If Only I Could Drink Like Everyone Else: Effects of Counterfactual Thinking and Personalized Normative Feedback on Perceived Behavioral Control Over Drinking.

Objective: Perceived behavioral control over drinking (PBCD) is an important factor in alcohol use, with lower scores linked to higher consumption. Counterfactual thinking (i.e. "If only … then …"), a cognitive strategy that strengthens causal links between antecedents and consequents, may increase PBCD by increasing engagement in Protective Behavioral Strategies (e.g. alternating water and alcohol to minimize negative drinking outcomes). This study examined a brief counterfactual-based intervention and a personalized normative feedback for protective behavioral strategies intervention (PBS-PNF) to increase PBCD among college students, relative to control, across five follow-up weeks.

Method: Undergraduate students (n = 239; 76.6% female) were randomly assigned to one of four conditions: control (recall negative drinking event), sham (recall and elaborate on negative drinking event), counterfactual (recall negative drinking event and generate counterfactual strategies), or PBS-PNF (estimate peers' use of protective behavioral strategies). PBCD was measured at baseline and at five follow-up sessions.

Results: A Bayesian-approach multi-level model was used to estimate PBCD across follow-up weeks. Those in the counterfactual and PBS-PNF conditions reported greater increases in PBCD across follow-ups compared to those in the sham condition who saw no change. Participants in the control condition saw decreases in PBCD over time. The counterfactual and PBS-PNF conditions did not differ on PBCD across time.

Conclusion: This study highlights the effectiveness of a brief counterfactual-based intervention to increase PBCD among early drinking college students. Specifically, personalized interventions that increase use of protective behavioral strategies may be particularly effective for individuals who have not yet solidified their drinking habits.