When a person goes through a traumatic experience, they often tend to think that what happened could have been different or even avoided. This process, known as counterfactual thinking, is an automatic psychological response to adverse experiences. Now, a study published in the journal Scientific Reports analyzes how this type of thinking affects women who have suffered an early gestational loss.
The conclusions of the work reveal that counterfactual thinking is highly frequent in these cases and that it could initially have an adaptive function, contributing to process the loss and to reformulate future goals, such as the possibility of a new pregnancy.
The main authors of the study are the experts Antoni Borrell, professor at the Faculty of Medicine and Health Sciences of the UB and member of the BCNatal-Hospital Clínic de Barcelona, and Aida Mallorquí, clinical psychologist of the clinical health psychology section of the Hospital Clínic de Barcelona, in collaboration with Antoni Rodríguez-Fornells, from the Faculty of Psychology, the Institute of Neurosciences of the University of Barcelona (UBneuro) and IDIBELL.
Thinking about a kinder life scenario
The nature of the cognitive processes that derive from perinatal loss are still poorly understood. The new research examines the prevalence and temporal evolution of counterfactual thinking in a group of 119 women immediately after suffering an early loss during pregnancy. Through an online psychological assessment, the traumatic impact, repetitive thoughts and frequency of this type of thinking were analyzed.
“This longitudinal study is the first to immediately follow a large sample of women to study a phenomenon that can affect mental health after a gestational loss,” says specialist Aida Mallorquí, first author of the article. “Interestingly, until now most studies on trauma and counterfactual thinking have been based on people evaluated years after the traumatic event, which limits the understanding of this type of psychological response,” she continues.
According to the article, counterfactual thinking was present in most women (72%) during the week after the loss. 99% of the participants imagined scenarios in which the loss could have been avoided.
In 91.6% of the cases, these thoughts were self-referential, i.e. they were related to the participants’ own behaviour, thoughts or emotional state. This implied a high sense of personal responsibility and possible feelings of guilt linked to the loss – “if I hadn’t exercised so much”, “if I hadn’t been so worried or stressed”.
Negative feelings were also often perceived as potentially harmful to the fetus, as was an unhealthy diet or other habits considered harmful, although most early losses are explained by fetal chromosomal abnormalities, an aspect unrelated to the woman’s behavior. “The belief that the mother’s psychological state can affect the fetus, as well as the fear of developing perinatal depression with consequences for the child, is widespread and is commonly observed in perinatal psychological consultations,” the experts explain.
The study also shows that, although this type of thinking appeared in most women, its persistence and frequency during the first four months indicated that the loss had been experienced in a traumatic way. In addition, the researchers found a relationship with rumination traits, that is, with the tendency of some people to repeatedly focus on negative emotions and worries without reaching an effective resolution.
More psychological resources to address gestational losses
The conclusions indicate that the initial activation of counterfactual thinking could act as an adaptive cognitive mechanism that provides psychological resources to cope with negative experiences. “This type of thinking would help women elaborate on the experience they have had, making them reflect on their own behavior in relation to the circumstances and the final outcome, and possibly prepare for a future pregnancy, given that epidemiological data indicate that 85% of women will achieve a pregnancy after an early gestational loss,” says the research team.
“Even so, our study indicates that when this thought pattern persists over time, it can indicate that the loss has been experienced in a traumatic way. This can condition a woman’s mental health and can influence future reproductive decisions. The fact that health professionals can offer information on the psychological repercussions of a gestational loss from the beginning of the experience could favor adaptation and emotional adjustment. A gestational loss is not only a biological event, but also an experience with a strong emotional impact that requires comprehensive care.”
The Bellvitge Biomedical Research Institute (IDIBELL) is a research centre created in 2004 and specialising in cancer, neuroscience, translational medicine and regenerative medicine. It has a team of more than 1,500 professionals who, from 73 research groups, publish more than 1,400 scientific articles a year. L’IDIBELL is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Health Institute, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.
IDIBELL is a member of the Campus d’Excelencia Internacional of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centres accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the HR Excellence in Research program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Centre of the AECC Scientific Foundation (FCAECC).