From if-then to here and now: Using personalized counterfactuals from past negative experiences to reduce future alcohol consequences.

Abstract

College students are at an increased risk for problematic alcohol use. To address this health concern, several interventions have used protective behavioral strategies (PBS). However, interventions promoting PBS remain underdeveloped and underutilized. Counterfactual thinking is a type of postmortem cognitive strategy that highlights causal links between a behavior and a negative outcome. Recent research demonstrates the effectiveness of applying counterfactuals for increasing PBS use intentions. The present study examines the effect of a brief counterfactual-based intervention for increasing PBS use and decreasing adverse alcohol outcomes. Undergraduate students (n = 73) completed an online multiweek (baseline and five weekly follow-ups) intervention. At baseline, participants completed demographics, PBS use, and alcohol use and consequences. They were then randomly assigned to one of three conditions: a control (negative event only), sham (negative event with detailed description), or counterfactual (If only … then …) condition. At weekly follow-up sessions, participants completed PBS use and alcohol use and consequences from the previous week. The counterfactual condition was presented with their counterfactuals generated at baseline. Relative to the active control, the counterfactual condition reported greater use of PBS across the five-week follow-ups. This in turn resulted in decreases in alcohol consumed and alcohol-related consequences. This study highlights the effectiveness of counterfactual thinking as a relevant harm-reduction strategy for alcohol-related outcomes in college students.

A mixed-method analysis of counterfactual thinking, negative event themes, and the transtheoretical model in a community sample of smokers

“…This suggests a need for increased processes of change use. Recent research has demonstrated the utility of pairing a counterfactual intervention with protective behavioral strategies to decrease alcohol intake among young adults (Smallman et al, 2022). In a similar vein, future work should look at using a counterfactual intervention to prompt participants to incorporate processes of change within the counterfactual content.…”