Haunted by vivid ‘what if’ thoughts: how counterfactual thinking is associated with posttraumatic stress reactions over time

Background: After trauma, the mind often returns not only to what happened, but to what could have happened. Counterfactual thinking (CFT) has been linked to posttraumatic stress reactions (PTSR), yet its role over time remains unclear.Objective: This longitudinal study examined how frequency and vividness of CFT relate to PTSR following sexual assault, addressing a lack of longitudinal research on these associations.Method: Participants (baseline N = 452; 437 women, 15 men; M age = 26.2 years, SD = 8.4) who had experienced sexual assault within the past year and were assessed at baseline, three months (N = 216), and six months (N = 232). The participants were recruited through Sexual Assault Care Centres and social media, thereby including both survivors who had sought professional help and those who had not. PTSR were assessed with the International Trauma Questionnaire, and CFT frequency and vividness with self-report items. We used latent growth curve models to examine launch effects (higher initial symptom levels) and snare effects (time-specific elevations in symptoms over time).Results: Higher baseline frequency and vividness of CFT were associated with higher PTSR levels at the first assessment, but not with symptom change over time. Vividness of CFT showed time specific associations with elevated PTSR, whereas frequency effects were less consistent.Conclusion: These findings suggest that CFT contributes to PTSR through stable and time specific processes and may represent a clinically relevant target. Future research should examine the mechanisms underlying these longitudinal associations.