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

The transtheoretical model has been used as a model of behavior change for tobacco users. However, it does not account for perceptions of past behavior that may provide additional guidance toward smoking cessation. No studies have examined associations between the transtheoretical model, content themes of smoking experiences, and counterfactual thoughts (i.e. "If only. . .then. . ."). Mturk participants (N = 178; 47.8% female) completed measures of smoking attitudes, behavior, and stage and processes of change use. Participants described a past negative smoking event and an event-related counterfactual thought-listing task. Participants in the precontemplation stage endorsed fewer processes of change. Also, participants in the action stage reported significantly more counterfactuals about cravings (e.g. If only I could have controlled my urge to smoke. . .) inferring that they may be identifying cravings or urges as relevant barriers toward smoking cessation. Identifying these self-relevant thoughts may provide additional ways to address and overcome barriers toward achieving long-term smoking cessation.

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.

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

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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.