Motivation and emotion/Book/2017/End of life regrets

End of life regrets:
What do people regret most, why, and what can be done about it?

Multimedia presentation (3 min)

Overview - What is regret?

Regret is a term commonly used in economical papers, but in this case we are referring the the self-conscious emotion of regret that often develops in later life and can cause emotional struggle (Lee & Ryu, 2017). When a person fails to make a choice or chooses to undertake behaviour that does not meet their values, beliefs or growth need, they may feel the need to go back and change this - they are experiencing a feeling of regret (Lucas, 2004; Zeelenberg & Pieters, 2007).

Regret is something that all people experience to varying degrees about many aspects of our lives and this will be investigated in the chapter below. Throughout we will investigate what people most commonly regret at the end of their lives and why. In addition we will look at how psychological knowledge and implemented practices could help to rid or minimise a person's feelings of regrets.

Focus questions What is regret? What do people regret most at the end of their lives? Why do we regret these things? What can we do to change this?

What do people regret most?

Typically people report to regret inaction rather than action, a person regrets the opportunities where they didn't try more than those instances when they tried and failed (Joel, Plaks & MacDonald, 2017; Morrison & Roese. 2011; Roese & Summerville, 2005; Summerville, 2011). The most common aspects of life that people regret are education, career, romance and parenting (Landman, Vandewater, Stewart & Malley, 1995; Roese & Summerville, 2005). People tend to regret choices in life where they have seen the largest opportunity potential for change, renewal or growth.

Figure 1. Missed opportunity quote on a coach's whiteboard (Okanagan Hockey Academy).

Men and women react different to regret and often experience it for different reasons. Women typically regret aspects in love, whilst men report more regrets associated with work (Morrison & Roese, 2011). Within romantic relationships, research indicates that that people are three times more likely to recall regret about missed romantic opportunities rather than rejection (Joel, Plaks & MacDonald, 2017). People, regardless of their level of attachment anxiety and self-esteem, feel that missed opportunities may have more consequence on the present and their future (Joel, Plaks & MacDonald, 2017). People are far more willing, in both actual and imagined decisions, to risk rejection rather than an opportunity (Joel, Plaks & MacDonald, 2017; Roese & Summerville, 2005).

Males also tend to have a much higher factor of regret for sexual relationship aspects than women (Roese, et al., 2006). These results may indicate an evolutionary perspective to the way in which men and women prioritise within a relationship and the consequential regrets when these relationships are not successful.

Other interpersonal regrets, such as those with parents, friends and siblings, were found to be no different between the sexes (Roese, et al., 2006).

Different cultures can experience varying types of regrets and the degree of intensity they are felt. A study conducted by Lee and Ryu (2017) illustrated that whilst Americans tend to have more regrets, Koreans reported a higher intensity for the regrets they have.

Psychology and Neuroscience behind regret (the why?)

Regret regulation theory

Regret regulation breaks down regret into three main categories, decision, alternatives and feelings-focused (Zeelenberg & Pieters, 2007). This theory consists of propositions that identify regret as a motivator for encouraging people to create better cognitive consequences for themselves (Morrison & Roese, 2011; Pieters & Zeelenberg, 2007; Zeelenberg & Pieters, 2007). Objective life circumstances such as demographic are key indicators of this theory as they illustrate predictive patterns of behaviour (Morrison & Roese, 2011).

This may not be useful as this could all just be a part of behaviour regulation (loop mechanism). People try to overcome their regret because they seek more preferable and positive outcomes, not because it is simply a necessity (Roese, Summerville & Fessel, 2007).

Opportunity principle and counterfactual thinking

Opportunity principle indicates that a person's biggest regret for past actions occurs when it appears there could have been opportunity to correct their actions (Epstude & Roese, 2008). When there is multiple ways to achieve a goal but the window to achieve these closes this can intensify the feelings of regret an individual experiences (Beike & Crone, 2008).

The lost opportunity principle explains that there is increased regret when you feel there is a better choice but cannot take it, or you are looking at what you may have missed out on (Beike, 2008; Roese, 1997). This means that there is less perceived opportunity in the future than there was in the past, and outcomes are non-repeatable.

Studies have illustrated that to overcome regrets adults need to confront low opportunities to overcome regret, and have the capacity to reengage goals (Bauer & Wrosch, 2011; Epstude & Roese, 2008). By doing this, the downward social comparisons acts as a self-protective function throughout their life span (Bauer & Wrosch, 2011; Epstude & Roese, 2008; Roese & Summerville, 2005).

Research suggests that it is a combination of the above principles, creating a Dynamic Opportunity Principle of regret (Summerville, 2011). The resulting regret from actions depends on a variety of factors both past and present, as well as the initial severity of regret at the time of the incident, although this does not directly correlate with retrospective regrets (Summerville, 2011). These theories are commonly credited to explain educational regrets that people may have (Beike, 2008; Epstude & Roese, 2008).

Regret aversion theory

When making decisions individuals may anticipate regret and make their choice to avoid this. A person may experience anticipated regret along with low cost-benefit calculations and selection difficulty, that lead them to postpone a decision, fail to act or just accept something 'as is' (Anderson, 2003). This may be good for avoiding initial experienced regret, however other regret theories have indicated that inaction rates higher than action for regret intensity, meaning this may be detrimental in the long run.

Psychosocial development (Erikson)

During the mature phase of around 65 years old till death, Erik Erikson set a stage of psychosocial development labelled wisdom, which looks at ego integrity versus despair (Sneed, Whirbourne & Culang, 2006). During this stage a person assesses their accomplishments and decides if they were successful (integrity) or unsuccessful (despair). This stage can be fraught with regret about the aspects of life that a person feels they did not achieve in.

Neuroscience - Brain activity and regret

Figure 2. MRI of orbitofrontal cortex

Through functional magnetic resonance imaging (fMRI) it has been illustrated that when a person feels regret, activity increases primarily in the medial orbitofrontal cortex, as well as the anterior singulate cortex and the hippocampus (Coricelli, Dolan & Sirigu, 2007; Coricelli, et al., 2007).

In a study conducted by Coricelli and colleagues (2007), participants were subject to gambling with two options and regret was induced by telling the participants the outcome of the unchosen option. The results of this study were that when a person undergoes regret-aversion, this has a cumulative effect on activity within the orbitofrontal cortex and amygdala. This indicates that whether it is experienced or anticipated regret, the same neural circuitry is used and the orbitofrontal cortex is the mediator (Coricelli, Dolan & Sirigu, 2007; Coricelli, et al., 2007).

What can we do to reduce end of life regrets?

Psychological aspects

Ideally to assist a person with managing their regret, both their current and future regrets should be assessed. Regret regulation strategies would encourage preventing future regret through anticipating regret, ensuring decision reversibility and increased decision quality, justifiably and responsibility (Zeelenberg & Pieters, 2007). However at a person's end of life it is their current regrets that trouble them. This theory suggests that for current regret management we need to justify decisions or deny responsibility for them, undo decisions where possible, suppress or deny regret, and undergo psychological repair work (Zeelenberg & Pieters, 2007). One of the key ways that end of life regrets can be reduced is by changing the way people think of opportunities.

Research suggests that we should encourage people to find the silver linings in situations, and by doing so, or by accepting that the situation could have been worse, a person's regret is reduced (Gilovich & Medvec, 1995; Teigen, 2005; Zeelenberg & Pieters, 2007). By teaching such strategies and those similiar, this can allow people to have the capacity to reduce the severity of regret at the time of incidences, as well as being able to employ this method retrospectively to regrets troubling them at the end of their life. In addition, a regret is felt more painfully when a person looks at the impact the event had on their life as a whole, as opposed to first-person imagery (Gilovich & Medvec, 1995; Valenti, Libby & Eibach, 2011). This would indicate that we should encourage people to allow the event to be of it's own, rather than an effect on their life as a whole or a predecessor to further life outcomes. Connolly and Zeelenberg (2002) stated that an individual must feel some personal responsibility to experience regret and that no choice opportunities have little to no regret associated. This would further support making psychological thinking changes to alleviate regret, meaning we need to encourage people to lessen the responsibility they feel in highly these regretted situations.

Cognitive dissonance is experienced by people with conflicts between behaviour and belief (Gilbert & Ebert, 2002). This occurs for someone who experiences strain between the future and lost opportunity principles, and by reducing this we can see a reduction in the degree of regret felt (Elliot & Devine, 1994; Gilbert & Ebert, 2002). By having the person take on more of a first-person stance as previously mentioned, and by going through the regrettable instances and aligning belief and action as closely as possible, regret can be reduced (Beike, 2008; Connolly & Zeelenberg, 2002; Elliot & Devine, 1994).

An easier way to reassess a situation rather that trying to change beliefs, is by substituting an achievable goal in for one that was previously blocked (King & Hicks, 2007; Wrosch, et al., 2005). An example given by Wrosch and collegues (2005) was an older woman who at 85 years regrets not having had children of her own, so instead creates an attainable relationship goal and puts all her energy into spending time with loved ones. By changing goals and undertaking one that is effective but short-term, it is very achievable for those with limited time and meets developmental needs (King & Hicks, 2007Sneed, Whirbourne & Culang, 2006; Wrosch, et al., 2005). This kind of redirection of regret into an achievement would be a very easy and strong way to assist those trying to relieve end of life regrets.

Education and opportunity

Looking at those life aspects with the most regrets, by providing information of possible opportunities for career and education, particularly to people becoming older who feel these avenues are not as accessible, would allow people to fulfill aspects of their life they may feel are incomplete. Further romantic and relationship opportunities could also be provided to those at the end of their life, giving them new opportunities to make up for those they may regret missing. This could be establishing friendship circles and even encouraging romantic interactions between older people.

Chronic procrastinators have significantly more regret about education pursuits, financial planning, health and wellness, parenting, and family and friend interactions than non-procrastinators (Ferrari, Barnes & Steel, 2009). Perhaps education could be implemented about some of these aspects such as finance at an earlier age to create greater understanding, as well as education on ways to manage procrastination in order to reduce severity, thus reducing regret potential.

Cultural specific consideration

In one study, regrets associated with leisure and addiction were highly related to geriatric depression in Americans, so one way to relieve this is to increase pride in leisure activities from a younger age, as well as during a persons later years (Lee & Ryu, 2017). In this same study Koreans were found to have regrets regarding health and career and it is suggested that increasing altruism within the culture and later years of life, may alleviate both geriatric depression and reduce these regrets (Lee & Ryu, 2017). This study suggests that we need to investigate the primary values within different countries and cultures, and then use these to implement activities both throughout people's lives to reduce the creation of regret, and as people near end of life to reduce the pain experienced by the inability to relieve such regrets.

Future research directions

• All of the research regarding regret, geriatric depression and end of life feelings, would indicate that in order to help reduce feelings of regrets at the end of life, further investigation should be made into the values of different populations to accurately design ways to reduce the instances of these regrets.
• Look into the negative effects of regret when maintained at end of life, and the possibility of these feelings being embraced as a reduction technique.
• Design population specific programs to reduce and relieve regret as a person nears the end of their life and do a before, during and after the intervention comparison to see how effective future plans may be.
• Further investigation should be made into ways to teach people to limit the instances they create regret about. This may be encouraging people to be more daring, education about career opportunities and realistic advice about the way the world works, learning ways to minimise intensity of any regret felt, and many other potential improvement opportunities.

Quiz

Here are a few questions to refresh your memory - choose the correct answers and click "Submit": 1 What is the most common category of regret reported by Women? Work related Love Financial Lust 2 What area of the brain is considered the mediator for regret? Amygdala Occipital lobe Hippocampus Orbitofrontal cortex 3 Which of the following statements is true? Different cultures experience different primary regrets and at different intensities Different cultures experience the same primary regrets but at different intensities Different cultures experience different primary regrets but at the same intensity Different cultures experience the same primary regrets and regret intensities

Conclusion

People feel the emotion of regret when they have a behaviour, situation or outcome they wish they could go back and change (Lucas, 2004). This may be due to a failure to make a choice or the choice they made did not reflect their values, beliefs or growth needs (Lucas, 2004). These feelings often cause emotional struggle, particularly later in life (Lee & Ryu, 2017). The most common aspects of life that people regret are education, career, romance and parenting (Roese & Summerville, 2005).

In regards to what regret is felt most strongly about, there are some differences between males and females, and between different cultures, as well as regret being felt to different degrees. There are multitudes of psychological theories to explain regret, but many relate to whether a person takes action or inaction, and whether they feel they can change an outcome. In order to reduce end of life regrets investigation needs to be undertaken into different populations to establish their needs, and implement programs for all ages, as well as having a target program for those at the end of their life to relieve and mend these opportunities where possible.

End of life regrets may be reduced by researching ways to resolve or relieve the feelings themselves, by providing opportunities or education to reduced people generating regrets to begin with, and alleviating them at an older age where possible. In addition, teaching people to just embrace and enjoy the life they have had and to do the best they can with the time they have left is key.

See also

• Death anxiety - in particular the section Theoretical background (Book chapter, 2016)
• Regret (Book chapter, 2016)
• Zeigarnik effect, section - When the Zeigarnik effect goes wrong (Book chapter, 2015)
• Regret (Wikipedia)

References

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External links

• Don't regret regret by Kathryn Schulz (TED Talk)
• What really matters at the end of life by BJ Miller (TED Talk)