'My child could have died': counterfactual thoughts and psychological distress in parents of trauma survivors

Eur J Psychotraumatol. 2024;15(1):2326736. doi: 10.1080/20008066.2024.2326736. Epub 2024 Mar 20.

Abstract

Background: After exposure to a potentially traumatic event, survivors may experience thoughts about 'what could have happened', referred to as counterfactual thoughts (CFTs). CFTs have been found to have a negative impact on survivors' mental health. This is the first study to investigate whether parents of trauma survivors experience CFTs and the association with psychological distress in this group.Objective: The main aim of the present study is to investigate CFTs in parents of trauma survivors and the relationship between the frequency and vividness of CFTs and psychological distress.Method: The participants (N = 310, 191 females) were parents of the youths targeted in the terror attack on Utøya island, Norway, in 2011. Frequency and vividness of CFTs, posttraumatic stress reactions (PTSR), and symptoms of anxiety and depression were measured 8.5-9 years post-terror.Results: The majority of the parents (74%) reported having experienced CFTs at some time point since the attack. For almost one-third of the parents, CFTs were still present more than eight years after the attack. Higher frequency and vividness of CFTs were uniquely associated with higher levels of PTSR, anxiety, and depression.Conclusion: The present findings suggest that frequent and vivid CFTs may contribute to mental health problems in parents of trauma survivors and should be addressed in therapy.

Antecedentes: Tras la exposición a un acontecimiento potencialmente traumático, los sobrevivientes pueden experimentar pensamientos sobre ‘lo que podría haber ocurrido’, denominados pensamientos contrafactuales (CFT, por sus siglas en inglés). Se ha descubierto que los CFT tienen un impacto negativo en la salud mental de los sobrevivientes. Este es el primer estudio que investiga si los padres de sobrevivientes de traumas experimentan CFT y su asociación con el malestar psicológico en este grupo.

Objetivo: El objetivo principal del presente estudio es investigar las CFT en padres de sobrevivientes de traumas y la relación entre la frecuencia, la intensidad de los CFT y el malestar psicológico.

Método: Los participantes (N = 310, 191 mujeres) eran padres de las jóvenes víctimas del ataque terrorista en la isla de Utøya, Noruega, en 2011. Se midieron la frecuencia y la intensidad de las CFT, las reacciones de estrés postraumático (PTSR por sus siglas en ingles), los síntomas de ansiedad y depresión entre 8,5 y 9 años después del atentado.

Resultados: La mayoría de los padres (74%) declararon haber experimentado CFT en algún momento desde el ataque. Para casi un tercio de los padres, los CFT seguían presentes más de ocho años después del ataque. La mayor frecuencia e intensidad de los CFT se asoció de forma única con niveles más altos de PTSR, ansiedad y depresión.

Conclusión: Los presentes hallazgos sugieren que los CFT frecuentes e intensos pueden contribuir a los problemas de salud mental en los padres de sobrevivientes de traumas y deben abordarse en la terapia.

Keywords: Trauma; counterfactual thinking; estrés postraumático; padres; parents; pensamiento contrafactual; posttraumatic stress; secondary trauma; trauma secundario.

Plain language summary

A quantitative study investigating the relationship between counterfactual thoughts and psychological distress, in parents of trauma survivors.The majority of the parents reported having experienced counterfactual thoughts at some time point since the attack. For almost one-third of the parents, counterfactual thouhgts were still present more than eight years after the attack. Higher frequency and vividness of counterfactual thoughts were uniquely associated with higher levels of psychological distress.The present findings suggest that frequent and vivid counterfactual thouhgts may contribute to mental health problems in parents of trauma survivors and should be addressed in therapy.

MeSH terms

  • Adolescent
  • Anxiety / epidemiology
  • Anxiety Disorders
  • Child
  • Female
  • Humans
  • Parents*
  • Psychological Distress*
  • Survivors