Undoing death: Counterfactual thinking and emotional adaptation to bereavement

2026/03/26 by Maarten C. Eisma, Jonne van der Laan, Nynke de Boer +3 · 1 voice
Psychology · #Death Anxiety and Social Exclusion #Forgiveness and Related Behaviors #Grief, Bereavement, and Mental Health

paper · doi:10.1016/j.jbtep.2026.102103

openalex created_date 2026/03/26 · openalex publication_date 2026/03/26 · openalex updated_date 2026/07/23

Abstract

Counterfactual thinking, mental simulations about how a situation could have turned out differently (if only… then… thoughts) increase grief and depression levels following bereavement. Thoughts about how (in)actions of oneself could have prevented the death (i.e., self-referent upward counterfactuals), are detrimental to post-loss mental health. Conversely, thoughts about how one's current situation could be (even) worse (i.e. downward counterfactuals), are theorized to improve post-loss mental health. There is limited information about what counterfactuals bereaved people spontaneously generate, who generates them, and how they relate to grief and depression severity. Using a counterfactual generation task, we aimed to clarify the associations of characteristics of a generated counterfactual with loss-related characteristics and grief and depression levels in a bereaved sample ( N = 343). Counterfactuals were predominantly upward (98%), self-referent (67%), and undid death (74%). Participants who had experienced unexpected, unnatural, or partner or child death generated more upward counterfactuals about undoing death. Higher grief levels related to more generated upward (vs. downward) counterfactuals and more (self-referent) upward counterfactuals about undoing death (vs. other upward counterfactuals). Following bereavement, downward counterfactuals are rare but potentially adaptive, whereas upward counterfactuals about undoing death are common and can interfere with psychological adaptation to bereavement. • We applied a novel Counterfactual Generation Task in a sample of bereaved adults • Self-referenced upward counterfactual thoughts about undoing death were common • Self-referent upward counterfactuals about undoing death related to higher grief levels • Downward counterfactuals were rare and related to lower grief levels • Counterfactual characteristics were not related to depression levels

Citations

• Bidirectional associations between prolonged grief symptoms and depressive, anxiety, and posttraumatic stress symptoms: A systematic review
• No pain, no gain: cross-lagged analyses of posttraumatic growth and anxiety, depression, posttraumatic stress and prolonged grief symptoms after loss
• The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression
• Prolonged grief symptoms and lingering attachment predict approach behavior toward the deceased

Discussions

• New paper: We examine the role of counterfactual thoughts in bereavement and prolonged grief. Thoughts about how the death could have been prevented, increased levels of grief illustrating dysfunction [bsky, 4 points, 0 comments]

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