Thinking About What Might Have Happened: Counterfactual Thinking and Post‐traumatic Stress in Individuals Directly and Indirectly Exposed to the 2011 Oslo Bombing

Abstract

Counterfactual thinking (CFT), that is thinking about what might have happened, is linked to post-traumatic stress. We studied the relationship between type and frequency of CFT and post-traumatic stress in a sample of directly (n=50) and indirectly exposed (n=50) ministerial employees 4years after the 2011 Oslo bombing. The results showed that frequency of CFT was associated with levels of post-traumatic stress, among both directly and indirectly exposed participants. In the directly exposed group, self-reported frequencies of downward counterfactuals were associated with post-traumatic stress. A similar trend was found for upward counterfactuals. In the indirectly exposed group, self-reported frequencies of both upward and downward counterfactuals were associated with higher levels of post-traumatic stress. These results point to the intriguing possibility that people may not only develop post-traumatic stress disorder as a result of actual experiences, but also via mental simulations of traumatic events that could have happened.

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

“…However, no data on the relationship between direction of CFT and number of PTSD symptoms. In contrast, Blix et al (2016) found a predominance of downward CFT in a study with survivors of a terror attack. In their study, 90% of both directly and indirectly exposed individuals reported a downward counterfactual first whilst the remaining 10% reported an upward counterfactual first.…”

“…Several studies assessed the direction of the first or most predominant CFT that came to mind using a thought listing task (Bhushan & Kumar, 2012;Blix et al, 2016;Dalgleish, 2004). In a study with 20 tsunami relief volunteers, 60% of respondents reported upward CFT first whereas the remaining 40% reported downward CFT first (Bhushan & Kumar, 2012).…”

“…Furthermore, they found that CFT pattern was independent of level of PTSD symptomatology/PTSD diagnosis. Blix et al (2016) also assessed intrusiveness of CFT and reported that intrusiveness of counterfactuals significantly predicted PTSD symptoms. Similarly, Blix et al (2018) found that vividness of CFT served as a predictor of levels of PTSD symptoms.…”

“…Blix et al, 2018). However, one publication indicated the opposite pattern with slightly less frequent and less easily accessible upward CFT when compared to downward CFT (Blix et al, 2016). The authors investigated CFT in individuals directly or indirectly exposed to the 2011 Oslo bombing and argued that downward CFT (e.g.…”

“…A slim evidence base exists indicating that CFT vividness and PTSD symptomatology seem to be positively related (Blix et al, 2016(Blix et al, , 2018.…”