Looming vulnerability to spreading contamination in subclinical OCD

The dual threat of COVID-19 to health and job security - Exploring the role of mindfulness in sustaining frontline employee-related outcomes

Navigating the increasingly uncertain business world requires organizations and employees to be highly adaptive to threats and changes. During COVID-19, the dual threats to health and job security have been especially salient for frontline employees. Drawing on the job demands-resources (JD-R) model, we investigated individual and organizational mindfulness as valuable resources, which influence employee outcomes of preventative behaviors, emotional exhaustion, and job performance both directly, and indirectly through threat appraisals. We find that individual and organizational mindfulness influence threat appraisals in a "counterbalanced manner": individual mindfulness decreases threat appraisals, while organizational mindfulness heightens the perceived threat of contracting COVID-19. The threat to health further serves as a double-edged sword, predicting both emotional exhaustion and preventative behaviors, while job insecurity impairs all employee outcomes. Based on these findings, we provide key implications for research and practice, and future research directions.

Obsessive-compulsive disorder-contamination fears, features, and treatment: novel smartphone therapies in light of global mental health and pandemics (COVID-19)

This review aims to shed light on the symptoms of obsessive-compulsive disorder (OCD) with a focus on contamination fears. In addition, we will briefly review the current therapies for OCD and detail what their limitations are. A key focus will be on discussing how smartphone solutions may provide approaches to novel treatments, especially when considering global mental health and the challenges imposed by rural environments and limited resources; as well as restrictions imposed by world-wide pandemics such as COVID-19. In brief, research that questions this review will seek to address include: (1) What are the symptoms of contamination-related OCD? (2) How effective are current OCD therapies and what are their limitations? (3) How can novel technologies help mitigate challenges imposed by global mental health and pandemics/COVID-19.

Behavioral avoidance tasks for eliciting disgust and anxiety in contamination fear: An examination of a test for a combined disgust and fear reaction

While research supports the role of disgust in contamination OCD, there is also an overlap with fear in motivating avoidance. The "heebie-jeebies" is an emotional response associated with fear and disgust that motivates avoidance of contact with skin-transmitted pathogens (e.g., parasites). This motivation aligns with characteristics of contamination OCD. From a screening of undergraduate students (N = 188), contamination fearful (n = 14), high trait-anxious (n = 14), and low trait-anxious (n = 18) groups were created. Participants engaged in disgust, fear, and "heebie-jeebies" behavioral avoidance tasks. Participants rated "heebie-jeebies" emotion, physical sensations, and behavioral urges. Duration or refusal of task was recorded. A significant interaction effect was found for disgust and anxiety. Participants with higher disgust reported higher "heebie-jeebies" emotion at high, but not low, levels of anxiety. Exploratory analyses revealed that many contamination fearful and high trait-anxious participants refused to complete the task. The interaction of disgust and anxiety significantly predicted the probability of refusal. Participants with higher disgust and anxiety were more likely to refuse to complete the task. Results suggest that the "heebie-jeebies" motivates avoidance of skin-transmitted pathogens. Future research is warranted to further investigate the "heebie-jeebies" and how it relates to contamination concerns.

Is disgust in obsessive-compulsive disorder mediated by fear of pathogens?

Individuals with obsessive-compulsive disorder (OCD) tend to report higher levels of disgust, but not much is known about factors that might underlie this relationship. The present study was motivated by the behavioral immune theory, which suggests that disgust has evolved as a protective reaction to potential presence of disease agents in the immediate environment. We examined the relationships between the intensity of experienced physical disgust, perceived vulnerability to disease, and OCD symptoms. The intensity of experienced disgust was assessed with a recent procedure whereby participants rate how disgusted they feel in response to color versus black-and-white pictures that evoke physical disgust. In addition to this procedure, participants (N = 403) completed measures of perceived vulnerability to disease, OCD symptoms, depression and anxiety. OCD symptoms were positively related to the physical disgust evoked by the pictures, and this relationship was mediated by reported emotional discomfort in contexts that connote a potential for pathogen transmission. Replicating previous findings, color pictures were rated as more disgusting than black-and-white pictures overall, and this effect was especially pronounced among people with higher OCD tendencies. These results suggest that, consistent with behavioral immune theory, disgust in OCD is a basic, concrete emotion that is at least partly mediated by fear of pathogens.

The effects of cognitive reappraisal on conditioned disgust in contamination-based OCD: An analogue study

Experimental research has shown that conditioned disgust is resistant to extinction, which may account for the slower habituation to disgust relative to fear in contamination-based obsessive-compulsive disorder (OCD). However, few studies have examined the efficacy of interventions that may attenuate conditioned disgust responses. Studies of cognitive reappraisal have demonstrated that reinterpreting a stimulus can alter emotional responding. This technique is based on cognitive theories which suggest that anxiety disorders arise from biased cognitions; therefore, changing a person's thoughts will elicit durable changes in emotional responses. Given the demonstrated effectiveness of cognitive reappraisal, the present study examined whether cognitive reappraisal would attenuate conditioned disgust responses. We conditioned participants high in contamination fear (n=55) using images of neutral food items (conditioned stimuli; CS) paired with videos of individuals vomiting (unconditioned stimuli; US) while we obtained subjective disgust reports. After conditioning, half of the participants were randomly assigned to cognitive reappraisal training aimed at decreasing their emotional response to the US and CS, while the other half received no such training. The findings showed that cognitive reappraisal participants demonstrated a reduction in learned disgust across sessions and further benefited from extinction. These findings suggest that cognitive reappraisal may be an effective strategy for attenuating learned disgust.

Obsessive-Compulsive Disorder in Paediatric and Adult Samples: Nature, Treatment and Cognitive Processes. A Review of the Theoretical and Empirical Literature

The appraisal model of obsessive-compulsive disorder (OCD) suggests that six key appraisal domains contribute to the aetiology and maintenance of OCD symptoms. An accumulating body of evidence supports this notion and suggests that modifying cognitive appraisals may be beneficial in reducing obsessive-compulsive symptomatology. This literature review first summarises the nature of OCD and its treatment, followed by a summary of the existing correlational and experimental research on the role of cognitive appraisal processes in OCD across both adult and paediatric samples. While correlational data provide some support for the relationship between cognitive appraisal domains and OCD symptoms, results are inconclusive, and experimental methods are warranted to determine the precise causal relationship between specific cognitive appraisal domains and OCD symptoms.

Homosexuality and Pro-Gay Ideology as Pathogens? Implications of a Disease-Spread Lay Model for Understanding Anti-Gay Behaviors

Negative behaviors targeting gay men and lesbians range from violent physical assault to casting a vote against gay marriage, with very different implications for those targeted. Existing accounts of such actions, however, are unable to differentially predict specific anti-gay behaviors, leaving a large theoretical hole in the literature and hindering the design of effective interventions. We propose (a) that many sexually prejudiced laypersons conceptualize homosexuality and pro-gay ideology as “contaminants” analogous to infectious pathogens and (b) that anti-gay behaviors can thus be viewed as strategic attempts to prevent, contain, treat, or eradicate the “pathogens” of homosexuality and pro-gay ideology. By considering analogues to disease-spread processes (e.g., susceptibility of specific subpopulations, inoculation procedures, prevalence in the local environment, interconnections among community members), we derive novel predictions regarding the incidence and nature of anti-gay behaviors and provide leverage for creating more tailored interventions to reduce such discrimination.

Predictive Validity of Explicit and Implicit Threat Overestimation in Contamination Fear

We examined the predictive validity of explicit and implicit measures of threat overestimation in relation to contamination-fear outcomes using structural equation modeling. Undergraduate students high in contamination fear (N = 56) completed explicit measures of contamination threat likelihood and severity, as well as looming vulnerability cognitions, in addition to an implicit measure of danger associations with potential contaminants. Participants also completed measures of contamination-fear symptoms, as well as subjective distress and avoidance during a behavioral avoidance task, and state looming vulnerability cognitions during an exposure task. The latent explicit (but not implicit) threat overestimation variable was a significant and unique predictor of contamination fear symptoms and self-reported affective and cognitive facets of contamination fear. On the contrary, the implicit (but not explicit) latent measure predicted behavioral avoidance (at the level of a trend). Results are discussed in terms of differential predictive validity of implicit versus explicit markers of threat processing and multiple fear response systems.

Examination of the convergent validity of looming vulnerability in the anxiety disorders

The looming vulnerability model proposes that individuals with anxiety generate dynamic mental scenarios of threats as intensifying and approaching faster than they can cope or respond. In addition to the looming cognitive style posing a general cognitive vulnerability for anxiety, the looming vulnerability model posits that different anxiety disorders can be distinguished based on the specific content of their looming vulnerability themes. The current study examined whether different anxiety disorders have distinct looming vulnerability content along the lines of disorder-specific themes. A treatment-seeking sample of individuals with DSM-IV anxiety disorders (N=172) completed measures of looming vulnerability prior to treatment initiation. Consistent with the looming vulnerability model, the results indicated that individuals with social phobia, obsessive compulsive disorder, and panic disorder reported significantly greater disorder-specific looming content compared to non-disorder specific looming content. Individuals with generalized anxiety disorder reported the same level of looming social threat as those with social phobia. The results suggest that different anxiety disorders can be distinguished by the specific content of looming vulnerability themes and provide empirical support for the convergent validity of the Looming Vulnerability Scale.

Pilot study of inducing smoking cessation attempts by activating a sense of looming vulnerability

Despite widespread knowledge of the negative health consequences of cigarette smoking, in 2007 a majority (60%) of daily smokers in the USA did not make a quit attempt lasting at least 24 h. Drawing on Riskind's looming cognitive vulnerability model of anxiety, we developed a guided imagery induction intended to increase smokers' perceived susceptibility to the consequences of continued smoking and thereby to increase quit attempts. In a pilot study of this induction, 72 adult daily smokers were randomly assigned to the looming imagery condition or to a control condition exposed to guided imagery that did not concern smoking or its dangers. Those in the looming condition reported significantly higher state anxiety and highly accessible negative outcome expectancies for smoking immediately after the induction, and a significantly lower smoking rate in the month after the experiment. Nonsignificant trends favored the looming condition also for increasing contemplation of quitting, self-efficacy for abstaining from cigarettes, intrinsic motivation to quit as a function of health concerns, and most importantly the likelihood of making a quit attempt in the month following the experiment. Further development and testing of the looming induction as a way to motivate quit attempts is warranted.

Inversion of the “Unrealistic Optimism” Bias Contributes to Overestimation of Threat in Obsessive-Compulsive Disorder

Background: Overestimation of threat (OET) is ascribed a pathogenetic role in obsessive-compulsive disorder (OCD). Aims: We hypothesized that OCD patients overestimate their personal but not the average risk for OCD-related events. Specifically, an attenuation of the common “unrealistic optimism” bias (UO) was expected for OCD patients. UO refers to the phenomenon that the subjective likelihood to personally experience a positive event is enhanced compared to other persons and vice versa for negative events. Method: Fifty-three participants with OCD as well as 40 healthy and 23 psychiatric controls participated in an internet survey. They were asked several questions about different event types (positive, negative, and OCD-related): the probability that this event will happen to oneself (block 1), to another person (block 2), comparison between oneself versus another person (block 3), appraisal of consequences (block 4), and prior encounters with event (block 5). Results: No evidence was obtained in OCD to overestimate the overall probability of negative or OCD-related events. However, whereas healthy participants displayed an UO bias, OCD participants perceived themselves as more vulnerable to experience OCD-related events. Conclusions: Results indicate that OCD is associated with inflated personal vulnerability and that this bias is not fully available to the consciousness of OCD participants.

Differential habituation of fear and disgust during repeated exposure to threat-relevant stimuli in contamination-based OCD: an analogue study

In the present study, participants (N=20) displaying marked contamination concerns were provided 30 min of repeated in vivo exposure to threat-relevant stimuli (cleaning a 'dirty' bed pan), during which time their fear and disgust levels were repeatedly assessed. Results indicated that repeated exposure led to a significant decline in fear but not disgust. The observed decline in fear remained significant after accounting for changes in disgust and vice versa. Although initial disgust was higher than initial fear ratings, differences between the two slopes were not statistically significant. Baseline trait anxiety and global disgust sensitivity levels prior to exposure did not moderate the level of fear or disgust activation during exposure. However, sensitivity specifically related to core and contamination disgust was marginally associated with fear and disgust parameters during outcome. There was also evidence that less fear decline during repeated exposure was associated with higher disgust ratings after the exposure was completed. Theoretical and clinical implications of the present findings for the treatment of contamination concerns in obsessive-compulsive disorder are discussed.

Trait-disgust vs. fear of contamination and the judgmental bias of contamination concerns

Mechanisms by which trait-disgust, i.e. relatively stable individual differences in disgust proneness, affects anxious psychopathology are not well understood. A possible pathway might be the impact of trait-disgust on cognitive processes, which are involved in the anxiety disorders. The present study extends findings on interpretational and attentional bias by investigating the judgmental bias. Based on theories on disgust, it was assumed that trait-disgust is related to predictions of catching a disease. The present study examined the likelihood of becoming ill, the probability of avoidance behaviour, and the urge to wash in relation to disgust-sensitivity, disgust propensity, fear of contamination, and general anxiety using real-life scenarios. Results suggest that disgust-sensitivity makes a unique contribution to a judgmental bias additionally to fear of contamination and even when controlling general anxiety. Future research concerning the causal direction of this bias is warranted.

Specificity of disgust sensitivity in the prediction of behavioral avoidance in contamination fear

This study examined the specificity of disgust sensitivity in predicting contamination-related anxiety and behavioral avoidance. Participants high (n=26) and low (n=30) in contamination fear completed self-report measures of disgust sensitivity, contamination cognitions (overestimation of the likelihood and severity of contamination from everyday objects), anxiety, and depression. They then completed three randomly presented contamination-based behavioral avoidance tasks (BATs) that consisted of exposure to a used comb, a cookie on the floor, and a bedpan filled with toilet water. Results indicated that disgust sensitivity was significantly associated with anxious and avoidant responding to the contamination-related BATs. This association remained largely intact after controlling for gender, contamination fear group membership, anxiety, and depression. Contamination cognitions were also significantly related to BAT responses. However, this relationship was fully mediated by disgust sensitivity. These findings indicate that disgust sensitivity has a specific and robust association with contamination concerns commonly observed in obsessive compulsive disorder. The findings are discussed in the context of a disease-avoidance model.

Looming threat-processing style in a cancer cohort

OBJECTIVE

Looming threat-processing style, where threats are perceived to be progressing (looming) at a frightening velocity, is implicated in anxiety vulnerability. This study aims to validate a new measure of looming, the looming cancer, and explore its clinical correlates in a chronic lymphocytic leukemia (CLL) cohort.

METHODS

In a cross-sectional design, 105 CLL patients completed the Looming Cancer Scale, Looming Cognitive Style Questionnaire (LCSQ), SF-36, Beck Anxiety Inventory (BAI) and Beck Depression Inventory II (BDI-II).

RESULTS

Exploratory factor analysis reduced the 20-item Looming Cancer Scale to a 10-item version, which demonstrated good psychometric properties (Cronbach's alpha=.926). Convergent validity was demonstrated by Pearson correlation with the LCSQ (0.418), BAI (0.380), BDI-II (0.336) and the mental component score of the SF-36 (-0.434) (all P<.001). Divergent validity was demonstrated by a lack of correlation with the SF-36 physical component score and cross tabulation frequencies of high and low loomers. High vs. low loomers showed significantly more anxiety (31% vs. 13%), depression (23% vs. 2%) and mixed anxiety-depression (18% vs. 2%). An area under the receiver operating characteristic curve analysis revealed high sensitivity (82%) and specificity (69%) in detecting mixed anxiety-depression using a cutoff score of >/=20/30.

CONCLUSIONS

The Looming Cancer Scale is a valid measurement of looming cognitive style and is the first time that the looming construct has been studied in a cancer cohort. The importance of this research lies in its potential to identify populations vulnerable to developing anxiety, depression and mixed anxiety-depression symptoms.

Multimodal assessment of disgust in contamination-related obsessive-compulsive disorder

The present study utilizes multiple methods to examine the relationship between disgust and contamination-related obsessive-compulsive disorder (OCD) symptoms in an analogue sample. Questionnaire findings revealed that participants with high OCD contamination concerns showed stronger disgust sensitivity than did participants with low OCD contamination symptoms after controlling for negative affect. High OCD participants (N=30) also reported significantly more disgust than did low OCD participants (N=30) when exposed to a disgust-inducing video, whereas no significant between-group differences were detected on other negative emotional dimensions. Results from a series of disgust-specific behavioral avoidance tasks (BATs) revealed that high OCD participants demonstrated both less compliance and less approach behavior. Subsequent analysis also revealed that disgust sensitivity generally mediated avoidance on the BATs among high OCD subjects. High OCD participants also rated the BATs as more fearful and disgusting than did low OCD participants, with disgust generally emerging as the dominant emotional response. The results are consistent with a disgust-based, disease-avoidance approach in understanding contamination-related OCD themes.

Does threatening imagery sensitize distress during contaminant exposure?

Prominent models of fear focus on the role of cognition in the development and maintenance of maladaptive responses. Little research, however, has evaluated the impact of cognition on distress reduction. The current study uses an experimental design to examine the effect of different types of imagery (moving harm, static harm, and safety) on reduction of distress associated with a contaminating stimulus in a normal university sample. Results indicate that use of moving harm imagery sensitizes distress during a 30-min exposure, whereas static harm and safety imagery reduce distress. These findings demonstrate that cognitive factors can moderate affective response during exposure. Clinical implications for the treatment of anxiety disorders are discussed.

Treating disgust reactions in contamination-based obsessive-compulsive disorder

Contamination fear associated with obsessive-compulsive disorder (OCD) has features that strongly suggest it is based in part on disgust. In particular, sympathetic magic, or the tendency for disgust-evoking stimuli to transfer that property to previously neutral stimuli, is common in contamination fear. Treatment for OCD typically involves exposure with response prevention for feared stimuli. Unexamined, however, has been the habituation for specific disgust stimuli among individuals with contamination fear. This study is a preliminary investigation with a group of primary contamination fearful participants diagnosed with OCD (C-OC; n = 9) compared to a group with primarily other symptoms of OCD (O-OC; n = 8). All participants were exposed to a set of disgust stimuli that were not associated with anxiety reactions for 30 min across five sessions, and exposed to anxiety-evoking stimuli specific to their OCD symptoms for 30 min. Comparisons showed that, while both groups had reduced disgust reactions, the C-OC group habituated more slowly and to a lesser degree than the O-OC group. No differences existed between the groups for anxiety reduction. The findings suggest that contamination fear is based in part on disgust reactions, and that disgust is amenable to exposure-based interventions.

Obsessive compulsive disorder: A review of possible specific internal representations within a broader cognitive theory

Obsessive Compulsive Disorder (OCD) is one of the most incapacitating of anxiety disorders, and is rated as a leading cause of disability by the World Health Organization (1996). Current cognitive models of OCD have focused on beliefs and management strategies involved in the development, maintenance, and exacerbation of OCD. However, despite evidence of their association to psychopathology, few researchers have applied the idea of underlying cognitive-affective structures, such as perceptions about the self and world, as operating in individuals with obsessive-compulsive thoughts and behaviors. This paper critically engages with current cognitive, developmental, and attachment research associated with views about the self and world. It is argued that consideration of such underlying cognitive-affective vulnerabilities may lead to a broader understanding of the development and maintenance of OCD. Consistent with previous theoretical work (e.g. ), we also argue that early experiences of parenting lead to the development of a dysfunctional self-structure and world-view relevant to OCD. Thus, this paper aims to extend the focus of current OCD research by exploring the possible role of a broader range of underlying vulnerability structures in the development and maintenance of OCD-related dysfunctional beliefs and symptoms.

The looming maladaptive style predicts shared variance in anxiety disorder symptoms: further support for a cognitive model of vulnerability to anxiety

Looming vulnerability pertains to a distinct cognitive phenomenology characterized by mental representations of dynamically intensifying danger and rapidly rising risk as one projects the self into an anticipated future [J. Pers. Soc. Psychol. 79 (2000) 837]. While looming appraisals can be experienced as state elicitation, some individuals are hypothesized to develop an enduring cognitive pattern of cross-situational looming appraisals, the looming maladaptive style (LMS), which functions as a cognitive vulnerability to anxiety. In the present study, we examined the extent to which the LMS predicts common variance in numerous anxiety disorder symptoms, independent of the potentially confounding effects of current depressive symptoms. Specifically, we hypothesized that controlling for depressive symptoms, LMS would predict shared variance in a latent factor comprised of indicators of five anxiety disorder symptoms: obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, social phobia, and specific phobic fears. Measures of these anxiety disorder symptoms, depressive symptoms, and looming vulnerability were administered to unselected college student population. Structural equations modeling analyses provided support for our hypothesis that LMS predicts shared variance in anxiety disorder symptoms and suggest that this cognitive style may be an overarching dimension of vulnerability to anxiety.

Sympathetic magic in contamination-related OCD

We examined whether patients with contamination-related obsessive-compulsive disorder (OCD) are characterized by sympathetic magic beliefs (i.e., an irrational understanding of how contagion is transmitted). We asked OCD patients (OCs), non-anxious control participants (NACs), and anxious control participants (ACs) to identify a "contaminated" object and rate its degree of contamination on a 0-100 scale. Next, we touched a clean pencil to the object, and participants rated the degree to which the pencil was contaminated. A second pencil was touched to the first pencil and was then rated. This process was continued for 12 pencils (12 degrees of removal from the original object). The same process was repeated using threat-non-relevant stimuli. Results indicated that for threat-relevant stimuli, OCs seemed to perceive a "chain of contagion" in which successive degrees of removal from the original object were not rated as less contaminated. In contrast, NACs and ACs quickly identified the pencils as not contaminated, suggesting that they recognize the contamination as degrading across objects. This difference was not seen using threat-nonrelevant stimuli. We also found that ratings of looming vulnerability (a belief that the contamination is spreading, approaching, or escalating in threat value) mediated the relationship between diagnostic group and the chain of contagion. We suggest that this process may be consistent with the sympathetic magic and disease-avoidance models of disgust, and that disgust may be a fruitful area for exploration in the study of OCD.

Disgust domains in the prediction of contamination fear

Previous research has shown a relationship between the emotion of disgust and the fear of contamination. Heightened sensitivity to disgust and increased concerns over contamination has been observed in various disorders, such as obsessive-compulsive disorder (OCD) and specific phobias. However, there is a paucity of research identifying the specific domains of disgust that contribute to contamination fear. The present study soughts to determine which domains of disgust elicitors reliably predict scores on a measure of OCD contamination obsessions and washing compulsions. We further conducted exploratory analyses that examined differences in disgust sensitivity among individuals classified as high and low in contamination fear. Three hundred and twenty-three undergraduate participants completed two measures of disgust sensitivity (Disgust Scale; Disgust Emotion Scale) and a measure of contamination fear (Padua inventory, contamination obsessions and washing compulsions subscale). Stepwise multiple regression analyses indicated that contamination fear was best predicted by seven different disgust domains, thereby suggesting that contamination fear is accounted for by generalized, rather than domain-specific, disgust elicitors. The categories of disgust that predicted contamination fear appeared to have an underlying commonality of threat of contagion. The relationship between fear of contamination and disgust sensitivity was more pronounced for animal reminder disgust elicitors as opposed to core disgust elicitors. Results also showed that individuals classified as high in contamination fear scored significantly higher than the low contamination fear group on all disgust domains. Clinical and research implications regarding the interrelationships between fear, disgust, and the fear of contamination are discussed.

Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.

Using mental imagery with subclinical OCD to 'freeze' contamination in its place: evidence for looming vulnerability theory

The present research examines the possibility that 'freezing' or slowing-down the rate at which threats can advance and thereby blocking a sense of looming vulnerability can reduce fears of contamination and avoidance behavior among individuals with obsessional symptoms. Mental imagery was used to reduce the rate at which threat can advance by means of instructions to imagine that contamination was 'frozen' in place and unable to move. Measures included self-reports of anxiety and worry, and indirect assessments of fear and avoidance behavior. A parallel mental imagery condition was used to examine the possibility that accentuating the spread or contamination, or its 'looming', would in turn accentuate fear and avoidance. The results, particularly of the more unobtrusive measures, indicated that freeze imagery reduced fear and avoidance for the relatively obsessional participants. In addition, support was found that it reduced fear for participants with relatively higher levels of imagination. However, the freeze imagery paradoxically seemed to sensitize the non-obsessional participants to possibilities of contamination they had not previously considered, and thus increased their fear. The results provide support for the looming vulnerability model of anxiety and suggest applications to treatment.

Looming vulnerability to threat: a cognitive paradigm for anxiety

The concept that perceived threat or danger is a cognitive antecedent of anxiety is central in clinical psychology, personality psychology, and social psychology. The aim in the current article is to review this concept and present a new conception called the looming vulnerability model. Looming vulnerability is conceptualized as an important cognitive component of threat or danger that elicits anxiety, sensitizes the individual to signs of movement and threat, biases cognitive processing, and makes the anxiety more persistent and less likely to habituate. In addition, it is postulated as a principal theme that discriminates anxiety and focal fears from depression. The looming vulnerability model integrates a disparate collection of findings and integrates the conceptualization of anxiety and fear with ethological and developmental observations. The social-cognitive and evolutionary basis of the sense of looming vulnerability are discussed, as well as its roots in cognitive schemata (fear scripts), its state elicitation by several potential classes of antecedent conditions, and possible treatment implications.