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Neuropsychologia. 2014 Feb;54:77-86. doi: 10.1016/j.neuropsychologia.2013.10.026. Epub 2013 Dec 10.

What might have been? The role of the ventromedial prefrontal cortex and lateral orbitofrontal cortex in counterfactual emotions and choice.

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Department of Psychology, University of North Carolina Charlotte, 4033 Colvard, 9201 University City Boulevard, Charlotte, NC 28223, United States. Electronic address:
University of Tennessee, Knoxville, TN 37996, United States.
University of Iowa, Department of Neurology, 2007 Roy Carver Pavilion, 200 Hawkins Drive, Iowa City, IA 52242, United States.
University of Southern California, SGM 501, 3620 South McClintock Ave. Los Angeles, CA 90089-1061.
Solomon Labs, 3720 Walnut St, Room C1. University of Pennsylvania, Philadelphia, PA 19104.


Counterfactual feelings of regret occur when people make comparisons between an actual outcome and a better outcome that would have occurred under a different choice. We investigated the choices of individuals with damage to the ventral medial prefrontal cortex (VMPFC) and the lateral orbital frontal cortex (LOFC) to see whether their emotional responses were sensitive to regret. Participants made choices between gambles, each with monetary outcomes. After every choice, subjects learned the consequences of both gambles and rated their emotional response to the outcome. Normal subjects and lesion control subjects tended to make better choices and reported post-decision emotions that were sensitive to regret comparisons. VMPFC patients tended to make worse choices, and, contrary to our predictions, they reported emotions that were sensitive to regret comparisons. In contrast, LOFC patients made better choices, but reported emotional reactions that were insensitive to regret comparisons. We suggest the VMPFC is involved in the association between choices and anticipated emotions that guide future choices, while the LOFC is involved in experienced emotions that follow choices, emotions that may signal the need for behavioral change.


Counterfactual comparison; Decision making; Emotion; OFC; Regret; VMPFC

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