Counterfactual thinking in psychiatric and neurological diseases: A scoping review

Abstract

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.

Prevalence and predictors of diabetes-related distress in adults with type 1 diabetes

“…For example, their constant worrying about the complication of diabetes due to non-optimal glycemia levels and the negative predictions about the future of their illness increasing their level of fear/anxiety may result in the patients feeling burnt by the constant effort needed to manage diabetes (to control their illness – glycemia levels) – leading to increased depression and fear due to living with diabetes, which then increases the negative perceptions of the future forming the vicious cycle 28 . Alternatively, constant worrying about the complications and negative predictions about the future of their illness, fear and depression may also lead to denial of the potential effects of chronic diabetes mellitus, which results in them failing to adhere to diet/medication and leading to non-optimal glycemia and ultimately increasing the possibility of complications of DM, followed by feelings of guilt when off-track with diabetes management 29 . This will again increase their worrying about complications closing the vicious cycle.…”

The asymmetric impact of decision-making confidence on regret and relief

“…Counterfactual thinking necessitates that an individual process both the true and counterfactual realities ( Redshaw and Suddendorf, 2020 ; Allaert et al, 2021 ; Tagini et al, 2021 ). The difference between these two realities influences the intensity of regret or relief experienced by an individual, with this comparison providing a premise to experience counterfactual emotions.…”

“…Specifically, in the negative condition, action was associated with the worsening of participant emotions (regret), whereas in the positive condition, it was associated with the enhancement of these emotions (relief). Counterfactual thinking necessitates that an individual process both the true and counterfactual realities (Redshaw and Suddendorf, 2020;Allaert et al, 2021;Tagini et al, 2021). The difference between these two realities influences the intensity of regret or relief experienced by an individual, with this comparison providing a premise to experience counterfactual emotions.…”

Counterfactual Thinking Induces Different Neural Patterns of Memory Modification in Anxious Individuals

“…Indeed, eCFT can turn maladaptive when ruminating on unattained outcomes conjures excessive disappointment and regret, or when brooding on hypothetically worse situations impedes disengagement from pathologically prolonged negative mood states 10,11 . Aberrant engagement with eCFT is implicated in many psychiatric and neurological disorders, including anxiety, depression, schizophrenia, and post-traumatic stress disorder 12 . Importantly, eCFT also appears to be impacted by individual differences in dispositional traits among nonclinical samples.…”