Connections Between Anticipated Regret and Anorexia Recovery

I’d like to do something tomorrow night. I feel guilty at my lazy lack of sociability. I’ll regret it in my dotage—the waste of all these opportunities. But should you make yourself “have fun” if you don’t particularly want to? Isn’t doing stuff only so that you’ll have things to remember just as bad as not doing them for fear you’ll regret them? Isn’t feeling compelled to live on the edge as bad as sacrificing everything for a career that might in 50 years allow you to retire in wealth and exhaustion and characterless virtue? (from my journal, 24 February 2001)

I’ve just moved to California for a year, and I am acutely aware of wanting not to waste it. I know that an easy way for me to waste it would be by letting “I have too much to do” get in the way of throwing myself into the experience of being here. And so I’ve been doing some imagining of 12 months from now and what the version of the intervening months will be that leads to regret versus gladness.

Anticipated regret feels like it should be too obscure an emotion to do much real work. Regret is wishing you’d done or not done something in the past; anticipated regret is imagining a future in which you wish you’d done or not done something in the past. That’s quite a complex counterfactual; amongst creatures on this planet, it’s probably pretty uniquely human that something with these layers can gain purchase on us.

But it does. Anticipated regret pops up in the most emotionally intense decision-making about whether to begin or continue to recover from an eating disorder—specifically, as one of the strongest forces acting towards “yes.” Anecdotally, it seems especially common where children are involved, in forms like, “I’m determined not to look back and feel I wasted this first year of motherhood,” or “I don’t want my kids to leave home and realize I was never really present for their entire childhood.” It also surfaces around major birthdays and around births, deaths, and other life transitions. Of course, it doesn’t always win out over fear, discomfort, and the trump card of all pro-anorexic sentiments, “But I can’t bear the idea of getting fat”—but sometimes it’s part of what does.

I had no idea when I thought up this blog post topic whether there’d be any research on it, but of course, there is, and it turns out that the research supports the idea that anticipated regret has practical potency: “The fact that anticipated regret has such an effect on behavioral choice shows that regret aversion is a clear motivator” (Zeelenberg, 2018, p. 283). It was long overlooked as a serious contributor to practical decision-making, but it has since been proposed as an expansion of previous models of behavioral intention that included attitudes (how do I feel about doing x?), perceived behavioral control (how much control do I have over doing x?), and subjective norms (would significant others want me to do x?) (e.g., Conner & Armitage, 1998). A 2016 meta-analysis found “a strong link between anticipated regret and behavioral intentions and a moderate relation between anticipated regret, intentions, and health behavior” (Zeelenberg, 2018, p. 281; see Brewer, DeFrank, and Gilkey, 2016). As Zeelenberg puts it, “Decision-makers are regret-averse,” and in this sense, the emotion does its evolved job: action guidance. In general, “feeling is for doing” (p. 289), and with anticipated regret, the feeling often seems to do a better job than more “rational” alternatives: “Anticipated regret had stronger associations with health behaviors and intentions than several other risk appraisals including perceived severity” (Brewer, DeFrank, and Gilkey, 2016, p. 11).

Anticipated regret may also work better than other emotions, such as fear. Fear can be made more effective by being supplemented with information about the potential behavior change, but can also heighten defensiveness. This aligns with what was a standard irritation for me when ill: when well-meaning people would try to make me take action by telling me how likely it was that I would die if I didn’t. It sometimes worked for a short while, but it was highly vulnerable to over-use. Research on HIV prevention found that “presenting HIV as highly threatening but easy to prevent” increased anticipated regret, which in turn strengthened intentions to use condoms: “Thus, interventions that target AR may be more effective than fear appeals, or interventions that target fear may work via increasing AR.”

Of course, eating disorder recovery is different from safer sex in many ways! Indeed, the experimental designs that researchers use to test the power of anticipated regret in sex-related contexts clarify through contrast the long-drawn-out complexity of decision-making about recovery. In one neat design (Richard et al., 1996; for an overview, see Koch, 2014), the AR condition involved simply inviting participants to predict their feelings either 1) about a casual sex encounter or 2) after a casual sex encounter. A single word change was enough to induce an entirely distinct cognitive-emotional response, with more negative emotions in the AR condition and a correlation, at a five-month follow-up, between the condition and condom use with new or casual sexual partners.

With a long-term prospect like eating disorder recovery or its absence, there are no obvious candidates for single episodes to have the “morning after” feeling about or not; life milestones are probably the most obvious option. With anorexia recovery, then, the selling point of “look how easy it is to do the right thing” may be a lot less accessible than with condom use and the like. But there may nonetheless be a sense in which anticipated regret “binds people to their intentions” (Abraham & Sheeran, 2003, p. 496) more adhesively than mere fear. You just need to work out what hook will help you find it.

As for what anticipated regret versus ordinary retrospective regret feel like, and how they incline us to act, some clear differences emerge. Looking at their respective experiential qualities, the anticipated kind is higher on pleasantness (because the bad decision may still be prevented), expectedness (it involves bracing yourself for the worst), and modifiability (“the functionality of this emotion in protecting the self from faulty decisions”; Zeelenberg, 2018, p. 286). When it comes to the kinds of action readiness the emotion brings about, anticipated regret is higher than the ordinary kind on information-search variables like optional knowledge (wanting to know everything about the options) and comparison (explicitly comparing the options). This aligns with the common tendency to do lots of recovery-related reading during the pre-decision phase—and, for some individuals, throughout recovery. (How helpful or unhelpful a response this is to the fear of the unknown or partially known is highly context-dependent.)

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The anticipated version is also higher on other control (the urge to leave things to other people, to delegate). This feature doesn’t seem particularly common with anorexia, where a lot of the problem is often an unwillingness to cede even small amounts of control to anyone else—or simply to chance or, indeed, to appetite. But it may be at play in the momentousness of deciding to seek intensive treatment that takes away all food decisions for a while; sometimes, that seems the only way to spare oneself the future pain of having remained ill. Finally, anticipated regret scores lower than retrospective regret on undoing (wanting to turn back time) and kicking oneself (self-recrimination) since, by definition, it involves less focus on what happened and one’s causal role in it. Rather than learning from mistakes, this is about preventing them.

In the second part of this miniseries, I’ll consider the relation between anticipated regret and presence: that feeling of being right here where this experience is happening, which is so often blocked by the mental chatter and haze of an eating disorder.