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Why Second-Guessing Yourself Can Be So Harmful

New research focuses on if-only thinking and its effect on your health.

Key points

  • Counterfactual or "if-only" thinking is the tendency to wish for a do-over after a negative event and it can affect one's mental health.
  • After the death of a loved one, people who engage in one type of counterfactual thinking have high levels of prolonged grief and depression.
  • The constant self-blame and focus on "undoing" an unchangeable negative event may prevent people from accepting it and forgiving themselves.
Source: fizkes/Shutterstock

There are decisions people make in life that they sorely regret, and for good reason. In the summer of 2021, the news is full of sad stories about people who decided not to get the COVID-19 vaccine when it was available to them and who then became ill with the virus. In some cases, the people expressing these regrets are speaking out from hospital beds, and even worse, do so before their death. The partners of these individuals also speak out with their own regrets for not having insisted that their loved ones “roll up their sleeves.”

These life-or-death situations are clearly ones in which people second guess a consequential decision. However, there are also less extreme conditions in which the thought flips through your mind that you wish you could take something back that you did or said. Perhaps you stubbed your toe while trying to reach for a shoe on an upper shelf of your closet. Although you hoped the pain would subside, you’re still in pain several days later. You replay in your head what you could have done differently to avoid hurting yourself and wish you could relive the scene, this time being more careful.

Counterfactual Thinking and Reactions to Loss

This tendency to wish for a do-over is called “counterfactual thinking,” which the University of Groningen's Maarten Eisma and colleagues (2021) define as “mental simulations about how the present situation may have evolved differently.” As an example, the Dutch authors note that “Following the death a child in a car accident, a parent for instance might think: 'If only I had paid more attention while driving, then my son would still be alive.'” Indeed, previous research that Eisma et al. cite suggests that 48 percent of adults who lost a child or partner in an accident still replay if-only scenarios for as long as seven years after the loss, the latest data point in the study. Presumably, these regrets could persist for one's entire life.

In cases other than the death or severe illness of someone you know, it’s possible that counterfactual thinking can actually work toward your benefit. According to the “opportunity principle,” reflecting on a past event is “functional only if the situation can be changed or is likely to occur in the future.” You can’t change the death of a loved one, but you can be more careful when you tiptoe onto a stepstool.

In a downward counterfactual, as you replay the situation, you feel lucky that it wasn’t worse. Perhaps you think about that stubbed toe and are grateful that you didn’t damage yourself more seriously. A downward counterfactual could apply to you or someone else as you contemplate their having recovered from COVID-19 instead of succumbing to its ravaging effects on the body.

Rumination over what might have been could also be involved in those who become ill with COVID-19 as well as, theoretically, their partners who blame themselves for not being more proactive. The University of Groningen study provides the closest empirical counterpart, having tested the role of counterfactual thinking in bereaved individuals studied longitudinally over a 6- and 12-month period. Proposing that people who engage in this type of unproductive thought process would show higher levels of depression and grief, the Dutch authors compared an online sample of 59 bereaved adults who showed these tendencies with 59 bereaved adults who did not.

The Four Types of Counterfactual Thinking

Eisma et al. proposed that because counterfactual thinking can occur in an upward or downward fashion, people experiencing bereavement might show different reactions to loss based on which they tended to use. Their measure of counterfactual thinking (the Counterfactual Thinking for Negative Events Scale; CTNES) therefore divided upward from downward thinking as well as self-referenced, other-referenced, or nonreferenced (not referring to anyone in particular). Think now about a negative event in your life, and see which process most closely applies to you by rating yourself on a 1 (never) to 5 (very often) scale:

Upward self-referent counterfactual thinking: As you relive the event, do you see yourself as the cause of the negative outcome? An example of an item from this scale is: “I think about how much better things would be if I had acted differently.”

Upward other-referent counterfactual thinking: In reliving the event, perhaps you don’t think about yourself and how you could have acted differently but about someone else who caused the event to happen. This process is indicated by the item: “If only other people had acted differently, the situation would have turned out better.”

Upward nonreferent counterfactual thinking: When the event replays in your mind, do you just wish it had turned out differently without thinking specifically about your role or the role of someone else? An item tapping this thought process is: “I think about how much better things could have been.”

Downward nonreferent counterfactual thinking: Consistent with the idea that a downward if-only thought would focus on the fact that things could have been worth, an item reflecting this process is: “I think about how much worse things could have been.”

The Role of Counterfactual Thinking After a Loss

The Dutch authors used the response by their participants to a question about whether they were thinking about the death of a loved one or not to categorize loss and no-loss groups. The subsequent comparisons of the mental health of these groups were based on their responses to a questionnaire assessing prolonged grief symptoms (e.g. “I feel I have trouble accepting the death,” and symptoms of depression (“I still enjoy the things I used to enjoy”—reverse coded).

Turning to the results, the scores on prolonged grief and depression of the bereaved were highest for those who engaged in upward self-referenced counterfactual thinking. The findings, according to the authors, suggest that “mentally ‘undoing death,’ in particular in relation to actions oneself could (not) have taken, is a problematic coping strategy that perpetuates post-loss mental health problems.”

This process of “undoing” a negative event may, paradoxically, be adaptive at first. You could reinforce your sense of predictability about the world in terms of the principle of fairness. You could even, the authors suggest, feel some relief. However, over time, in view of an “immutable reality,” this process can lead to greater distress as you refuse to accept this unchangeable fact. It’s also possible that the self-blame involved in this form of if-only thinking means that you keep beating yourself up for doing, or not doing, something that could have prevented the loss.

What to Do If You’re an If-Only Thinker

As you can see from these findings, the constant self-blame involved in upward self-referent counterfactual thinking will prevent you from either accepting the loss or forgiving yourself for your role in it. The implications of the study are that, in order to cope with a negative event, particularly one with serious and unchangeable consequences, you will recover better if you can turn off what you might call the “movie in your mind.” Constantly replaying the scene with a different ending than the one that occurred not only becomes nonproductive but can actually prolong your grief and sadness.

If you tend to engage in this type of second-guessing often, and not just in relation to major events, you can potentially benefit from what’s known as Acceptance and Commitment Therapy (ACT). In this approach, as described by Celia Kennedy and colleagues from Australia’s University of Wollongong (2020), people are helped “to reduce their commitment to the counterfactual past, accept their current reality (i.e., accept uncomfortable emotions and tolerate uncertainty), connect with their values, and engage with their current life.”

As impossible as it might seem, even the events that you can’t reverse but wish you could can become a part of a different story you tell yourself. Rather than continuing to fantasize about life without that event, you can learn to tolerate your feelings of distress without taking that next step to self-blame and unproductive re-imagining. Although not specifically addressed in these articles about loss, you might also think about ways to turn your experience into an object lesson for someone else. For example, if you were in that unfortunate COVID-19 situation, you could join a pro-vaccine effort in your community so that others don’t suffer what you and your partner did.

To sum up, managing your feeling after a loss or negative event of some type requires that you turn off your second-guessing as you accept its reality. Moving toward more productive ways of thinking can help restore and promote your ability to achieve fulfillment even when that fulfillment becomes tested.

Facebook image: fizkes/Shutterstock


Eisma, M. C., Epstude, K., Schut, H. A. W., Stroebe, M. S., Simion, A., & Boelen, P. A. (2021). Upward and downward counterfactual thought after loss: A multiwave controlled longitudinal study. Behavior Therapy, 52(3), 577-593. doi:10.1016/j.beth.2020.07.007

Kennedy, C., Deane, F. P., & Chan, A. Y. C. (2021). 'What might have been…': Counterfactual thinking, psychological symptoms and posttraumatic growth when a loved one is missing. Cognitive Therapy and Research, 45(2), 322-332. doi:10.1007/s10608-020-10156-7

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