing interventions to assist people overcome undesirable consequences of comparative behavior.

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.

Traumatic stress sufferers: work as therapy or trigger?

Purpose

While a return to work following trauma exposure can be therapeutic, this is not always so. As with many topics related to traumatic stress in organizations, several contingency factors complicate the effort to draw an overarching conclusion about whether returning to work is therapeutic. The purpose of this paper is to present important determinants of whether work is therapeutic or triggering for those with traumatic stress conditions. The need for contingency approaches in the study of traumatic stress in organizations is illustrated.

Design/methodology/approach

Literature on traumatic stress in organizations is reviewed.

Findings

Three of the key determinants of whether a return to work is therapeutic or triggering for traumatic stress sufferers are trauma-type contingencies, condition-type contingencies and work-setting contingencies. For instance, human-caused and task-related traumas are more likely than natural disasters to make a return-to-work triggering. Additionally, the time since developing a traumatic stress condition is inversely related to the degree of improvement in that condition through the experience of working. Moreover, managerial actions can affect how therapeutic an employee’s return to work is.

Practical implications

These findings suggest the challenges of reintegrating a traumatized employee to the workplace can be highly situation-specific. Careful consideration of the traumatic event suffered by each traumatic stress victim, their traumatic stress condition, and the work setting to which they would return are recommended.

Social implications

Promoting mental health in organizations can contribute to employers’ social performance.

Originality/value

Examination of the factors that complicate predicting whether work is therapeutic posttrauma demonstrates how contingency approaches can advance research on trauma in organizations.

How am I doing compared to different standards? Comparative thinking and well-being following exposure to a vehicle-ramming attack

Background: Exposure to potentially adverse events might intensify thinking about different comparison standards in relation to one's own well-being. Objective: To examine how frequently survivors of a recent potentially traumatic event use different comparison standards to evaluate their current well-being. Method: A survey with 223 participants directly or indirectly exposed to a vehicle-ramming attack was conducted. Symptoms of post-traumatic stress disorder (PTSD) and depression, quality of life, and the sum score of the frequency of different types of comparison standards were assessed. The latter consisted of temporal, counterfactual, social, dimensional, and criteria-based comparisons. Results: In total, 98% of participants reported some form of comparative thinking during the last two weeks. The most frequent comparison types were temporal and dimensional comparisons, with 94 and 87% of participants reporting them, respectively. Notably, comparative thinking predicted unique variance in PTSD symptoms, over and above depressive symptoms. Conclusion: The results suggest that comparative thinking may be a significant factor in understanding psychological distress following exposure to aversive events. Replication of the results in larger samples and using longitudinal and experimental designs is clearly necessary.

I'd do much better, if only … counterfactual comparisons related to traumatic life events

The association between posttraumatic stress disorder (PTSD) and counterfactual comparisons (CFC) is poorly understood and CFC-measures are missing. We developed and applied the Posttraumatic Counterfactual Comparisons Scale (P-CFC-S), which measures frequency, intensity and affective impact of trauma-related CFC. We further measured trauma history, PTSD symptoms, probable PTSD diagnosis, posttraumatic cognitions, satisfaction with life and basic sociodemographic information. The sample consisted of 556 adults (62.95% female) who had all experienced at least one potentially traumatic event and of whom 15.29% fulfilled a probable PTSD diagnosis. The P-CFC-S yielded adequate internal consistency and a one-factor structure in the explorative factor analysis. CFC were common, and about two-fold more common in individuals with probable PTSD compared to those without. In hierarchical regression analyses, the frequency and intensity in CFC explained a significant amount of variance in PTSD symptoms when potentially confounding variables (i.e. age, gender, posttraumatic cognitions and counterfactual thinking) were accounted for. Our findings suggest that CFC may be an active ingredient in PTSD maintenance. Longitudinal research is needed to examine the dynamics between CFC and PTSD and the hypothesis that CFC is related to cognitive avoidance and/or maladaptive appraisals of trauma meaning.