Counterfactual Thinking and Health Behavior Change Interventions

Counterfactual thinking (i.e., thoughts of “if only” or “what might have been”) is a pervasive cognitive strategy in which one imagines a better or worse alternative to past events, features, or states. Other theories of health behavior change (e.g., health belief model, theory of planned behavior) have been employed in interventions to target specific health preventative behaviors (e.g., substance use, eating disorders, risky sexual behaviors). However, counterfactual thinking has potential to help move these behaviors along and may provide a new avenue for health behavior change that encompass facets of other models, in addition to cognitive personalization, intention, and adherence enhancement. This chapter provides empirical outcomes on how counterfactual thinking has influenced these various health behaviors and introduces areas for future research. Specifically, counterfactual thinking has the potential to act in a protective/harm reduction manner, in addition to being adaptable to cultural factors or needs. Finally, the chapter provides a roadmap for future research aimed at increasing the use of counterfactual thinking to reduce significant health behavior problems.