Using a counterfactual-based intervention to change eating intentions: Results from Hispanic and non-Hispanic undergraduate and community samples

Finding ways to improve eating behavior has become a major focus of interventions designed to improve health outcomes. Counterfactual thinking (i.e., mental simulations of how a past outcome could have been different) is a cognitive strategy that has been shown to improve behavior regulation and could be a promising intervention to improve eating behavior. The purpose of the current research was to examine the effect of a counterfactual-based intervention to shift contemplation to change eating behavior, motivation towards eating healthier, and intentions to engage in healthier eating behaviors. Participants in both studies were randomly assigned to either a counterfactual-based intervention or a control condition. In Study 1, those in the counterfactual-based intervention condition reported an increase in readiness to change their eating behavior, higher extrinsic motivation towards eating healthy, and higher intentions to eat healthy compared to those in the control condition. Within the counterfactual condition, individuals who self-identified as Hispanic had higher intentions to use their counterfactual strategies than those who identified as non-Hispanic. Study 2 found similar results using a more diverse community sample. Those in the counterfactual-based intervention condition reported an increase in readiness to change, intentions to eat healthy, and intentions to use their counterfactual strategies, with this effect being stronger for self-identified Hispanic participants. These studies provide initial evidence for the use of a counterfactual-based intervention to improve eating behavior in diverse populations.

Should I have been more careful or less careless? The comparative nature of counterfactual thoughts alters judgments of their impact

Counterfactual thoughts inherently imply a comparison of a given reality to an alternative state of affairs. Previous research mainly considered consequences of different counterfactual types, namely focus (other vs. self), structure (additive vs. subtractive), and direction (upward vs. downward). The current work investigates whether a 'more-than' versus 'less-than' comparative nature of counterfactual thoughts alters judgments of their impact. Four experiments demonstrated that self-generated other- (Studies 1 and 3) and self-focused (Study 2) upward counterfactuals are judged more impactful when they entail 'more-than' rather than 'less-than' comparisons. Judgments include plausibility and persuasiveness, as well as counterfactuals' likelihood to change future behavior and feelings. Self-reported ease of thought generation and (dis)fluency gauged by difficulty in thought generation was similarly affected. This more-less asymmetry reversed in Study 3 for downward counterfactual thoughts, with 'less-than' counterfactuals being judged more impactful and easier to generate. Further attesting to the role of ease, when spontaneously generating comparative counterfactuals, participants correctly provided more 'more-than' upward counterfactuals, but more 'less-than' downward counterfactuals (Study 4). These findings delineate one of the to date few conditions for a reversal of the more-less asymmetry and provide support for a correspondence principle, the simulation heuristic, and thus the role of ease in counterfactual thinking. They suggest that especially 'more-than' counterfactuals following negative events, and 'less-than' counterfactuals following positive events, are likely to have an important impact on people. (226 words).

Decision Reversibility and Satisfaction: The Mediating Role of Counterfactual Thinking and Anticipated Regret

Purpose

Extensive research has shown that reversible decisions yield lower post-decision satisfaction than irreversible decisions. However, to date, little is known about how decision reversibility affects post-decision satisfaction. Based on regret theory, this study aimed to examine the mediating role of counterfactual thinking and anticipated regret in the association between decision reversibility and satisfaction.

Methods

In this study (130 participants), participants were randomly assigned to two personnel decision situations with reversible and irreversible decision outcomes, and all participants completed questionnaires during the process of completing the decision task. The questionnaires used included the Counterfactual Thinking for Negative Events Scale, Anticipated Regret Scale, and satisfaction questionnaire. Finally, the data were statistically analyzed using the base package in R and PROCESS 3.5.

Results

The results show that (1) Compared to irreversible decisions, reversible decisions have a significant negative impact on satisfaction. (2) Counterfactual thinking plays a mediating role between decision reversibility and satisfaction. (3) Compared with irreversible decisions, reversible decisions further lowered the level of post-decision satisfaction through the chain mediating effects of counterfactual thinking and anticipated regret.

Conclusion

People's lowered levels of post-decision satisfaction in the reversible decision condition relate to increased levels of counterfactual thinking and anticipated regret. In addition, counterfactual thinking can play a mediating role alone, indicating that this variable may be critical in understanding the mechanisms by which decision reversibility affects satisfaction. This knowledge may be used to help people optimize their decision-making behavior.

The lived experience of HIV-infected patients in the face of a positive diagnosis of the disease: a phenomenological study

Background

AIDS as a human crisis may lead to devastating psychological trauma and stress for patients. Therefore, it is necessary to study different aspects of their lives for better support and care. Accordingly, this study aimed to explain the lived experience of HIV-infected patients in the face of a positive diagnosis of the disease.

Methods

This qualitative study is a descriptive phenomenological study. Sampling was done purposefully and participants were selected based on the inclusion and exclusion criteria. Data collection was conducted, using semi-structured interviews. Data analysis was performed using Colaizzi’s method.

Results

12 AIDS patients participated in this study. As a result of data analysis, 5 main themes and 12 sub-themes were identified, which include: emotional shock (loathing, motivation of social isolation), the fear of the consequences (fear of the death, fear of loneliness, fear of disgrace), the feeling of the guilt (feeling of regret, feeling guilty, feeling of conscience-stricken), the discouragement (suicidal ideation, disappointment), and the escape from reality (denial, trying to hide).

Conclusion

The results of this study showed that patients will experience unpleasant phenomenon in the face of the positive diagnosis of the disease and will be subjected to severe psychological pressures that require attention and support of medical and laboratory centers.

Patients will experience severe psychological stress in the face of a positive diagnosis of HIV.

Patients who are diagnosed with HIV are prone to make a blunder and dreadful decisions.

AIDS patients need emotional and informational support when they receive a positive diagnosis.

As a piece of bad news, presenting the positive diagnosis of HIV required the psychic preparation of the patient

Using counterfactual thinking theory to change alcohol protective behavioural strategy use intentions

OBJECTIVES

Despite numerous drinking interventions, alcohol use among college students remains a significant problem. Typically activated after negative events, counterfactual thinking is a cognitive process that contrasts reality with an imagined better alternative. As a result, counterfactual thinking highlights potential causal links between problematic behaviours and negative outcomes, which can strengthen intentions to change behaviour. Recent research has found that modifying behavioural intentions to engage in protective behavioural strategies (PBS) has led to increased PBS use and reduced alcohol outcomes. The current study evaluated counterfactual thinking as a way to increase PBS use intentions.

DESIGN

Intervention US study with college student drinkers.

METHODS

A sample of college students (n = 466) completed a web-based assessment of demographics, drinking, alcohol consequences, and PBS use. Those who endorsed an adverse drinking event were randomly assigned to an intervention condition (Control, Negative event only, Negative event with description, or Negative event with counterfactual). Following the intervention, participants reported intentions to engage in each PBS subtype over the next week.

RESULTS

Relative to control, the counterfactual condition resulted in greater PBS use intentions across all subtypes. Neither the negative event only nor the negative event with description resulted in higher PBS use intentions, relative to control. Importantly, the control group did not report whether they experienced a negative event; thus, we cannot definitively determine the effect this may have on the data.

CONCLUSIONS

This study provides a new theory-driven avenue for alcohol use interventions utilizing counterfactual thinking to enhance safe drinking intentions.

Improving workplace safety by thinking about what might have been: A first look at the role of counterfactual thinking

INTRODUCTION

Information processing theories of workplace safety suggest that cognition is an antecedent of safety behavior. However, little research has directly tested cognitive factors as predictors of workplace safety within organizational psychology and behavior research. Counterfactuals (cognitions about "what might have been") can be functional when they consist of characteristics (e.g., "upward' - focusing on better outcomes) that alter behavior in a manner consistent with those outcomes. This field study aimed to examine the influence of counterfactual thinking on safety behavior and explanatory mechanisms and boundary conditions of that relationship.

METHOD

A sample of 240 medical providers from a hospital in China responded to three surveys over a four-month time frame.

RESULTS

Results showed that upward counterfactuals were positively related to supervisor ratings of safety compliance and participation. These relationships were mediated by safety knowledge but not by safety motivation. Upward counterfactuals were more strongly related to safety behavior and knowledge than downward counterfactuals. As expected, safety locus of control strengthened the mediating effects of safety knowledge on the relationship between upward counterfactuals and safety behavior. Conclusions and Practical Applications: The findings demonstrated that counterfactual thinking is positively associated with safety behavior and knowledge, thus expanding the variables related to workplace safety and laying some initial groundwork for new safety interventions incorporating counterfactual thinking.

What Might Have Been: Near Miss Experiences and Adjustment to a Terrorist Attack

Near miss experiences—narrowly avoiding a traumatic event—are associated with distress, despite signaling good fortune. For some, near miss experiences call to mind those who, unlike oneself, were directly affected by the event, leading to “survivor guilt” or distress over one’s comparative good fortune. Survivor guilt, in turn, may function as upward counterfactual thinking about others’ negative outcomes, leading to intrusive thoughts and post-traumatic stress. We compared individuals who did or did not report a near miss with respect to the September 11, 2001, terrorist attacks—that is, almost being directly affected—in a national longitudinal study ( N = 1,433). Near miss experiences predicted higher levels of reexperiencing symptoms and probable post-traumatic stress disorder, as well as maintenance of reexperiencing symptoms over the next 3 years. These associations were partially accounted for by survivor guilt. Near misses may be associated with distress in part because they entail reflection on negative outcomes for others.

On the Existential Road From Regret to Heroism: Searching for Meaning in Life

We investigated whether regret predicted the motivation to act heroically. In a series of studies, we examined the relationship between regret, search for meaning in life, and heroism motivation. First, Study 1 (a and b) investigated the association between regret and search for meaning in life, considering regret as a whole, action regret, and inaction regret. As expected, regret correlated positively with search for meaning in life. In two additional studies (Study 2 and 3), we examined whether regret predicted heroism motivation and whether this effect was mediated through search for meaning in life. Study 2 confirmed this hypothesis for individual differences in regret, using a correlational design. Study 3 confirmed the hypothesis for temporary experiences of regret, using an experimental design. In addition, in Study 3 we found that heroism motivation was stronger for people with high self-enhancement needs than for those with lower self-enhancement needs. We discuss the relationship between regret and heroism in light of these results and explore their implications.

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.

When Wanting the Best Goes Right or Wrong: Distinguishing Between Adaptive and Maladaptive Maximization

Researchers have often disagreed on how to define maximization, leading to conflicting conclusions about its potential benefits or drawbacks. Drawing from motivation research, we distinguish between the goals (i.e., wanting the best) and strategies (e.g., alternative search) associated with maximizing. Three studies illustrate how this differentiation offers insight into when maximizers do or do not experience affective costs when making decisions. In Study 1, we show that two motivational orientations, promotion focus and assessment mode, are both associated with the goal of wanting the best, yet assessment (not promotion) is related to the use of alternative search strategies. In Study 2, we demonstrate that alternative search strategies are associated with frustration on a discrete decision task. In Study 3, we provide evidence that one reason for this link may be due to reconsideration of previously dismissed options. We discuss the potential of this approach to integrate research in this area.

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.

Emotional intensity in episodic autobiographical memory and counterfactual thinking

Episodic counterfactual thoughts-imagined alternative ways in which personal past events might have occurred-are frequently accompanied by intense emotions. Here, participants recollected positive and negative autobiographical memories and then generated better and worse episodic counterfactual events from those memories. Our results suggest that the projected emotional intensity during the simulated remembered/imagined event is significantly higher than but typically positively related to the emotional intensity while remembering/imagining the event. Furthermore, repeatedly simulating counterfactual events heightened the emotional intensity felt while simulating the counterfactual event. Finally, for both the emotional intensity accompanying the experience of remembering/imagining and the projected emotional intensity during the simulated remembered/imagined event, the emotional intensity of negative memories was greater than the emotional intensity of upward counterfactuals generated from them but lower than the emotional intensity of downward counterfactuals generated from them. These findings are discussed in relation to clinical work and functional theories of counterfactual thinking.

Self-Compassion Promotes Personal Improvement From Regret Experiences via Acceptance

Why do some people report more personal improvement from their regret experiences than others? Three studies examined whether self-compassion promotes personal improvement derived from recalled regret experiences. In Study 1, we coded anonymous regret descriptions posted on a blog website. People who spontaneously described their regret with greater self-compassion were also judged as having expressed more personal improvement. In Study 2, higher trait self-compassion predicted greater self-reported and observer-rated personal improvement derived from recalled regret experiences. In Study 3, people induced to take a self-compassionate perspective toward a recalled regret experience reported greater acceptance, forgiveness, and personal improvement. A multiple mediation analysis comparing acceptance and forgiveness showed self-compassion led to greater personal improvement, in part, through heightened acceptance. Furthermore, self-compassion's effects on personal improvement were distinct from self-esteem and were not explained by adaptive emotional responses. Overall, the results suggest that self-compassion spurs positive adjustment in the face of regrets.

Prefactual Thoughts: Mental Simulations about What Might Happen

Thought about the future can take many forms, from goal planning to intentions and from fantasies to magical thinking. The term prefactual has guided some past research, yet its potential impact has been hampered by inconsistency in its definition. Here we define prefactual thought as a conditional (if-then) proposition about an action-outcome linkage that may (or may not) take place in the future, such as “If I take action X, it will lead to outcome Y.” A prefactual embraces a causal belief that an action (if taken) will result in the outcome with a high degree of certainty. A form of mental simulation, prefactuals often derive from counterfactuals (which focus on the past) and feed into intentions (which center on the future). This article provides an overview of extant findings, draws connections to goal pursuit and affect regulation, and clarifies the value of the prefactual construct for conceptualizations of prospection.

The Role of Counterfactual Thinking on Attitudes Toward ADHD Medication Use

OBJECTIVE

Despite serious health risks, attitudes toward Attention-Deficit Hyperactivity Disorder (ADHD) medication use in college students remain favorable. Given the robust link between attitudes and behavior (e.g., the Theory of Planned Behavior), it is important to understand how these attitudes are developed and maintained. The current study examined the role of counterfactual, or "what if'" thinking as a mechanism for the development of attitudes toward ADHD medications.

METHOD

All participants (n = 190) were asked to read either a positive or negative scenario regarding ADHD medication misuse and rate their attitudes toward the behavior; half of the participants were also asked to generate counterfactuals prior to rating their attitudes.

RESULTS

Results suggest that scenario valence influenced the direction of counterfactual statements. Further, through the generation of upward counterfactuals, the negative scenario elicited more positive attitudes toward ADHD medication misuse.

CONCLUSIONS

Based on limited prior research, it is suggested that upward counterfactuals may allow individuals to explain away the misuse of ADHD medication and avoid negative emotions such as guilt and shame related to current or prior ADHD medication misuse. In sum, additional research is needed to confirm preliminary findings that suggest counterfactual thinking could be a precursor to ADHD medication misuse.