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Related Experiment Video

Updated: Jan 5, 2026

Continuous Theta Burst Stimulation of the Posterior Medial Frontal Cortex to Experimentally Reduce Ideological Threat Responses

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Published on: September 28, 2018

"If only…": Counterfactual thinking in bereavement.

Robert A Neimeyer¹, Shani Pitcho-Prelorentzos², Michal Mahat-Shamir²

¹Portland Institute for Loss and Transition, Portland, Oregon, USA.

|October 26, 2019

Summary

Complicated grief is often sustained by ruminative counterfactual thinking, or "if only" thoughts, about loss. Therapists can help by addressing these entrenched preoccupations to aid in meaning reconstruction.

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Last Updated: Jan 5, 2026

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Area of Science:

Psychology
Bereavement Studies
Cognitive Behavioral Therapy

Background:

Complicated grief can prolong suffering after a loved one's death.
Ruminative counterfactual thinking, focusing on "if only" scenarios, is a key factor in prolonged grief.
This cognitive process hinders the bereaved individual's ability to reconstruct meaning from the loss.

Purpose of the Study:

To review evidence linking counterfactual thinking to complicated grief.
To identify common themes or foci of counterfactual "if only" thoughts.
To present therapeutic strategies for managing rumination in bereavement.

Main Methods:

Literature review of studies on grief and cognitive processes.
Identification and categorization of four main foci for counterfactual thinking.
Case vignettes illustrating "if only" thoughts and therapeutic interventions.

Main Results:

Counterfactual thinking directed at the self, deceased, others, or circumstances sustains suffering.
Specific therapeutic approaches can resolve, mitigate, or redirect rumination.
Addressing "if only" thoughts is crucial for meaning reconstruction in complicated grief.

Conclusions:

Ruminative counterfactual thinking is a significant impediment in complicated grief.
Therapeutic interventions targeting "if only" cognition can alleviate suffering.
Clinicians should consider counterfactual preoccupations when treating prolonged grief.