The association between looming cognitive style and posttraumatic stress symptoms: The case of older Holocaust survivors

The looming cognitive style (LCS) refers to a tendency to produce mental illustrations and images of adverse events and potentially threatening situations with perceived accumulating threat and danger. LCS is a well-known cognitive vulnerability for anxiety, nevertheless few studies examined the relationship between LCS and posttraumatic reactions. Among the existing studies, a higher LCS was reported in Holocaust survivors relative to matched comparisons, and directly associated with posttraumatic stress symptoms (PTSS) in older Holocaust survivors. The current study aimed to expand the understanding of the relationship between LCS with PTSS in general, and among older Holocaust survivors in particular. Moreover, whether the number of Holocaust experiences encountered by Holocaust survivors moderated this relationship. The sample consisted of 153 older Holocaust survivors (Mage = 82.42, SD = 5.75). Participants were interviewed regarding their background characteristics, PTSS, LCS, and number of Holocaust experiences. Participants reporting higher LCS showed higher PTSS. There was an interaction between LCS and number of Holocaust experiences for predicting PTSS, suggesting that LCS was associated with higher PTSS to a stronger degree among Holocaust survivors who experienced a smaller number of Holocaust experiences. The findings indicate that Holocaust trauma may have influenced the LCS of Holocaust survivors throughout their lives and into old age. The results provide insight for mental health practitioners treating older Holocaust survivors in focusing on reducing schematic processing biases for threat information and anxiety to enhance better mental health for those suffering from posttraumatic stress symptoms.

Culture‐specific appraisal biases contribute to emotion dispositions

We suggest that cultural factors may encourage the development of affective personality traits or emotional dispositions by producing or rewarding specific appraisal biases. To buttress this argument, we describe a putative mechanism and review the pertinent evidence: (a) an emotion disposition (trait affect) is a risk factor for experiencing certain emotions more readily and/or more frequently, (b) appraisal bias tends to cause certain emotions to be more readily experienced and may thus lead to the emergence of emotion dispositions and even emotional disturbances and (c) cultural goal, belief and value systems may encourage certain types of appraisal bias and may thus provide an explanation for vestiges of culture‐specific modal personality. Copyright © 2009 John Wiley & Sons, Ltd.

Looming Vulnerability and Smoking Cessation Attempts

INTRODUCTION

The looming vulnerability model holds that people become anxious when they perceive threats as growing larger and accelerating toward them in space and time. Preliminary research suggested that a guided imagery induction designed to activate a sense that health consequences of smoking are a looming threat led more smokers to attempt to quit. This study tested the effect on quit attempts in a larger sample and examined age, sex, and sensation seeking as moderators.

AIMS AND METHODS

Adult smokers (≥10 cigarettes/day) screened for risk of anxiety or mood disorders (N = 278, 52% male; 77% African American) were randomly assigned to receive (1) looming vulnerability or (2) neutral guided imagery exercises. At a 4-week follow-up, they reported quit attempts, smoking rate, self-efficacy, outcome expectancies, and contemplation status.

RESULTS

Those in the looming condition (17%) were no more likely than those in the control condition (20%) to make a quit attempt. There were no significant group differences in expectancies, contemplation, or follow-up smoking rate, and no significant moderators.

CONCLUSIONS

The looming induction was the same one used in earlier work in which it had stronger effects. Those who respond to it with increased urgency about quitting smoking might be offset by others who are more reactant and deny the message. Inconsistencies across studies may reflect differences in inclusion criteria, such that the present sample was on average heavier smokers with longer smoking history and more severe nicotine dependence, yet higher self-efficacy.

IMPLICATIONS

An induction designed to activate a sense that the health consequences of smoking constitute a looming vulnerability failed to increase quit attempts or reduce smoking rate among adult daily smokers. Inconsistencies across studies might reflect varying sample characteristics resulting from changes in screening criteria.

Qualitative Evaluation of Cancer Survivors' Experiences of Metacognitive Therapy: A New Perspective on Psychotherapy in Cancer Care

Background

Preliminary evidence suggests that metacognitive therapy (MCT), a brief, process-focused psychological intervention, alleviates distress in cancer survivors. In a longitudinal qualitative study nested in an open trial of MCT for cancer survivors, we explored how patients understood, experienced and applied MCT.

Methods

Patients received six MCT sessions. Consenting patients provided semi-structured interviews post-intervention (n = 19), and at 3- and 6-months follow-up (n = 14 and 10 respectively). Interviews were audio-recorded and transcribed. Analysis followed a constant comparison approach.

Results

Participants felt “overwhelmed” by worry before starting MCT and doubted that such brief therapy could help. Their accounts focused on feeling “challenged” to think differently by the psychologist. Those completing therapy were enthusiastic about it. They described having learned that thoughts are “only thoughts,” that feelings of worry or sadness are a normal part of life, and that they were in control of whether and how they engaged with thoughts. Consequently, most described a sense of freedom to live free from worry. A minority described being unable to apply MCT to certain thoughts. Two patients who withdrew before completing MCT did not describe having learned what MCT was intended to achieve.

Conclusion

MCT is an acceptable brief intervention for distressed cancer survivors. Feeling challenged to understand the processes maintaining their distress was central to their enthusiasm for it, irrespective of their presenting difficulties.

Implications for Cancer Survivors

The complexity of emotional distress in cancer survivors can potentially be addressed using a transdiagnostic model which focuses on the psychological processes which maintain distress.

Development and validation of the cigarette smoking consequences looming scale

INTRODUCTION

Experimental manipulations intended to alter cognitive appraisals of smoking-related threats may affect cigarette smoking and motivation to quit. However, no previous measure has directly assessed perceptions of smoking-related threats as increasing and coming closer in space and/or time (i.e., "looming"). The current research develops such a measure of dynamic smoking-related threat appraisal: the Cigarette Smoking Consequences Looming Scale (CSCLS).

METHODS

In Study 1 (N = 124 daily smokers), the researchers created an initial, scenario-based version of the CSCLS and refined the measure based on factor analysis. In Study 2, 143 daily smokers completed a condensed CSCLS organized around two factors (Physical and Social consequence of smoking). In each study, participants also completed measures of dispositional looming perception, motivation to quit smoking, and smoking outcome expectancies.

RESULTS

The CSCLS showed strong internal consistency and concurrent validity in that scores on the measure correlated as expected in both studies with a general tendency to perceive threats as looming, outcome expectancies for smoking, and motivation to quit smoking.

CONCLUSIONS

Measuring perceptions of smoking-related consequences as looming may provide greater insight into the cognitive factors associated with motivation to quit smoking, which in turn may inform communications about the risks of smoking.

The spark that might have ignited the fire: The association of cognitive and psychological factors with state anxiety in light of the Syrian-Israeli incident

The current study aimed to explore Israelis' state anxiety due to a Syrian-Israeli incident that occurred on February 10, 2018, when an Israeli F-16 fighter jet was shot down by Syrian air defense forces. In line with the "looming vulnerability" model which emphasizes the importance of the dynamic nature of psychologically threatening situations, the following psychological factors were suggested: associative memory of prior events, worries of future war, sense of safety, and death anxiety. We employed two cross-sectional points of time in our assessment: 36 hours and three months after the incident. Using an online survey, 162 adult participants were recruited in Study 1 and 172 in Study 2. The participants completed set of questionnaires measuring state anxiety along with other psychological measures. The results of the two studies suggested that higher levels of worry of future war and lower levels of sense of safety associated with higher state anxiety. The looming vulnerability model and variables associated with state anxiety were found to have a salient role in explaining state anxiety as a response to a negative unexpected event.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder

Objective:

To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand.

Method:

Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders.

Results:

The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy.

Conclusion:

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.

Moderator Role of Looming Cognitive Style (LCS) in the Relationship Between Attentional Control and Anxiety: Difference Between Shifting and Focusing Dimensions

Attentional control (AC) that is composed of shifting and focusing dimensions had been suggested as a transdiagnostic risk factor, associated with development and maintenance of various psychological disorders. In comparison, Looming Cognitive Style (LCS) had been documented as a trait-based, disorders-specific characteristic that is linked to high levels of subjectively felt anxiety. The present study investigated whether individual differences in LCS moderated the association of shifting and focusing with anxiety. Participants were 402 individuals between ages 18 and 68 recruited through advertisements posted on various forums, e-mail groups, and social media websites. They filled out questionnaires assessing AC, LCS, anxiety, and depression online. Results of the moderation analyses indicated that at high levels of LCS, low attentional shifting ability was associated with more intense anxiety. A similar relationship with LCS was not observed for focusing. In conclusion, for individuals who have high LCS and low shifting ability, content of and distress coming from looming images is experienced in a more intense manner due to difficulty in shifting to another (perhaps less anxiety provoking) content more flexibly. The findings are providing support for the interactive-synergistic perspective, indicating that deficits in shifting capacity may potentiate negative impact of looming cognitions.

Anxiety effects on disaster precautionary behaviors: A multi-path cognitive model

Previous studies have revealed a negative relationship between anxiety and health-promoting behavior. This study identified three cognitive pathways through which anxiety operates on preparedness behaviors for terrorist attacks. Preparedness was regressed on trait anxiety, perceived threat, and self-efficacy based on data from 306 adults. Mediating paths through perceived threat (positive) and self-efficacy (negative) and an independent negative path were identified. Results suggest that the anxiety/precautionary behavior relationship is more complex than previously thought, involving multiple pathways of competing directionality. Interventions to improve disaster preparedness and thus reduce disaster-related morbidity/mortality would benefit by capitalizing on this multidimensionality.

The Looming Maladaptive Style Questionnaire: Measurement invariance and relations to anxiety and depression across 10 countries

The Looming Maladaptive Style Questionnaire (LMSQ) is a self-report measure designed to assess the looming cognitive style, a tendency to interpret threats as rapidly approaching and increasing in magnitude. To date, no systematic evaluation on the psychometric properties of the LMSQ across diverse cultural contexts has been done. In the present research, the measurement invariance of the LMSQ test scores was examined in 10 countries (N=4000). Confirmatory factor analysis suggested that a two-factor model (i.e., physical looming and social looming) fitted the data well across countries. Partial measurement invariance was established for the LMSQ scores across the countries whereas full measurement invariance was achieved across gender. Meta-analytic structural equation modeling was applied to examine the unique contributions of the two looming factors to anxiety and depression symptoms. Results indicated that the test scores underlying two looming factors were crucial and valid predictors of symptoms. The LMSQ shows promise as a measure with cross-cultural generalizability and opens new avenues for its use in diverse cultural settings.

Cognitive vulnerabilities in parents as a potential risk factor for anxiety symptoms in young adult offspring: An exploration of looming cognitive style

BACKGROUND AND OBJECTIVES

Given that anxiety runs in families, it is critical to understand the cognitive factors that may be responsible for this intergenerational transmission. The present study offers a first step by exploring the link between mother and father tendencies to view potentially threatening situations as rapidly escalating toward dreaded outcomes (i.e., looming cognitive style) and the emotional disturbances and looming cognitive styles of their adult offspring.

METHODS

We assessed cognitive vulnerabilities, anxiety, and depressive symptoms in a non-clinical sample (N = 382) of Italian college students and their parents.

RESULTS

The looming cognitive style of fathers, but not mothers, was significantly related to greater anxiety in adult offspring. This finding was obtained for both sons and daughters, and remained even after statistically controlling for the anxiety, worry, depressive symptoms, and anxiety sensitivity (AS) of parents). Notably, the association between fathers' looming cognitive style and offspring symptoms was not related to their child's depressive symptoms, and similar to prior work, served as a cognitive marker specific to anxiety.

LIMITATIONS

The present study relied on a cross-sectional design and did not use clients diagnosed with anxiety disorders.

CONCLUSIONS

The findings suggest that it may prove fruitful to consider parental vulnerabilities such as looming cognitive styles in comprehensive cognitive and interpersonal models of anxiety. The intergenerational transmission of emotional difficulties seems to extend beyond anxiety to beliefs about the escalation of threat.

The Role of the Hostile-World Scenario in Predicting Physical and Mental Health Outcomes in Older Adults

OBJECTIVE

The hostile-world scenario (HWS) denotes a personal belief system regarding threats to one's physical and mental integrity. We examined whether the HWS predicted health among older adults.

METHOD

The Israeli branch of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) provided data on 1,286 participants, aged 50+, interviewed in two waves 4 years apart. A special measure assembled items pertinent to the HWS throughout the SHARE survey. Nine outcomes indicated physical health (e.g., activities of daily living, medical conditions) and mental health (e.g., depressive symptoms, satisfaction with life).

RESULTS

The HWS at Wave 1 predicted all physical and mental outcomes at Wave 2, except cognitive functioning, beyond effects of sociodemographics and the respective outcome's baseline at Wave 1. This predictive effect was stronger among older participants.

DISCUSSION

The results support the conception of the HWS as a psychological monitor that senses approaching functional declines in later life.

The effects of anxiety and depression on stress-related growth among Chinese army recruits: Resilience and coping as mediators

Stress-related growth can occur after various traumas or stressful events. In order to investigate how anxiety and depression relate to stress-related growth, this study was conducted with 443 Chinese army recruits who had just finished a 3-month recruit training program. Path analyses revealed that resilience and positive/negative coping partially mediated the effect of anxiety on perceived stress-related growth, while negative coping fully mediated the relationship between depression and perceived stress-related growth. Moreover, positive coping partially carried the influence of resilience on perceived stress-related growth. Anxiety and depression may be potential targets for intervention to enhance the development of stress-related growth among Chinese army recruits.

Psychiatrists' and psychologists' practice patterns: different profiles in a Spanish clinical sample

Important differences in clinical practice exist between psychiatrists and psychologists. However, there is scarce information on the characteristics of patients receiving treatment from these two groups of professionals. We examined the diagnoses assigned to the patients who received treatment from psychiatrists and psychologists in outpatient settings of Madrid, Spain, from 1980 to 2008. The psychologists were more likely to see anxiety-related disorders, whereas the psychiatrists tended to see disorders with a more prominent biological underpinning, such as schizophrenia or bipolar disorder. The profile of the patients seen by the psychologists is different from that of the psychiatrists. Disorders whose development is more related to distress were usually treated by the psychologists, whereas disorders with a more prominent biological underpinning were usually treated by the psychiatrists. In addition, the dramatic increase in the diagnosis of adjustment disorder might be related to the increasing "psychologization" and "medicalization" of the difficulties of everyday life.

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.

The direction of effects between perceived parental behavioral control and psychological control and adolescents' self-reported GAD and SAD symptoms

This study examined the direction of effects and age and sex differences between adolescents' perceptions of parental behavioral and psychological control and adolescents' self-reports of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) symptoms. The study focused on 1,313 Dutch adolescents (early-to-middle cohort n = 923, 70.3%; middle-to-late cohort n = 390, 29.7%) from the general population. A multi-group, structural equation model was employed to analyze the direction of the effects between behavioral control, psychological control and GAD and SAD symptoms for the adolescent cohorts. The current study demonstrated that a unidirectional child effect model of the adolescents' GAD and SAD symptoms predicting parental control best described the data. Additionally, adolescent GAD and SAD symptoms were stronger and more systematically related to psychological control than to behavioral control. With regard to age-sex differences, anxiety symptoms almost systematically predicted parental control over time for the early adolescent boys, whereas no significant differences were found between the late adolescent boys and girls.

Neural activity associated with monitoring the oscillating threat value of a tarantula

Phylogenetic threats such as spiders evoke our deepest primitive fears. When close or looming, such threats engage evolutionarily conserved monitoring systems and defense reactions that promote self-preservation. With the use of a modified behavioral approach task within functional MRI, we show that, as a tarantula was placed closer to a subject's foot, increased experiences of fear coincided with augmented activity in a cascade of fear-related brain networks including the periaqueductal gray, amygdala, and bed nucleus of the stria terminalis. Activity in the amygdala was also associated with underprediction of the tarantula's threat value and, in addition to the bed nucleus of the stria terminalis, with monitoring the tarantula's threat value as indexed by its direction of movement. Conversely, the orbitofrontal cortex was engaged as the tarantula grew more distant, suggesting that this region emits safety signals or expels fear. Our findings fractionate the neurobiological mechanisms associated with basic fear and potentially illuminate the perturbed reactions that characterize clinical phobias.

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.

The effects of social evaluation and looming threat on self-attentional biases and social anxiety

This paper examines how two proposed cognitive vulnerabilities of social anxiety, the fear of negative evaluation, and looming cognitive style may combine with socially demanding situations in predicting social anxiety symptoms and performance deficits. Fifty-two individuals previously identified as possessing these two cognitive vulnerabilities were randomly assigned to conditions in a 2 (high versus low social evaluation)x2 (high versus low temporal looming) experimental design. Significant interaction effects were found for: (a) residual change in anxiety symptoms from baseline level, and (b) performance on a speech task. Specifically, cognitively at-risk individuals exhibited the most increase in anxiety and the most performance deficits in the condition where social evaluation and temporal looming were high. In addition, a mediational effect of illusion of transparency (a form of self-attentional bias) between situational demands and residual change in anxiety was found. Implications arising from these results are discussed.

The Origins of Specific Phobias: Influential Theories and Current Perspectives

Fears are quick and adaptive responses that permit powerful reply to imminent threats. Less adaptive, phobias are extreme manifestations of fear to objects or situations in the absence of a proportional danger. Although the utility of fear is accepted, the nature of phobias is controversial. Initial theories favored a fear conditioning-based explanation, with vicarious and information learning pathways subsequently included as additional routes to the development of specific phobias. More recently, an important group of investigations strengthened the case for a nonassociative account of fear acquisition proposing that evolutionarily relevant fears can occur without any need of critical learning experiences. In parallel, there is some evidence for a dedicated fear module in the detection of threats, involving the amygdala, which is relatively independent from conscious cognitive control. Nonetheless, cognitive models stress learning and developmental factors and their role in the etiology and maintenance of phobic behavior. This article critically reviews each of these views and theories stressing their recent developments, weaknesses, and controversies with an aim to provide the groundwork for the construction of a more integrated position. Finally, the authors suggest encouraging trends in recent research.