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Counterfactual Thinking in Patients with Amnesia

Lookup NU author(s): Dr Sinead MullallyORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


We often engage in counterfactual (CF) thinking, which involves reflecting on 'what might have been'. Creating alternative versions of reality seems to have parallels with recollecting the past and imagining the future in requiring the simulation of internally-generated models of complex events. Given that episodic memory and imagining the future are impaired in patients with hippocampal damage and amnesia, we wondered whether successful CFthinking also depends upon the integrity of the hippocampus. Here using two non-episodic CF thinking tasks we found that patients with bilateral hippocampal damage and amnesia performed comparably to matched controls. They could deconstruct reality, add in and recombine elements, change relations between temporal sequences of events, enabling them to determine plausible alternatives of complex episodes. A difference between the patients and control participants was evident, however, in the patients' subtle avoidance of CF simulations that required the construction of an internal spatial representation. Overall, our findings suggest that mental simulation in the form of non-episodic CF thinking, does not seem to depend upon the hippocampus unless there is the added requirement for construction of a coherent spatial scene within which to play out scenarios.

Publication metadata

Author(s): Mullally SL, Maguire EA

Publication type: Article

Publication status: Published

Journal: Hippocampus

Year: 2014

Volume: 24

Issue: 11

Pages: 1261-1266

Print publication date: 01/11/2014

Online publication date: 11/07/2014

Acceptance date: 30/06/2014

Date deposited: 16/07/2014

ISSN (print): 1050-9631

ISSN (electronic): 1098-1063

Publisher: John Wiley & Sons, Inc.


DOI: 10.1002/hipo.22323


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