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In this chapter, we extend looming vulnerability theory and research in new directions beyond the usual perimeters of cognitive-behavioral research on anxiety. The topics we will cover include: (1) fear of disease and changes in appearance (such as due to fatness or aging); (2) the determinants of suicidality, smoking cessation, and new disorders involving anger, pathological gambling, and mood disorders; and (3) several novel constructs related to how perceptions of dynamic gains and losses can influence other disorders or problems at other levels of analysis.

Anxiety and Beyond

Fears of Serious Disease

Fears of contracting or developing serious diseases such as cancer, heart disease, or diabetes, or even frightful diseases such as Ebola, are widespread and not limited solely to individuals diagnosed with anxiety disorders or related disorders such as OCD. The role of dynamic perceptions of growing threat can be illustrated with the fear of contracting HIV and/or AIDS .

In one study of these issues, Riskind and Maddux (1994) examined whether inflated perceptions of rapid dynamic gains in growing and spreading threat contributed to fears of HIV. The study was stimulated by a story that was reported by the Wall Street Journal (“fear of AIDS,” 1985) during the height of the initial hysteria about AIDS. The reporter(s) stated that tourists in the New Orleans French Quarter were eating canned food in their hotel rooms and shunning its famous restaurants (for fear of coming into contact with HIV). Riskind and Maddux thought that these tourists’ extreme reactions could reflect the fact that they had inflated perceptions of rapid dynamic gains and approaching movement by HIV. For example, it seemed that the tourists may have been imagining the virus as rapidly spreading toward them from the air and floating or even catapulting off waiters, cooks, and other patrons in the restaurants toward themselves. In testing this hypothesis, Riskind and Maddux administered a questionnaire packet to undergraduates that contained measures of fears and behavioral avoidance as well as a measure of the looming spread of HIV. This key measure of the looming spread of HIV contained two hypothetical vignettes that described casual, everyday situations in which they might have contact with someone who had HIV (e.g., sitting next to the person on a bus or in a restaurant). The data of this study revealed that the college students’ levels of fear and behavioral avoidance were significantly and positively related to inflated perceptions of the looming spread of HIV. As compared to the students who were less fearful of HIV, the fearful students imagined the HIV virus as more mobile, active and energetic, and as moving toward them from individuals who they were casually exposed to in public places (e.g., a bus or restaurant). It should be obvious that these findings parallel the studies we have described elsewhere (see Chap. 13) showing that fear of contamination in OCD is strongly related to inflated perceptions of the dynamic gains of spreading and growing contamination.

People’s inflated perceptions of the rapid spread and progression of disease can also influence anxiety about cancer and other serious diseases that they develop. Levin, Li, and Riskind (2007) examined the impact of rapid dynamic gains in cancer patients who were undergoing treatment for chronic lymphocytic leukemia. A questionnaire packet was given to these patients that contained the looming cognitive style (LCS) measure (the LMSQ), and anxiety and depression symptom measures. Another aspect of the study is that they were also administered a new cancer-specific looming cognitive style questionnaire that assessed their perceptions of rapid dynamic gains by their cancer: they rated their perceptions of the rapid progression of cancer, the risk of getting rapidly sicker and the rising risk of their becoming more vulnerable to other illnesses, and their increasing risk of being paralyzed by fear and stress . Consistent with the predictions of this study, the results showed that both the looming cognitive style and the cancer-specific looming cognitive style were significantly and positively correlated with anxiety and depression .

Based on the preceding studies, it would be expected that similar faulty perceptions of dynamic growing threat will play roles in anxiety and a myriad of other medical and psychiatric problems. Moreover, exaggerated perceptions of rapid gains in threats or diseases could potentially have a significant impact on health outcomes by affecting the course of diseases (e.g., by triggering maladaptive coping that interferences with treatment) and adversely affect the quality of patients’ lives.

Fears of Rapid Conversion of Food to Fat

In another domain that has significant health implications, it has been widely assumed in the field that exaggerated fear of fat play a critical etiological role in eating disorders (Powers, Schulman, Glegnorn, & Prange, 1987; Rosen, 1990; Tylka & Subich, 1999). A study conducted by Riskind and Kleiman (2018) speculated that inflated perceptions of rapid dynamic gains in “fatness” contribute to the fear of fat. We predicted that a person who has eating disorder symptoms may distort the rapid dynamic gains in fat they can suffer from eating food. For example, the person might imagine that eating a hamburger and fries, or a piece of candy can being almost instantaneously be translated into an equivalent body mass of fat. Thus, we predicted that faulty perceptions of rapid gains in looming fat will contribute to higher levels of fear of fat as well as its correlated eating disorder symptoms (Becker, Grinspoon, Klibanski, & Herzog, 1999; Sullivan, 1995).

To test this hypothesis , a sample of primarily female undergraduate college students were given a questionnaire packet containing a measure of fear of fat, eating disorder symptoms, and a set of hypothetical fear-relevant vignettes dealing with the inflated perception of rapid dynamic gains in fat after the consumption of fattening foods. For example, a vignette asked them to imagine eating a hamburger and fries and to rate the speed with which the food could be converted to fat. Structural equations modeling analyses on these confirmed that the participant’s distorted perceptions of rapid dynamic gains due to the rapid conversion of food to fat predicted their fear of fat scores on Goldfarb, Dykens, and Gerrard’s (1985) fear of fat scale. Equally important, it was found that these distorted perceptions also contributed to the prediction of significant additional variance in eating disorder symptoms, above and beyond the contributions of other appraisals (the likelihood of getting fat, lack of control). Further replication of these findings in DSM-diagnosed eating disorder patients seems to be warranted, because such disorders are associated with a host of health consequences, including emotional distress in relationships (Masuda, Price, Anderson, & Wendell, 2010), poor physical health and increased mortality risk (Becker et al., 1999; Sullivan, 1995).

It seems likely that dysfunctional perceptions of rapidly growing and approaching threat are also likely implicated in other disorders and problems. For example, the LCS, which has been shown to predict higher future levels of worry (see Chap. 9), could be likely to contribute to problems with insomnia, alcoholism, and substance abuse, and as we will now see, may make significant contributions to escape motivation in suicide.

LCS and Suicidality

Research over the past decade has indicated that anxiety symptoms and disorders are major risk factors that predict liability to suicide and suicidality . Moreover, these effects are not attributable to other conditions that are comorbid with anxiety. They have been demonstrated even when comorbid conditions and sociodemographic factors have been controlled (Boden, Fergusson, & Horwood, 2007; Bolton et al., 2008; Sareen et al., 2005). Given that anxiety constitutes a major public health problem that accounts for immense suffering, we have explored the idea that perceptions of looming vulnerability to rapidly growing and approaching threat play a significant role in suicidality (Riskind, Long, Williams, & White, 2000). One mechanism through which this could occur is that the perception of rapidly growing and approaching threat and anxiety could augment a person’s escape motivation to escape from pain. Escape motivation has been seen as a core mechanism in suicide in several contemporary theories which have emphasized the desire to “escape from pain” (Shneidman, 1998) and intolerably painful circumstances (O’Connor, 2003; Williams, 1997), as well as painful self-awareness (Baumeister, 1990), and painful interpersonal circumstances (Joiner, 2005).

A few studies have been conducted to test the associations between the looming cognitive style (LCS) and suicidality . In the first of these, Schaefer, Esposito-Smythers, and Riskind (2012) designed an experiment to investigate Baumeister’s hypothesis that time dilation (or overestimation) is an early sign of incipient suicidality. This study attempted to examine whether time overestimation (e.g., counting down 1 min when only 30 s have passed) predicts suicidal ideation and whether this effect is greater among individuals who have higher LCS or trait anxiety scores. Their study revealed that the participant’s tendencies to overestimate time intervals predicted higher scores on Beck’s Suicide Ideation scale but only when they had high scores on the LCS or trait anxiety. Thus, participants who evinced time overestimation had higher suicidality scores but only when their levels of LCS or trait anxiety were high. Individuals who were low in LCS or trait anxiety , however,  showed no such relationships.  It should be noted, however, that, the results of this study were limited by its cross-sectional design.

Two subsequent studies by Riskind and Kleiman (2017) took the above findings much farther and extended them with a prospective research design. They tested the hypothesis that the LCS acts to augments the effects of a person’s initially high suicide ideation on suicide ideation over a month prospective interval. It was predicted that a person’s LCS leads to a more negative course of suicide ideation if the person initially already has such motivation. Our theoretical rationale was that when a someone is already thinking of suicide as an escape, their tendency to perceive rapidly growing and approaching threat amplifies their escape motivation to think of suicide as a solution for problems. We conducted two studies with college students (N-416) to test this hypothesis. Our data consistently showed that the LCS and initial level of suicidality significantly interacted to predict a more negative course of suicidal ideation over a 4-week prospectively interval. As expected, college students who were already thinking of suicide , and who also had the LCS, tended to increase in suicidal ideation over the subsequent 4-weeks. These students not only evinced stability in their suicidality, but a pattern of escalating suicidality. By contrast, if students who were already thinking about suicide lacked the LCS, they showed no further increase in their suicidality and even tended to decline in suicidality over time .

It should be obvious that these findings warrant more investigation because they have the potential to advance understanding of mechanisms that lead to suicidality as well as to afford novel opportunities for treatment. Further work could thus benefit from extending these findings to clinical or other at-risk populations.

Looming Vulnerability and Smoking Cessation

Another novel avenue for research on looming vulnerability involves the application of the model to develop new applied strategies for promoting smoking cessation. In considering the previous theory and research on looming vulnerability, McDonald, O’Brien, Farr, and Haaga (2010) speculated that smokers who fail to quit smoking may be discounting, or failing to recognize, the future risks of serious medical problems. In a sense, smokers may lack an adaptive dynamic experience of threat in life-threatening health problems that can be incurred by their smoking. McDonald et al. reasoned that quit attempts by smokers could potentially be increased by heightening their perceptions of the dynamic growing threat of these adverse health risks. They tested this hypothesis by giving smokers guided imagery exercises to visualize the rapid advance and escalation of health problems that smoking behavior would bring closer. Their data showed that smokers in the looming enhancement condition showed both increased anxiety and decreased smoking rates in the following month, relative to a control condition. In an unpublished doctoral dissertation, Carrington (2015) has provided preliminary evidence that a similar guided imagery intervention might help in motivating cessation of alcohol consumption.

It is plausible that other problems might benefit from similar looming enhancement interventions . For example, such interventions could plausibly increase patients’ adherence to medical recommendations in treatments for cancer, diabetes, or sexually transmitted disease, and particularly when combined with clear information about what individuals can do to reduce their perceptions of the dynamic looming threat and their fear.

Looming Provocation and Aggression: Hostility, Anger, and Paranoia

As we indicated, some additional new constructs can also be considered that are related to how perceptions of dynamic gains and losses may contribute to other disorders and problems. We will cover these issues by first considering how such perceptions may influence emotional states of anger and hostility . These emotions share the evolutionary function of mobilizing the individual to deal with perceived threat.

We will theorize that perceptions of rapidly growing and approaching threat could contribute to anger and hostility via perceptions of “looming provocation.” When people are angered by what they perceive as intentional and unjustified intrusions in their affairs or unjustified provocations, they may perceive that the provocations will continue to rapidly rise and escalate in intolerable intrusiveness unless they forcefully respond. Thus, the perceptions of rapid dynamic gains in such provocations, rather than only the perception of any single provocation alone, may also significantly contribute to anger as well as aggressive actions.

Some individuals, more than others, may also tend toward anger-proneness because they develop a characteristic “looming provocation” cognitive style. Such a dysfunctional cognitive style could bias them to extrapolate from any single incident of perceived provocation that there will be increasingly intolerable provocations that will continue unless they take aggressive action to put a stop to it.

In one study that was conducted by Riskind et al. (2013), a large sample of Spanish participants were administered a packet containing the looming cognitive style (LCS) and measures of social threat cognitions (e.g., about being rejected) and mood states. Structure equations modeling indicated that: (a) the LCS for social threat predicted social threat cognitions and social anxiety, and (b) the LCS was indirectly linked to hostility via the intervening role of social threat cognitions. Why would perceptions of rapid dynamic gains in social threat situations be associated with hostility? Individuals who tend to interpret ambiguous social threat situations as both (a) rapidly escalating and as (b) intentional, unjustified rejections could be especially likely  to become hostile. This suggests that a measure that is designed to assess a “looming provocation” bias would be strongly predictive of anger and hostility . A further possible prediction is that if individuals were to have both the LCS and a hostile attribution bias (Dodge, 2006; Nasby, Hayden, & DePaulo, 1980), which leads them to interpret ambiguous incidents as provocations, they will be far more hostile than if they have the hostile attribution bias alone.

Paranoia

By extending the preceding logic, it is plausible that some people more than others may have a “looming provocation/persecution” cognitive style that makes them more prone to paranoia . Such individuals might tend to interpret ambiguous signs of hostility by others or their negative intentions as signs of rapidly escalating plans and plots that could harm them. Such a cognitive style could logically contribute to a variety of the correlates of paranoid ideation, including worry, hypervigilance, and aggressive behavior. The idea that perceptions of rapidly growing and approaching threats of this kind could play a role in paranoia is consistent with evidence that anxiety and worry play important roles in persecutory delusions (Freeman, Garety, Kuipers, Fowler, & Bebbington, 2002; Morrison & Wells, 2007). A recent study with a psychotic inpatient sample found a significant positive association between LCS and worry (Clemente, Gleeson, & Lim, 2013). Unfortunately, there was no attempt to pinpoint the unique worry concerns of these psychotic patients, so it is unknown whether their looming cognitive styles were predicting worries related to persecutory ideational themes.

Looming Vulnerability in Personality Disorders

From one perspective, psychopathic and anti-social personality disorders can be seen as representing the flip side of anxiety disorders because they are associated with a lack of normal anxiety and fear of punishment (which may impair their ability to learn from past punishment). A study by Sugiura and Sugiura (2012) on Japanese students examined the relationship between a self-report measure of psychopathy and the LCS. They found a significant inverse relationship between the LCS and psychopathy that was moderated by attentional control. The pattern of the relationship revealed that psychopathy scores predicted reduced LCS but this effect only occurred for individuals who lower attentional control. In other words, the LCS was only related to psychopathy in the students who had the lowest levels of attentional control. The researchers suggested that more psychopathic individuals had lower LCS scores because they had a lower capacity to imagine the rapidly growing threat of negative outcomes. 

It seems plausible that faulty perceptions of rapidly growing threats could also be related to other personality disorders. Many disorders such as borderline or avoidant personality disorder could be associated with dysfunctional perceptions that overestimate or underestimate the rapid escalation or lack of escalation of threats .

Extending the Scope of Looming Vulnerability to Positive Outcomes and Rewards: Looming Opportunity and Receding Opportunity

An interesting new set of avenues for theory and research center around the possible roles of dysfunctional perceptions of rapid dynamic gains and losses in positive outcomes and rewards. We refer to these constructs as the perceptions of “looming opportunity ” and “receding opportunity .” It seems possible that these constructs might be related to a variety of disorders associated with the impaired function of the behavioral activation or reward system.

A person can be said to have extreme perceptions of looming opportunity when the person is biased to perceive ambiguous situations as offering an opportunity for dynamic rapid gains in positive outcomes and rewards. The person is prone, in other words, to interpret ambiguous positive outcomes as rapidly growing and approaching. Such a cognitive bias would be likely to excite reward-seeking motivation and activate the behavioral approach (or activation) system (Alloy et al., 2012; Johnson, Edge, Holmes, & Carver, 2012). By contrast, a person can be said to have extreme perceptions of receding opportunity when the person is biased to perceive that possible opportunities for reward have likely already passed them by and are rapidly receding. It seems plausible that such perceptions would tend to dampen the behavioral facilitation system.

In the first test of these hypotheses , Riskind and Frost (2017) conducted a study to examine perceptions of looming opportunity in problem gamblers. Using a community-drawn sample of scratch ticket and lottery gamblers, Riskind and Frost administered a packet of questionnaires that included the South Oaks Gambling Screen and other measures, as well as a new measure of looming opportunity appraisals for gambling, a brief vignette-based questionnaire measure that assessed the extent to which participants were biased to interpret ambiguous gambling scenarios (e.g., the chances of winning after buying a lottery ticket) with a sense of looming opportunity . The study found numerous significant positive associations between the sense of looming opportunity (e.g., how quickly are the chances of winning increasing moment by moment?) and measures of problem gambling ( e.g., the South Oaks gambling screen). Additionally, the participants’ perceptions of looming opportunity and their scores on gambling measures continued to be significant when controlling for static predictions of winning (e.g., “what are the chances of winning the jackpot”), but the static prediction measure and gambling were not significantly associated. Thus, these findings lend support to the idea that inflated perceptions of rapid dynamic gains in rewards and opportunity are related to dysregulated and disinhibited reward-seeking.

The looming opportunity construct could also plausibly be extended to bipolar states because they also involve significant disinhibited reward-seeking. Further studies of cognitive factors in bipolar disorder might benefit by examining whether bipolar manic states are associated with exaggerated perceptions of looming opportunity (e.g., rapidly developing and escalating opportunities for successes in a rapidly rising stock market or gaining wide recognition for special abilities).

A Role for Looming and Receding Opportunity in Depression?

Likewise, it seems logically plausible that an absence of looming opportunity perceptions, as well as inflated perceptions of receding opportunity , could play a significant role in depression. Depression is associated with deficits in positive affect and reward-seeking motivation (Clark & Watson, 1991; Watson, Clark, & Carey, 1988) and these in turn could stem from a loss or lack of perceptions of dynamic gains in future opportunities. Moreover, a person who is depressed is likely to be cognitive biased to interpret opportunities as moving ever further away into the past and out of reach, or view present opportunities as rapidly dwindling. Such perceptions of receding opportunity would intuitively seem to be a component of the cognitive phenomenology of hopelessness and a depressive sense of emptiness and loss.

Perceptions of Dynamic Gains and Losses at a Macro Social Level

A few words are in order about the applicability of the theoretical concepts we have presented to higher social units of analysis beyond that of single individuals. It is suggested that they can be extended to a more community-wide or even global unit of analysis. For example, perceptions of looming vulnerability and looming provocation could play a role in conflicts between groups and nations as well as individuals, as well as in widespread panics. Similarly, perceptions of looming opportunity and receding opportunity could play a part in bull and bear oscillations in the stock market. For a third example, targeted interventions to heighten or reduce perceptions of looming vulnerability might be likely to help amplify the impact of public service announcements which are often ignored by the public until it is too late for one to act (e.g., hurricane or extreme weather warnings).

Conclusions

As we have described, the looming vulnerability model and its extensions stimulate interesting new avenues for research on problems beyond the work we have reviewed on anxiety alone. Furthermore, it inspires several intriguing new hypotheses and concepts that could be pursued in future research.