I'd do much better, if only … counterfactual comparisons related to traumatic life events.

The association between posttraumatic stress disorder (PTSD) and counterfactual comparisons (CFC) is poorly understood and CFC-measures are missing. We developed and applied the Posttraumatic Counterfactual Comparisons Scale (P-CFC-S), which measures frequency, intensity and affective impact of trauma-related CFC. We further measured trauma history, PTSD symptoms, probable PTSD diagnosis, posttraumatic cognitions, satisfaction with life and basic sociodemographic information. The sample consisted of 556 adults (62.95% female) who had all experienced at least one potentially traumatic event and of whom 15.29% fulfilled a probable PTSD diagnosis. The P-CFC-S yielded adequate internal consistency and a one-factor structure in the explorative factor analysis. CFC were common, and about two-fold more common in individuals with probable PTSD compared to those without. In hierarchical regression analyses, the frequency and intensity in CFC explained a significant amount of variance in PTSD symptoms when potentially confounding variables (i.e. age, gender, posttraumatic cognitions and counterfactual thinking) were accounted for. Our findings suggest that CFC may be an active ingredient in PTSD maintenance. Longitudinal research is needed to examine the dynamics between CFC and PTSD and the hypothesis that CFC is related to cognitive avoidance and/or maladaptive appraisals of trauma meaning.