A causal counterfactual graph neural network for arising-from-chair abnormality detection in parkinsonians.

The arising-from-chair task assessment is a key aspect of the evaluation of movement disorders in Parkinson's disease (PD). However, common scale-based clinical assessment methods are highly subjective and dependent on the neurologist's expertise. Alternate automated methods for arising-from-chair assessment can be established based on quantitative susceptibility mapping (QSM) images with multiple-instance learning. However, performance stability for such methods can be typically undermined by the presence of irrelevant or spuriously-relevant features that mask the intrinsic causal features. Therefore, we propose a QSM-based arising-from-chair assessment method using a causal graph-neural-network framework, where counterfactual and debiasing strategies are developed and integrated into this framework for capturing causal features. Specifically, the counterfactual strategy is proposed to suppress irrelevant features caused by background noise, by producing incorrect predictions when dropping causal parts. The debiasing strategy is proposed to suppress spuriously relevant features caused by the sampling bias and it comprises a resampling guidance scheme for selecting stable instances and a causal invariance constraint for improving stability under various interferences. The results of extensive experiments demonstrated the superiority of the proposed method in detecting arising-from-chair abnormalities. Its clinical feasibility was further confirmed by the coincidence between the selected causal features and those reported in earlier medical studies. Additionally, the proposed method was extensible for another motion task of leg agility. Overall, this study provides a potential tool for automated arising-from-chair assessment in PD patients, and also introduces causal counterfactual thinking in medical image analysis. Our source code is publicly available at https://github.com/SJTUBME-QianLab/CFGNN-PDarising.

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

When individuals make uncertain decisions, they often evaluate the correctness of their choices in what is referred to as decision-making confidence. The outcomes of such decision-making can lead to counterfactual thinking wherein alternative possible outcomes are contemplated. This, in turn, can elicit counterfactual emotions including upward and downward counterfactual thinking, which, respectively, refer to regret and relief. Decision-making confidence and counterfactual emotions have key effects on how individuals learn from the past and prepare for the future. However, there has been little understanding of how these experiences are related. For this study, 98 total adults were recruited with the goal of assessing the connections between decision-making confidence and sensations of regret and relief when completing a card-based gambling task. The results of this study suggest that decision-making confidence may reduce the intensity of relief while increasing the degree of regret experienced. These findings thus emphasize the important effect that decision confidence has on emotional processing.

Memory control immediately improves unpleasant emotions associated with autobiographical memories of past immoral actions.

The ability to stop unwanted memories from coming to mind is theorised to be essential for maintaining good mental health. People can employ intentional strategies to prevent conscious intrusions of negative memories, and repeated attempts to stop retrieval both reduces the frequency of intrusions and improves subsequent emotions elicited by those memories. However, it is still unknown whether memory control can improve negative emotions immediately, at the time control is attempted. It is also not clear which strategy is most beneficial for emotion regulation; clearing the mind of any thoughts of negative memories via direct suppression, or substituting memory recall with alternative thoughts. Here, we provide novel evidence that memory control immediately regulates negative emotions associated with autobiographical memories of morally wrong actions. Repeated control significantly improved negative emotions over time, regardless of the strategy used to implement control. Thought substitution involving either positive diversionary thinking or counterfactual thinking both induced positive feelings, whereas direct suppression neutralised emotions, regardless of whether memories were positive or negative. These empirical findings have implications for clinical practice as they indicate that memory control strategies could be effective emotion regulation methods for real-world intrusive memories.

'My child could have died': counterfactual thoughts and psychological distress in parents of trauma survivors.

Background: After exposure to a potentially traumatic event, survivors may experience thoughts about 'what could have happened', referred to as counterfactual thoughts (CFTs). CFTs have been found to have a negative impact on survivors' mental health. This is the first study to investigate whether parents of trauma survivors experience CFTs and the association with psychological distress in this group.Objective: The main aim of the present study is to investigate CFTs in parents of trauma survivors and the relationship between the frequency and vividness of CFTs and psychological distress.Method: The participants (N = 310, 191 females) were parents of the youths targeted in the terror attack on Utøya island, Norway, in 2011. Frequency and vividness of CFTs, posttraumatic stress reactions (PTSR), and symptoms of anxiety and depression were measured 8.5-9 years post-terror.Results: The majority of the parents (74%) reported having experienced CFTs at some time point since the attack. For almost one-third of the parents, CFTs were still present more than eight years after the attack. Higher frequency and vividness of CFTs were uniquely associated with higher levels of PTSR, anxiety, and depression.Conclusion: The present findings suggest that frequent and vivid CFTs may contribute to mental health problems in parents of trauma survivors and should be addressed in therapy.

A quantitative study investigating the relationship between counterfactual thoughts and psychological distress, in parents of trauma survivors.The majority of the parents reported having experienced counterfactual thoughts at some time point since the attack. For almost one-third of the parents, counterfactual thouhgts were still present more than eight years after the attack. Higher frequency and vividness of counterfactual thoughts were uniquely associated with higher levels of psychological distress.The present findings suggest that frequent and vivid counterfactual thouhgts may contribute to mental health problems in parents of trauma survivors and should be addressed in therapy.

Looking at Mental Images: Eye-Tracking Mental Simulation During Retrospective Causal Judgment.

How do people evaluate causal relationships? Do they just consider what actually happened, or do they also consider what could have counterfactually happened? Using eye tracking and Gaussian process modeling, we investigated how people mentally simulated past events to judge what caused the outcomes to occur. Participants played a virtual ball-shooting game and then-while looking at a blank screen-mentally simulated (a) what actually happened, (b) what counterfactually could have happened, or (c) what caused the outcome to happen. Our findings showed that participants moved their eyes in patterns consistent with the actual or counterfactual events that they mentally simulated. When simulating what caused the outcome to occur, participants moved their eyes consistent with simulations of counterfactual possibilities. These results favor counterfactual theories of causal reasoning, demonstrate how eye movements can reflect simulation during this reasoning and provide a novel approach for investigating retrospective causal reasoning and counterfactual thinking.

Counterfactual imagination impairs memory for true actions: EEG and behavioural evidence.

Imagined events can be misremembered as experienced, leading to memory distortions. However, less is known regarding how imagining counterfactual versions of past events can impair existing memories. We addressed this issue, and used EEG to investigate the neurocognitive processes involved when retrieving memories of true events that are associated with a competing imagined event. Participants first performed simple actions with everyday objects (e.g., rolling dice). A week later, they were shown pictures of some of the objects and either imagined the same action they had originally performed, or imagined a counterfactual action (e.g., stacking the dice). Subsequent tests showed that memory for performed actions was reduced after counterfactual imagination when compared to both veridical imagination and a baseline condition that had not been imagined at all, providing novel evidence that counterfactual imagination impairs true memories beyond simple forgetting over time. ERPs and EEG oscillations showed evidence of separate processes associated with memory retrieval versus post-retrieval processes that were recruited to support recall of memories that were challenging to access. The findings show that counterfactual imagination can cause impairments to sensorimotor-rich event memories, and provide new evidence regarding the neurocognitive mechanisms that are recruited when people need to distinguish memories of imagined versus true events.

Young children experience both regret and relief in a gain-or-loss context.

Recent research has provided compelling evidence that children experience the negative counterfactual emotion of regret, by manipulating the presence of a counterfactual action that would have led to participants receiving a better outcome. However, it remains unclear if children similarly experience regret's positive counterpart, relief. The current study examined children's negative and positive counterfactual emotions in a novel gain-or-loss context. Four- to 9-year-old children (N = 136) were presented with two opaque boxes concealing information that would lead to a gain or loss of stickers, respectively. Half of the children chose between two keys that matched each box, whereas the other half were compelled to select one box because only one of the two keys matched. After seeing inside the alternative, non-chosen box, children were significantly more likely to report a change in emotion when they could have opened that box than when they could not have. The effects were similar for children who lost stickers and won stickers, and neither effect varied with age. These findings suggest that children may become capable of experiencing regret and relief around the same time, although their expression of these counterfactual emotions may vary with actual and counterfactual gains and losses.

Perceived plausibility modulates hippocampal activity in episodic counterfactual thinking.

Episodic counterfactual thinking (ECT) consists of imagining alternative outcomes to past personal events. Previous research has shown that ECT shares common neural substrates with episodic future thinking (EFT): our ability to imagine possible future events. Both ECT and EFT have been shown to critically depend on the hippocampus, and past research has explored hippocampal engagement as a function of the perceived plausibility of an imagined future event. However, the extent to which the hippocampus is modulated by perceived plausibility during ECT is unknown. In this study, we combine two functional magnetic resonance imaging datasets to investigate whether perceived plausibility modulates hippocampal activity during ECT. Our results indicate that plausibility parametrically modulates hippocampal activity during ECT, and that such modulation is confined to the left anterior portion of the hippocampus. Moreover, our results indicate that this modulation is positive, such that increased activity in the left anterior hippocampus is associated with higher ratings of ECT plausibility. We suggest that neither effort nor difficulty alone can account for these results, and instead suggest possible alternatives to explain the role of the hippocampus during the construction of plausible and implausible ECT.

An exploratory study on counterfactual thinking in amyotrophic lateral sclerosis.

Objectives: This study aimed at exploring (1) the motor and non-motor correlates of counterfactual thinking (CFT) abilities in non-demented amyotrophic lateral sclerosis (ALS) patients and (2) the ability of CFT measures to discriminate these patients from healthy controls (HCs) and patients with and without cognitive impairment. Methods: N = 110 ALS patients and N = 51 HCs were administered two CFT tasks, whose sum, resulting in a CFT Index (CFTI), was addressed as the outcome. Patients further underwent an in-depth cognitive, behavioral, and motor-functional evaluation. Correlational analyses were run to explore the correlates of the CFTI in patients. Logistic regressions were performed to test whether the CFTI could discriminate patients from HCs. Results: The CFTI was selectively associated (p ≤ 0.005) with fluency and memory subscales of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS), but not with other variables. CFTI scores discriminated patients from HCs (p < 0.001) with high accuracy (82%), but not patients with a normal vs. defective performance on the ECAS-Total. Conclusion: CFT measures in non-demented ALS patients were associated with verbal fluency and memory functions, and they were also able to discriminate them from HCs.

Impact of Actor's Initial State of Engagement in a Course of Action on Judgements of Post-decisional Regret and Joy: Revisiting Kahneman and Tversky (1982).

According to the phenomenon commonly known as action effect and vastly replicated across the judgment and decision-making literature, more regret is associated with decisions resulting from action than inaction. Action vs. inaction, however, might either refer to change vs. no change or doing something vs. not doing something. The purpose of this study was to examine the effect of this variation in operationalization of action-inaction on the strength of action effect, for both positive and negative outcomes, across four different domains of employment, finance, education, and health. This was an experimental scenario-based study (N = 215) with four between-subjects conditions varying in outcome valence and the actor's initial state as either engaged or non-engaged in a particular course of action. Action effect was found to be stronger with respect to the initially engaged than the initially non-engaged decision-maker (ηp2 = .04), indicating that action as change results in a stronger action effect than action as doing something. The effect of the initial state was also moderated by domain. In addition, we both replicated and went beyond prior empirical literature regarding the effect of outcome valence and domain on action effect, with our findings being mostly consistent across joy and regret. Findings are discussed in light of the norm theory and its key concept of normality and contribute to the literature on moderators of action effect.

Impact of Actor’s Initial State of Engagement in a Course of Action on Judgements of Post-decisional Regret and Joy: Revisiting Kahneman and Tversky (1982)

According to the phenomenon commonly known as action effect and vastly replicated across the judgment and decision-making literature, more regret is associated with decisions resulting from action than inaction. Action vs. inaction, however, might either refer to change vs. no change or doing something vs. not doing something. The purpose of this study was to examine the effect of this variation in operationalization of action-inaction on the strength of action effect, for both positive and negative outcomes, across four different domains of employment, finance, education, and health. This was an experimental scenario-based study (N = 215) with four between-subjects conditions varying in outcome valence and the actor’s initial state as either engaged or non-engaged in a particular course of action. Action effect was found to be stronger with respect to the initially engaged than the initially non-engaged decision-maker (ηp2 = .04), indicating that action as change results in a stronger action effect than action as doing something. The effect of the initial state was also moderated by domain. In addition, we both replicated and went beyond prior empirical literature regarding the effect of outcome valence and domain on action effect, with our findings being mostly consistent across joy and regret. Findings are discussed in light of the norm theory and its key concept of normality and contribute to the literature on moderators of action effect. (AU)

Incremental learning for an evolving stream of medical ultrasound images via counterfactual thinking.

Despite the fact that traditional deep learning (DL) approaches provide promising accuracy and efficiency in medical ultrasound image analysis, they cannot replace the physician in making a diagnosis since the DL model is only appropriate in static application scenarios. Currently, most DL-based models are incapable of learning new tasks in the dynamic clinical environments due to the catastrophic forgetting of old tasks. To address the above problem, we propose an incremental classifier that is sequentially trained on evolving tasks for medical ultrasound images by counterfactual thinking. Specifically, the proposed model consists of a feature extractor and a classifier that can add new classes at any time during training. Toward a more discriminative model in the continual learning setting, a contrastive strategy is designed to leverage fine-grained information by generating a series of counterfactual regions. For model optimization, we design a multi-task loss made up of a knowledge distillation loss, a cross-entropy loss, and a contrasting loss. This objective jointly enjoys the merits of less forgetting, better accuracy, and fine-grained information utilization. A newly collected dataset with 52 medical ultrasound classification tasks is used to demonstrate the effectiveness of our method. The proposed approach achieves 76.59%, 11.67%, and 7.93% in terms of the average incremental accuracy, forgetting rate, and feature retention, respectively.

For Better and For Worse: Frequent Gamblers Use Dual Counterfactuals to Justify Continued Gambling.

How might frequent gamblers convince themselves to keep playing despite persistent losses or after a win that should be savored? The purpose of this research is to examine the unexplored question of how frequent gamblers' use counterfactual thinking to motivate their desire to continue gambling. Using a sample of n = 69 high and n = 69 low frequency gamblers in a field setting, we found that infrequent gamblers tended to consider how the perceived outcome of losing "could have been better" (i.e., upward counterfactual thinking), and how a winning outcome "could have been worse" (i.e., downward counterfactual thinking). This pattern of counterfactual thinking is considered typical in many settings and may, in a gambling context, support a potentially more responsible approach by helping infrequent gamblers to learn from past mistakes to avoid significant future losses and to savor wins to protect returns gained. Alternatively, we found that frequent gamblers were more likely to generate 'dual counterfactuals' which include both upward and downward counterfactuals in response to losses and wins. We argue that this dual pattern of counterfactual thinking may allow frequent gamblers to more easily justify their desire to continue gambling. Findings suggest that challenging gamblers counterfactual thinking patterns could assist clinicians in moderating the potential for high-risk behaviors.

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.

Dissociated deficits of anticipated and experienced regret in at-risk suicidal individuals.

Backgrounds: Decision-making deficits have been reported as trans-diagnostic characteristics of vulnerability to suicidal behaviors, independent of co-existing psychiatric disorders. Individuals with suicidal behaviors often regret their decision to attempt suicide and may have impairments in future-oriented processing. However, it is not clear how people with suicidal dispositions use future-oriented cognition and past experience of regret to guide decision-making. Here, we examined the processes of regret anticipation and experience in subclinical youth with and without suicidal ideation during value-based decision-making. Methods: In total, 80 young adults with suicidal ideation and 79 healthy controls completed a computational counterfactual thinking task and self-reported measures of suicidal behaviors, depression, anxiety, impulsivity, rumination, hopelessness, and childhood maltreatment. Results: Individuals with suicidal ideation showed a reduced ability to anticipate regret compared to healthy controls. Specifically, suicidal ideators' experience of regret/relief was significantly different from that of healthy controls upon obtained outcomes, while their disappointment/pleasure experience was not significantly different from healthy controls. Conclusion: These findings suggest that young adults with suicidal ideation have difficulty predicting the consequences or the future value of their behavior. Individuals with suicidal ideation showed impairments in value comparison and flat affect to retrospective rewards, whereas individuals with high suicidality showed blunted affect to immediate rewards. Identifying the counterfactual decision-making characteristics of at-risk suicidal individuals may help to elucidate measurable markers of suicidal vulnerability and identify future intervention targets.

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.

The Effect of Counterfactual Potency on Behavioral Intentions.

This research examines how counterfactual potency (CP), the multiplicative effect of the likelihoods of the "if" and "then" clauses of counterfactuals, determines the effects of counterfactuals on behavioral intentions. In Study 1, we found that participants who read highly (vs. minimally) mutable vignettes perceived the counterfactuals as more likely and endorsed relevant intentions more. However, CP did not mediate the effect of mutability on intentions. In Studies 2 and 3, we found that CP directly affected intentions and also mediated the effects of mutability on intentions when mutability was specifically manipulated via controllability (Study 2) or norm violation (Study 3). Finally, Study 4 used archival reaction time data to show that more concrete counterfactuals were perceived as more likely and subsequently facilitated intentions. Taken together, the current research provides evidence that more likely counterfactuals facilitate behavioral intentions.

Unintentional Inception: When a Premium Is Offered to Unintentional Creations.

Creations can be fundamentally intended or unintended from their outset. Past work has focused on intentional creations, finding that people place a premium on effort. We examine the role of unintentionality in the inception of creations in six studies using a variety of stimuli (N = 1,965), finding that people offer a premium to unintentional creations versus otherwise identical intentional creations. We demonstrate that the unintentionality involved in the inception of a creation results in greater downward counterfactual thought about how the unintentional creation may have never been created at all, and this in turn heightens perceptions that the creation was a product of fate, causing people to place a premium on such creations. We provide evidence for this causal pathway using a combination of mediation and moderation approaches. Further, we illuminate that this premium is not offered when a negative outcome is ascribed to an unintentional creation.

The Spontaneous Counterfactual Inference Task: Misremembering What Might Have Been.

Counterfactuals, thoughts about "what might have been," play an important role in causal judgment, emotion, and motivation, and spontaneously arise during daily life. However, current methods to measure spontaneous counterfactual thinking are cumbersome and subjective. The current research adapts a paradigm from the Spontaneous Trait Inference literature to develop the Spontaneous Counterfactual Inference measure (SCFI), which uses false recognition of counterfactual statements as a measure of spontaneous counterfactual thought. Studies 1a and 1b demonstrate that the SCFI is sensitive to precursors of counterfactual thinking: norm violation and counterfactual closeness. Study 2 demonstrates that the SCFI converges with the generation of counterfactual statements in an open-ended writing task. The SCFI also predicts two important consequences of counterfactual thought, blame (Study 3), and intention endorsement (Study 4). The SCFI thus offers a new tool for researchers interested in counterfactual thinking.

Counterfactual thinking elicits emotional change in young children.

Adults often reason about what might have happened had they chosen an alternative course of action in the past, which can elicit the counterfactual emotion of regret. It is unclear whether young children's emotions are similarly impacted by counterfactual thinking about past possibilities. In this study, 4- to 9-year-old children (N = 160) opened one of two boxes, which concealed small and large prizes, respectively. Some children had the means to open either box, whereas other children only had the means to open one box. After seeing that the prize they did not obtain was larger than the one they did obtain, children were significantly more likely to report a negative change in emotion when the non-obtained prize had been a straightforward counterfactual possibility than when it had not. This shows that even young children experience counterfactual emotions following choices, which may ultimately drive them to make better choices in the future. This article is part of the theme issue 'Thinking about possibilities: mechanisms, ontogeny, functions and phylogeny'.