Looming Cognitive Vulnerability to Anxiety and Its

Reduction in Psychotherapy
John H. Riskind
George Mason University

Neil A. Rector
Sunnybrook Research Institute, Toronto, Ontario, Canada and University of
Toronto

Steven Taylor
University of British Columbia

This article describes clinical strategies derived from the looming vulnera-
bility model (Riskind, 1997a; Riskind & Williams, 2005). “Looming vulner-
ability” is a phenomenon involving anxiety and behavioral urgency marked
by dynamic perceptions of a threatening stimulus as moving swiftly toward
oneself in time or space. The looming vulnerability model integrates the
cognitive conceptualization of anxiety with a disparate collection of etho-
logical and developmental observations and social– cognitive and emotion
research findings. According to the model, distorted looming vulnerability
perceptions play a role in vulnerability to and maintenance of anxiety.
Procedures to address these distorted perceptions would be expected to
enhance treatment outcomes. Here we outline “looming-reduction” strate-
gies with the hope that these will have value when integrated with empirically
supported treatments for anxiety.
Keywords: looming vulnerability, threat, anxiety disorders, cognitive– behavioral therapy

John H. Riskind, Department of Psychology, George Mason University; Neil A. Rector,

Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON, Canada, and
Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Steven Taylor,
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Correspondence concerning this article should be addressed to John H. Riskind, Depart-
ment of Psychology, George Mason University, 9992 Main Street, Fairfax, VA 22031. E-mail:
jriskind@gmu.edu

137
Journal of Psychotherapy Integration © 2012 American Psychological Association
2012, Vol. 22, No. 2, 137–162 1053-0479/12/$12.00 DOI: 10.1037/a0028011
138 Riskind, Rector, and Taylor

Despite the established efficacy of cognitive– behavioral therapy (CBT)

for anxiety disorders (e.g., United Kingdom Department of Health Services,
National Institute of Health and Clinical Excellence), a sizable percentage of
patients do not demonstrate significant symptomatic reductions and/or re-
main at heightened risk of relapse following treatment (Hofmann & Smits,
2008). In an effort to improve the efficacy of current protocols, the present article
describes clinical approaches derived from the looming vulnerability model
(Riskind, 1997a; Riskind, & Williams, & Joiner, 2006). We have piloted these
approaches with the hope that they will be integrated with existing, empirically
supported treatments for anxiety disorders.

DYNAMIC DANGER CONTENT IN THREAT APPRAISAL:

LOOMING VULNERABILITY

Contemporary cognitive models are based on the assumption that anxiety is

elicited by a person’s estimates of probabilities of potentially threatening or
undesirable events occurring, and the costs of these events if they were to occur.
However, models that focus exclusively on the probabilities and costs of unde-
sirable events neglect an important variable affecting anxiety behavior—
perceptions of “looming vulnerability” to threat. Anxious people exaggerate
threats that they perceive to be dynamically changing or looming before them,
thereby intensifying their anxiety. Surprisingly, this dynamic element has been
largely underplayed or overlooked in anxiety research until recently.
The looming vulnerability model was formulated to integrate the cogni-
tive conceptualization of anxiety and fear (Clark & Beck, 2010) with etho-
logical and developmental observations and social– cognitive research that
show the importance of perceptions of dynamic change in threats (Riskind,
1997a; Riskind & Williams, 2005; Riskind, Williams, Gessner, Chrosniak, &
Cortina, 2000). According to the model, the perception of dynamic change in
threats is crucial to anxiety, because it is relevant to evolutionarily based
strategies for evading threats (Griffiths, Bench, & Frackowiak, 1994; Schiff,
Caviness, & Gibson, 1962; Schiff & Oldak, 1990). Perceiving threats as
moving and advancing provides an evolutionary advantage by leading to
early detection of threats and, therefore, a greater likelihood of avoiding harm
(Bach, Neuhoff, Perrig, & Seifritz, 2009; Ghazanfar, Neuhoff, & Logothetis,
2002). Among individuals with excessive anxiety, these inflated perceptions
of change in threats have surpassed their evolutionary benefit and lead to
maladaptive coping responses (Riskind, 1997a; Riskind et al., 2000; Riskind
& Williams, 2005). Exaggerated perceptions of threat progression provoke a
sense of urgency to take flight, as well as hypervigilance to threat cues,
maladaptive worry, or other maladaptive avoidance or coping responses. In
Looming Vulnerability 139

this model, anxious people generate perceptions of patterns of dynamic

changes, rather than motionless or static scenarios, and these are crucial in
intensifying their anxiety.

Looming Vulnerability in Relation to Other Cognitive–Behavioral Models

The looming vulnerability model differs from other recent models, for
example, intolerance for uncertainty (e.g., Dugas & Robichaud, 2007), worry
(e.g., Borkovec, Alcaine, & Behar, 2004), or metacognition (Wells & King,
2006), for its emphasis is on perceptual and cognitive distortions of the
forward progress of threat (whether it is external or internal). Such distortions
compress the time and space available to the person to cope or respond
(Riskind, 1997a). At one level, spider-fearful people might exhibit perceptual
illusions of dynamic images of spiders as moving or preparing to move
suddenly to jump toward them, or individuals who have been physically
assaulted or been in automobile accidents might have illusions of the ad-
vancing spatial movement of their threatening stimuli.
Beyond this, the conceptual idea is that anxious patients often have a
distorted sense of the rate of change (“threat velocity”) with which potentially
threatening or dangerous events are developing and advancing in relation to
themselves (Rector, Kamkar, & Riskind, 2008; Riskind & Williams, 1999).
At any given moment, more units of time seem to have passed, which
compresses the psychological (spatial and temporal) distance from the threat
object. As a result, for some anxious patients, the future horizon seems to be
contracting so quickly and events hurtling forward so rapidly that the events
seem to be virtually present in the here-and-now even if they would actually
occur later in time— even months or years away (“time contraction”). Anx-
ious patients can feel as if the threatening events are thrusting or projecting
themselves into the present so quickly that there is insufficient time to cope
(“insufficient coping time”). Time is a coping resource, and their distorted
sense of time velocity and time contraction can cause them to fear that they
are incapable of coping and keeping up, lowering their self-confidence.
At the extremes, anxious patients may see many problems across differ-
ent content domains—such as occupational, family, and health problems—as
all simultaneously compressed in time (“arriving all at once”). This often
occurs despite the fact that some events would naturally follow each other
over long stretches of a lifetime. For example, getting engaged, married,
needing to buy a larger house, having children, finding babysitters, and
paying for children’s college education may all be perceived as about to
happen simultaneously. Thus, they perceive too little recuperative time for
them to regroup. When such distortions pile on, they may sometimes be
140 Riskind, Rector, and Taylor

overwhelming and even augment desperate feelings leading to suicide (Rec-

tor et al., 2008).

Relationship of Looming Vulnerability to Other Theoretical and

Empirical Work

A wide variety of other empirical and theoretical work across many

bodies of literatures appears to show that perceptions of dynamic changes in
outcomes that affect well-being are important to appraisal, emotions, and
behavior. For example, Aspinwall and Taylor’s (1997) model of mental
simulation suggests that the perception and prediction of dynamic change
would be crucial for appraisals of threats to be useful for proactive coping
when individuals perceive warning signals of emerging stressful events.
Their model suggests that proactive coping requires an active, dynamic
process of mental simulation of the likely course of an “incipient stress” or
adverse event. They argue, moreover, that “a static representation of what a
warning signal means” (p. 424) would be insufficient for coping with an
emerging stress or threat. Their model is compatible with the idea that
simulating threats (running them forward in time) as “looming” at a rate too
fast for coping may undermine effective proactive coping and cause anxiety.
Carver and Scheier’s (1990) self-regulatory model proposed that a per-
son’s perceptions of the dynamic rate of change in his or her progress toward
(or away) from goals at any moment is a key driver of the intensity of his or
her affect. In their model, positive affect ensues when the person sees a rapid
rate of progress toward positive goals, whereas negative affect results when
the person sees a slow rate of progress away from negative goals. A faster
advancing threat will, of course, result in lower progress away from a
negative goal. Thus, Carver and Scheier’s model can be seen as consistent
with the view that a person’s perception that a threatening stimulus is making
rapid forward progress is a key influence on his or her anxiety. The impor-
tance of perceptions of dynamic change is also supported in work of Hsee and
Abelson (1991) on the “velocity relation,” which demonstrates that satisfac-
tion depends on the rate with which outcomes are changing, as well as their
absolute values. For example, individuals are more satisfied when they
experience rapidly improving outcomes than when the same high final
outcomes are constant (static) or when they improve more slowly. The
importance of dynamic change is also apparent in the suggestions of
Baumeister and Bratslavsky’s (1999), Ortony, Clore, & Collins’ (1988), and
others, that emotions are due to changes in stimuli, not just the stimuli alone.
A similar theme is seen in Kahneman and Tversky’s prospect theory (1979),
which posits that decision makers evaluate potential gains and losses relative
Looming Vulnerability 141

to changes they represent from a subjective reference point, not the absolute
magnitude of final states.
Helson’s (1964) adaptation-level theory also emphasized changes or
differences from a prior reference point as critical to the subjective perception
of stimuli. For example, when a person puts a hand in cooler water, the hand
adapts, and then when it is placed in warm water, the water feels hot, but
when the person adapts to the hand in hot water, warm water feels cold.
According to the hedonic treadmill model, which is theoretically related to
Helson’s model, shifting adaptation levels help to explain why individuals
return to prior levels of well-being and happiness after the occurrence of even
major positive or negative events (Brickman, Coates, & Janoff-Bulman,
1978). In the original formulation of the looming vulnerability model, Ris-
kind (1997a) proposed that static or unvarying stimuli expedite habituation,
whereas dynamic changes in stimuli impede such habituation. In this regard,
the looming vulnerability model is in accord with Gray’s (1987) model of
anxiety, which states that mismatches with expectancies activate the behav-
ioral inhibition system. Thus, dynamic changes in threat stimuli would cause
continuing mismatches of expectations that will maintain the continued
activation of the behavioral inhibition system.
Dynamic changes that can affect well-being, particularly those related to
approaching danger, may be more behaviorally urgent and have greater
perceptual salience (Bach et al., 2008; Bach, Neuhoff, Perrig, & Seifritz,
2009). Several different bodies of research show that visual and auditory
signals of negative stimuli that are growing in intensity or moving closer
elicit more negative reactions, defensive behavior, in both human adults
(Bach et al., 2008; Bach, Neuhoff, Perrig, & Seifritz, 2009; Tajadura-
Jiménez, Väljamäe, Asutay, & Västfjäll, 2010) and infants (Ball & Tronick,
1971; Kayed, & Van der Meer, 2007), Rhesus monkeys(Ghazanfar, & Maier,
2009), as well as in animals as different from humans as fruit flies (Card &
Dickenson, 2008); and barnacles (Gwilliam, 1963). Changes in physical
distance of pictures with negative emotional content (but not positive or
neutral) produce more negative reactions when these pictures move closer to
human observers, but not if they move further away or remain static (Müh-
lberger, Neumann, Wieser, & Pauli, 2008).
Researchers recently showed that simply imagining (or mentally simu-
lating) such pictures as becoming larger and moving closer evoked more
negative reactions from participants than imagining them as staying the same
(static) or as moving away (Davis, Gross, & Ochsner, 2011). Thus, changes
in psychological (not just actual) distance from a negative stimulus influence
negative reactions.
Anderson (2010) has described a basic organizing principle of the brain
as “neural reuse.” That is, neural circuitry that evolved for earlier functions
are reused in later evolved adaptations. The neural reuse principle may help
142 Riskind, Rector, and Taylor

to explain why mental images of dynamic changes and increasing intensity of

threats getting closer evoke more negative reactions than static images or
dynamic changes in threats getting smaller: Namely, they tap some of the
same neural machinery as do visual and auditory perceptions of approaching
threat. In each case, dynamic changes and increases in threat values may
contribute to anxiety and fear beyond the absolute magnitudes of those
values, in much the same way auditory signals of approaching threat influ-
ence reactions beyond the absolute intensity of such signals (Bach et al.,
2008, 2009). Additionally, subjective perceptions of the increasing intensity,
proximity, or probability of occurrence of threats and their outcomes—not
just their absolute magnitudes — may help carry some of the psychological
impact that such variables have on anxiety and fear.1
Emerging research indicates that a reason for such functional equivalence of
mental images or expectations of dynamic change with perceptual sensation of
such change is that human thinking is fundamentally embodied in body-based
metaphors (Anderson, 2010; Landau, Meier, & Keefer, 2010; Niedenthal, Bar-
salou, Winkielman, Krauth-Gruber, & Ric, 2005). Embodied cognition assumes
that the varying content of human, perception, cognition and information pro-
cessing is based in corresponding changes in patterns of physical sensations and
action, and other physical events in the body. For example, just thinking about
someone who is tall may be related to an upward head orientation. Moreover,
such body experiences provide root metaphors that help us to think about abstract
concepts. For example, the somewhat abstract concept of time is based on
experience with spatial position and movement, for example, the future is ahead
of us spatially, while the past is behind us (Miles, Nind, & Macrae, 2010), much
like concepts such as top evaluations or rising prices. Similarly, the concept of
cause– effect may be embodied within experiences of pushing and pulling. Thus,
visual and auditory or other bodily signals of approaching objects may provide
human thought with embodied root metaphors for threat. Moreover, metaphor-
dominated thought related to perceived dynamic change and spatial movement
may provide a basis for how people think about threats in everyday social life
(e.g., deadlines, anticipated interpersonal confrontations, or health problems).

EMPIRICAL INVESTIGATIONS

Effects of Experimental Manipulations

Experimental research using a variety of methodologies demonstrate that

perceptions of the forward progress and movement of threatening stimuli can

1
We follow Kahneman and Tversky’s (1979, p. 278) wording that “the carriers of value
are changes in wealth or welfare, rather than final states.”
Looming Vulnerability 143

function causally in anxiety and fear, and subjective assessments of threat

(Riskind, Williams, & Joiner, 2006). For example, greater anxiety and fear,
as well as threat appraisals (i.e., probability, lack of control), are produced by
video tapes showing film clips of spiders moving toward the viewer , and
then tapes showing spiders that are motionless or moving away from the
viewer (Riskind, Kelley, Moore, Harman, & Gaines, 1992; Riskind & Mad-
dux, 1993).
Similarly, experimental manipulations of threat movement by means of
mental imagery instructions (Dorfin & Woody, 2006; Riskind, Wheeler, &
Picerno, 1997) or verbal descriptions (Riskind & Wahl, 1992), rather than
video clips, produce similar results. For example, Dorfin and Woody showed
that undergraduate participants who received instructions to imagine steril-
ized drops of urine placed on their arms reported higher levels of distress and
other threat cognitions than those receiving instructions to imagine the urine
drops as static (not moving) or as safe. Also as predicted by the looming
vulnerability model, they found that habituation to the urine stimulus was
hindered by imagined threat movement. Indeed, the participants became
more sensitized over time during urine exposure with movement imagery,
rather than habituated as in static imagery or safety imagery instructions.
Such studies demonstrate that perceptions of dynamic changes in threat and
threat progression have a powerful impact on anxiety/fear symptoms relative
to static representations of the same threats. They converge, too, with the
previously described studies of the heightened effects of negative stimuli that
are perceived or imagined as rapidly moving closer in actual or psychological
space.

Looming Vulnerability Across the Anxiety Spectrum

Inflated perceptions of looming vulnerability are present across the

spectrum of anxiety disorder. For example, individuals with specific fears,
such as fear of disease or spiders, report perceptions of looming vulnerability
to their fearful threat stimuli. (Riskind, 1997a). Spider-fearful people exhibit
perceptual illusions involving dynamic images of spiders as suddenly jump-
ing or moving toward them (Rachman & Cuk, 1992; Riskind, Moore, &
Bowley, 1995; Riskind et al., 1992; Riskind & Maddux, 1993). Similarly,
individuals who fear disease (Riskind & Maddux, 1994) and are germapho-
bic, and those who have OCD symptoms (Riskind, Abreu, Strauss, & Holt,
1997; Tolin, Worhunsky, & Maltby, 2004) generate mental scenes of germs
(or viruses) as moving and spreading toward them. Moreover, female college
students who have been physically assaulted appear to have an interpretive
bias toward perceiving interpersonal threat situations as more quickly pro-
gressing and rising in danger (Elwood, Williams, Olatunji, & Lohr, 2007).
144 Riskind, Rector, and Taylor

Inflated perceptions of looming vulnerability to rapidly intensifying

threat have been shown to be associated with social anxiety in undergraduates
(Brown & Stopa, 2008; Haikal & Hong, 2010; Williams, Shahar, Riskind, &
Joiner, 2004), as well as in patients diagnosed, according to the Diagnostic
and Statistical Manual of Mental Disorders (DSM), with social anxiety
disorder (Riskind, Rector, & Cassin, 2011), generalized anxiety disorder
(GAD; Riskind, Rector, & Cassin, 2011; Riskind & Williams, 2005), obses-
sive– compulsive disorder (OCD; Riskind & Rector, 2007; Riskind, Rector,
& Cassin, 2011; Elwood, Riskind, & Olatunji 2011; Tolin et al., 2004), and
panic disorder (Riskind, Rector, & Cassin, 2011). In addition, structural
equation modeling studies have also indicated that heightened perceptions of
looming vulnerability are found as a pervasive theme across the spectrum of
anxiety disorder symptoms, including GAD, OCD, PTSD, panic, and simple
phobias (Williams et al., 2004; Reardon & Williams, 2007).

Incremental Prediction

Questionnaire measures of subjective perceptions of looming vulnera-

bility to threat progression consistently correlate with anxiety, fear, catastro-
phizing, and worry more generally (Riskind, & Williams, 2005) but looming
vulnerability is distinct from these. In addition, such measures of looming
vulnerability often independently account for additional variance in anxiety,
fear, and worry when adjusting for threat probabilities, perceived lack of
control, and other appraisals (Riskind et al., 1992; Riskind, Williams, &
Joiner, 2006). Incremental prediction has been demonstrated in relation to
specific fearful objects, including fear of spiders (Riskind et al., 1992),
contamination (Dorfin & Woody, 2006; Riskind, Abreu, Strauss, & Holt,
1997; Riskind & Rector, 2007; Tolin et al., 2004; Williams, Olatunji, El-
wood, Connolly, & Lohr, 2006), disgust (Williams et al., 2006), fear of
disease (Riskind & Maddux, 1994), and fear of terrorism (Riskind &
Kleiman, 2009). It has also been found for fears of unpredictable aggressive
behavior by others (Riskind & Wahl, 1992).

Cognitive Vulnerability to Anxiety

In the model, habitual patterns of inflating patterns of change and

progression of threat create a negative cognitive style, or cognitive vulner-
ability, which functions as a danger schema and creates heightened suscep-
tibility or risk for anxiety. Looming cognitive style (LCS; Riskind, Rector, &
Cassin, 2011; Riskind & Williams, 2005; Riskind et al., 2000) is conceptu-
Looming Vulnerability 145

alized as a characteristic pattern of generating dynamic perceptions, mental

images, and simulations of threats (e.g., social rejection, disease, physical
injury) as rapidly intensifying and progressing more quickly than the indi-
vidual may be able to cope or respond.
Research has shown that individual differences in LCS are predictive of
anxiety (Riskind et al., 2000; Riskind & Williams, 2005; Riskind, Williams,
& Joiner, 2006), even when adjusting for anxiety sensitivity, negative affec-
tivity, attributional style, intolerance of uncertainty, subjective threat proba-
bilities, and depression (Reardon & Williams, 2007; Williams, Shahar et al.,
2004; Riskind et al., 2006; Riskind, Hughes, Joiner, Williams, & Cortina,
2009). In addition, both prospective and cross-sectional studies have corrob-
orated that these associations are often specific to anxiety and worry, and are
less closely related to depression (Adler & Strunk, 2010; Riskind, Tzur,
Williams, Mann, & Shahar, 2007; Williams, 2000; Riskind, Williams, &
Joiner, 2006). LCS is also strongly predictive of depression, however, in
patients with diagnosed with GAD (Tzur-Bitan, Meiran, Steinberg, & Shahar,
in press).
In support of the model, studies show that people who haveLCS expe-
rience increases in anxiety up to six weeks after their exposure to negative
life events, but people withoutLCS do not experience significantly elevated
anxiety following negative life events (Adler & Strunk, 2010; Williams,
2000). Likewise, Adler and Strunk found that for individuals with LCS,
subjective threat probabilities were strongly related to increases in anxiety,
but for people without LCS, threat probabilities did not predict increases in
anxiety. LCS predicts higher levels of anxiety, worry, and OCD symptom
changes over time (Riskind, Tzur et al., 2007), when adjusting for intolerance
of uncertainty and depression, and LCS also predicts stress generation
(Riskind, Black, & Shahar, 2010). Finally, LCS predicts a higher likelihood
of past anxiety disorders in individuals who were screened for not having
anxiety or mood disorders at baseline (Black, Riskind, & Kleiman, 2010).

Looming Cognitive Style and Information Processing

Research also supports the idea that individuals with LCS exhibit stron-
ger memory bias for threat information (Riskind et al., 2000), and interpre-
tative bias for ambiguous verbal homophones (Riskind et al., 2000) and
visual stimuli in the direction of threat (Williams, Riskind, Olatunji, &
Elwood, 2004). This link between LCS and information processing was
found even when adjusting for current level of anxiety and subjective threat
probabilities in LCS questionnaire. But when subjective perceptions of
looming vulnerability were controlled, scores of threat probabilities and
anxiety did not relate to homophone bias (Riskind et al., 2000).
146 Riskind, Rector, and Taylor

Cognitive Distortions

Dangers appear to be psychologically closer (spatially and temporally)

than neutral situations. For example, the edge of a theater stage appeared to
be psychologically closer to blindfolded participants—as measured by dis-
tance walked, speed of walking, and distance before slowing down—when
they walked toward a precipitous drop than when the danger was absent
(Langer, Werner, & Wapner, 1965). Participants also counted down 5 min-
utes faster when blindfolded on a trolley moving toward a precipitous drop
than when moving away from the drop (3.52 vs. 4.11 seconds) (Langer,
Wapner, & Werner, 1961). Overestimation of time duration (time flies by
faster for the anxious person even when it slows down) provides more time
for dangers to progress and get closer. This looming psychological closeness
helps amplify the anxiety. A recent experiment examined the effects of a
manipulation of “temporal looming,” in which participants briefly waiting to
videotape a speech about themselves. Participants had greater anxiety when
their attention to time pressing them was increased by a count-down clock
(Haikal & Hong, 2010). Moreover, this temporal looming manipulation
increased two illusions associated with social anxiety, the “illusion of trans-
parency” (that others see one’s internal sensation) and the “spotlight effect”
(that others notice and remember behaviors that they don’t).

LOOMING VULNERABILITY REDUCTION

General Considerations

Building on the preceding body of theory and empirical research, we

have been developing and piloting “looming-reduction” methods and tech-
niques that can be incorporated into the standard practice of CBT, and
possibly to other types of therapies:

1. Case Conceptualization

This involves an ongoing process of assessment and synthesis of infor-

mation that leads to hypothesis testing and revision. Case conceptualization
can be informed by the idea that distorted perceptions of threat progression
can characterize the spontaneous mental images and transitory automatic
thoughts of anxious patients. For example, such mental images may not
simply represent single static snapshots of a single moment, but a sequence
of dynamic changes and kinetic moments of threat progression (e.g., spiders
Looming Vulnerability 147

jumping, cars veering). Similarly, anxious patients may self-generate exag-

gerated threat progression scenarios—such as interpersonal rejection, health
problems, and automobile accidents—in which things happen too quickly for
them to cope. They may have automatic thoughts such as “I can’t keep up
with my work,” “I’m racing against the clock,” or “things are headed for a
crash.” They may also have underlying beliefs that are automatically acti-
vated such as “Things are happening too fast,” “I don’t have enough time,”
or “I’m not quick enough to solve problems.” Thus, recognition of looming-
related cognitive distortions and perceptual illusions may offer additional
tools for conceptualizing cases and selecting corresponding targeted strate-
gies that might be useful.

2. Psychoeducation

When treatment commences, or when particular perceptual illusions or

cognitive distortions become salient, patients can be told how these may
influence their anxiety. This information may also be imparted in conjunction
with Socratic questioning during looming reduction and imagery or behav-
ioral methods. In addition, patients sometimes spontaneously recognize their
own cognitive distortions when they participate in looming-reduction imag-
ery or exercises.

3. Imagery Rehearsal and Modification

Imagery exercises are often used for looming reduction. Practice or

“warm-up” exercises may be unnecessary. When patients have difficulty with
imagery, even after practice or “warm-up” exercises, imagery exercises can
be used as a basis for Socratic discussion, or behavioral tasks can be used.
Although they emphasize dynamic threat content and distortions (e.g., “all at
once,” or “insufficient coping time”), these imagery exercises are used and
integrated in cognitive-behavioral therapy much like other imagery exercises.

4. Behavioral Tasks

Standard behavioral tasks such as exposure may be conducted in the

same typical step-by-step manner and for the same duration, with a few
modifications. These are included to help patients identify, test, and modify
distorted beliefs and perceptual illusions that exaggerate their looming vul-
nerability. For example, a clinician can ask patients to rate their perceptions
148 Riskind, Rector, and Taylor

of how quickly their perceived threats are progressing and their perceptions
of control, and rate their standard anxiety discomfort using the Subjective
Units of Distress Scale (SUDS) before, during, and after the tasks. Behavioral
methods can be often combined with Socratic or imagery methods to con-
solidate changes and elaborate meaning of distortions of threat progression.
As noted, some evidence from a study on exposure to sterilized drops of urine
suggests that providing static imagery instructions may expedite desensiti-
zation when individuals have dynamic imagery (Dorfin & Woody, 2006).

5. Homework Assignments

Patients can practice variations of traditional homework exercises out-

side of sessions that are tailored to increase the impact of looming-reduction
strategies. For example, they can be given homework to practice using
imagery techniques learned in sessions, behavioral experiments to test the
reality of distorted dynamic danger perceptions, and thought records to
monitor dynamic mental images and thoughts and their related distortions
(e.g., time contraction, time acceleration). Clinicians can tell patients that
such homework exercises will help them to develop coping tools.

6. Assessment

Measures of threat-specific forms of looming vulnerability, as well as a

broader or general tendency to perceive and simulate threats as rapidly
advancing, i.e., LCS, have been developed for research purposes and can be
readily developed for new fears. In the clinical situation, one can simply ask
participants to make ratings such as how much does threat seem to be
advancing or progressing, how fast, how much movement does it show (e.g.,
on a 100-point scale) Such ratings can be used much like SUDS ratings to
assess changes in looming vulnerability. There is also some recent evidence
in a sample of GADS that CBT can bring about changes in LCS in some
individuals.

SPECIFIC STRATEGIES AND METHODS

The following are some specific looming-reduction interventions that we

are piloting in clinical work based on the LVM and empirical data. These
methods include (a) “freeze frame,” (b) “receding frame,” (c) “slowing down
the clock,” (d) “conveyor belt,” (e) “speedometer,” (f) “freight train,” and (g)
Looming Vulnerability 149

“time interpolation and elongation.” The basic feature shared by these meth-
ods is that they seek to change the patients’ views of threat progression that
intensify anxiety, perceptions of helplessness, and lack of control. Addition-
ally, as will be seen below, patients can be helped to recognize cognitive
distortions with looming-reduction imagery that “speeds up” threat progres-
sion as well as slows it down.
Looming reduction strategies and methods can often be introduced very
straightforwardly. Sometimes, clinicians can use a simple metaphor such as:
“It almost sounds as if you are feeling like your problems are like some sort
of a freight train that is speeding toward you. Does that sound right? Let’s try
this.” Alternatively, the clinician can simply say “It sounds as if the situation
is speeding along very quickly and faster than you can deal with it.” Socratic
questioning is usually integral to looming-reduction strategies to identify
distortions and the benefit of slowing threat progress. Several different
methods can be used in the same session but care is taken to avoid diluting
the impact or “oversaturating” patients, so usually no more than two or three
methods are used.
Typically, looming-reduction methods take up just a part of a total given
session and are indicated when (a) they seem to closely resume patients’
phenomenology (e.g., feeling as if the clock is ticking away, or patients’
perceptions that threats are progressing faster than their coping responses),
(b) they seem applicable for theoretical reasons or their similarities to other
cases, and/or (c) other cognitive– behavioral techniques don’t seem fully
effective.

“Freeze Frame”

According to the looming vulnerability model, threat scenarios that are

imagined as progressing at a slower rate (or even not at all) become less
threatening. In the freeze-frame method, mental imagery is used to slow
down threat progression, as if one were watching a movie of the events in a
frame-by-frame manner, and then they are finally stopped altogether as if
they are “frozen,” or arrested in time. The technique can be used for worry
or catastrophizing sequences such as a disagreement spiraling out of control.
The technique can also be used in physical threat situations. For example,
individuals who suffer from trauma from motor-vehicle accidents may ex-
perience perceptual illusions of automobiles veering across the center lines
toward them (Taylor, 2006). Moreover, such illusions may contribute to their
fear of driving. Thus, the freeze frame may be useful for treating such
perceptual illusions or those found in patients with a fear of spiders (jumping)
or physical assault (others moving quickly toward them).
150 Riskind, Rector, and Taylor

In some cases, providing preparatory information about the interventions

may be helpful. For example, with auto-accident victims who imagine cars
swerving, the perceptual illusions can be explained in the following way:
“It’s a fear-related illusion, perhaps arising from your playing out in your
mind the events that you fear.” They can be informed that they can cope with
the illusion by not taking it seriously (e.g., “Remind yourself that it’s just a
harmless perceptual illusion that will eventually disappear”). Such instruc-
tions, of course, might have minimal impact—much like providing any list of
cognitive distortions— unless they are part of an integrated treatment inter-
vention.
Some patients, such as motor-vehicle accident victims, fear that their
illusions are dangerous because they might place themselves in jeopardy by
acting on them (Taylor, 2006). For instance, a motor-vehicle accident victim
may fear crashing into a telephone pole as a result of swerving away from an
oncoming car perceived to be veering across the center line toward the
patient’s car (Taylor, 2006). Although some patients may be at risk for such
hazardous actions, in most cases the distortions are distressing but not
dangerous, and they usually disappear over the course of exposure therapy
(Taylor, 2006). Even so, the therapist and patient should evaluate the evi-
dence for and against the idea that the illusions place the patient at risk.
Exposure exercises can be conducted in such a way that the distortions do not
create a hazard (e.g., the accident victim suffering from such looming
illusions might initially travel as a passenger during driving-related exposure
assignments) (Taylor, 2006).
Freezing patient’s images and cognitive simulations of threat progression
often seems to have several beneficial consequences. These include increas-
ing distancing from cognitions and patients’ abilities to evaluate them with
objectivity, increasing the perception that they have time to plan and have
control, and enabling them to better test their danger predictions and beliefs.

“Recede Frame”

In another somewhat related type of imagery manipulation—the recede-

frame method—threatening stimuli can also be imagined as moving away
and growing smaller. In a recent study, Davis et al. (2011) showed that
participants had significantly fewer negative reactions when told they should
imagine a negative scene that they saw as “receding until it was the size of
a postage stamp,” compared with when they were told to imagine no change,
or to imagine the scene as growing larger and moving toward them.
Looming Vulnerability 151

“Slowing the Clock”

Anxious patients are hypothesized to perceive threat progression to be so

swift that they perceive themselves as having insufficient time to cope, and
then feel overwhelmed. The slowing-the-clock technique can be described
with an example taken from a session with a 28-year-old married Caucasian
woman with social anxiety disorder. This particular patient had a past history
of major depression and currently suffered from shame proneness and ex-
treme shyness. Her clinical issues centered on her intense conflict about
staying in her marriage, dislike of her in-laws, and worry about the future.
The agenda of the session described here centered on her reports that she
“is completely stressed out” and fears she “would have to leave her current
job, and wouldn’t be able to get another job.” On probing her cognitions and
affect, the therapist asked if she felt pressured by time, and whether it was
almost as if the clock were “ticking away” on her.

Patient: Yes, I feel like time is just ticking away. It makes me more anxious and the
more anxious I get, the more I procrastinate.

The therapist provided her with the following instructions:

Therapist: Let’s try this. Imagine yourself sitting by a huge clock. Now as you think
about the situation at work, imagine that the clock is ticking and raise your finger to
signal to me each time a minute goes by. Count the number of minutes.

The therapist did this for 2 or 3 minutes. Then he asked her how many minutes she
counted. How many actually did go by? The patient estimated that 6 minutes had
gone by and the therapist asked her how she explained the discrepancy.

Patient: It’s just in my head. Time is just going faster there. It feels like time is going
faster than it is. I feel like it is making me procrastinate. Realizing that makes me feel
better. If I remember this, it will help me to see it is not really going like this, even
though I think it is. (She made a hand motion of clocks turning.) I’m always doing
too many things at once.

Therapist: Anyone would be more anxious if they felt the clock was ticking as fast
as you did. How do you feel right now?

Patient: The more I can do to slow it down, the better off I will be.

The patient reported that she felt more confidence after slowing down the
subjective perception of the rapid rate at which the threat situation was
advancing. Afterward, she seemed better able to view her problems with
objectivity, and then spontaneously shifted on her own into a problem-
solving mode. Thus, she said: “Maybe if I just put in my calendar and just say
I’m going to do it, and plan on sending out a resume each day. If I can map
it out, I don’t have to keep stressing about it.” If patients don’t spontaneously
152 Riskind, Rector, and Taylor

transition into a problem-solving mode on their own, they can be guided to

do this by the therapist.

“Slowing the Conveyor Belt”

This strategy can be illustrated with an example from a therapy session

with a 42-year-old married Caucasian man who had a comorbid diagnosis of
GAD and dysthymia. The patient had a history of traumatic career setbacks,
despite a degree in a specialized field from an elite Ivy League university, and
had typical automatic thoughts relating to inadequacy and failure to achieve
his potential. He had underlying beliefs tracing to his childhood such as “I’m
defective,” “I could turn out like my mother” (who had developed bipolar
disorder), “My life will eventually fall to pieces no matter my successes.”
The conveyor-belt technique was used in a session in which he voiced
anxiety that he was failing to make the unsolicited “cold calls” required to
generate business for his company. He reported that he feared looking
“foolish, idiotic, and small” were he to receive negative reactions to an
unsolicited call. Although he feared making the calls, he felt compelled to
make them because otherwise his business would fail. He reported that if he
couldn’t make these calls, he would be wasting his whole life and could lose
his “wife, family, and even his sanity.”

Therapist: If you were to make an unsolicited call, it almost sounds like you feel it
would be like stepping onto a conveyor belt that is moving you closer and closer to
what you fear now: a place where you will feel idiotic, foolish, and small.
(The patient agrees that this is “exactly” how he feels and the therapist resumes.)
Therapist: Can you visualize yourself getting on this imaginary conveyor belt? What
are you experiencing?
Patient: It is as if events are moving too fast and I can’t control the speed. I’m out
of control and I’m on a “conveyor belt to doom” and I can’t get off.
(When asked about his automatic thoughts in reaction to the image, he reported such
thoughts as “I’m wasting my time,” “this isn’t going anywhere,” “I won’t be
successful,” and “If I couldn’t call other companies to generate business for myself,
I would be wasting my whole life, wouldn’t be capable of anything else, would lose
my family, would need to be institutionalized.”)
Therapist: How true is this? Would a person who has no control over how quickly
he would end up looking “idiotic and foolish” after an unsuccessful call automati-
cally and rapidly end up wasting his whole life, losing his family, being institution-
alized? Is it really true that you would have no control at all over how fast this would
move toward you?
Patient: Well, actually, I guess if I can speak slowly, I can slow the conveyor belt.
I can know the product I’m selling so I’m prepared to make the sales calls. I can get
rid of the possibility of “looking stupid” by not caring as much. I also control half
Looming Vulnerability 153

of the conversation with the person I call. (When asked, the patient said he felt more
control).
Therapist: So let’s return to your fear of your wasting your whole life, not just your
time, if you couldn’t make those calls.
Patient: Yes, that would be a pretty horrifying thought. What is the point of living?
If I’m not capable of even that, it would be a conveyer belt to doom and oblivion,
losing everything, my wife, kids— even my sanity.
Therapist: If you could slow down the conveyor belt in the previous case, isn’t there
something you could do here?
Patient: Yes, there are number of things I can do to slow down the “conveyor belt
to doom.” For example, I can try to work more effectively and I can plan.
Therapist: How fast or quickly does this “conveyor belt to doom” seem to be moving
now?
Patient: Not so fast. I see that it depends on what I do with it. Right now, it is idling.
I can also go in the opposite direction to success.

Thus, using this looming-reduction technique appeared to help this

patient to note and reappraise anxiety-producing cognitive distortions of the
rapid rate with which threat was advancing, and this increased his sense of
control.

“Slowing the Speedometer”

To illustrate this next technique, we use an example taken from a session

with a 27-year-old married Caucasian man who suffered from both GAD and
OCD (and had suffered from major depressive episodes in the past). The
patient reported acute anxiety that he would experience a recurrence of
previously treated obsessions and compulsions. Moreover, he feared that he
was “living on borrowed time” because of the precariousness of his job. In
addition, he voiced his fear that he would be unemployed for two years and
that his “anxiety will run completely out of control,” he would lose his ability
to function, he would slide into major depression, and his marriage would
“collapse.”

Therapist: It sounds like you foresee a whole sequence or slew of things happen-
ing—that some of your previous problems will come back, you will slide into
depression, you will lose your wife—and you feel you are “living on borrowed
time.” Is that right? Well, as you are imagining these events, does it seem to you as
if they are unfolding for you very quickly, or does it seem like they are unfolding
slowly? For example, let’s imagine for the moment that you could measure the speed
with which they are unfolding on a speedometer, like in a car. How many mph would
you rate them as going? And also rate how anxious you feel, and how much control
you feel you have in this situation, on a 100-point scale.
154 Riskind, Rector, and Taylor

Patient: It feels like things are happening very, very quickly, like 100 mph. I’d say
I’d feel about 70 or 80 degrees of anxiety and about 20 or 30 degrees of control.
Therapist: Okay, let’s try this. Can you imagine that on this speedometer, the speed
with which these events are coming about for you slows down? Imagine that it goes
from 100 mph to 95 mph, and then from 95 mph to 90 mph?
Patient: Yes. I can imagine that.
Therapist: Now imagine that the speed on the speedometer goes down from 90 mph
to 85 mph, and then to 80 mph. And it keeps going down from 80 mph to 70 mph,
all the way to 40 mph. How does it feel for you when you imagine that?
Patient: That feels great! My anxiety is much lower, like about a 20 right now. And
I’d rate my control like about a 60 or 70. I can really see that this has always been
a problem for me. In college, I was always thinking that there were too many things
to do and not enough time to do them.

After discussing the cognitive distortions that led him to “pile-on” threats
that made him feel overwhelmed, the patient began to practice this and other
techniques at home to help him to recognize and counter the dysfunctional
thinking.

“Slowing the Freight Train”

Another technique to slowing down the perceived rate with which threat
is advancing is illustrated with an example from work with a 34-year
old-unmarried woman with GAD. She was being treated for symptoms of
chronic worry, anxiety and tension, and comorbid depression. This woman
reported that her own parents had a “screwed up” marriage and much of her
anxiety centered on the security of her relationship with her fiancé. Some of
her typical automatic thoughts were “I’m like a fixer-upper,” “I’m a burden
on him,” “Our relationship is doomed,” ”We are headed for a crash.” She had
underlying beliefs such as “I’m incapable of having a successful relation-
ships,” “I’m setting myself up to be hurt if I let my guard down and let
someone get close to me.” Standard CBT techniques had been highly effec-
tive in reducing her depression. However, her anxiety and catastrophizing
continued, and standard approaches such as decatastophizing were not as
helpful.
She reported severe worries in this session about losing her job if she
went back to school, and not having enough money after she got married. She
further worried (catastrophized) that her lack of income would cause her
husband to leave her, and she’d end up “a menial doing temp work.”
The clinician asked her to imagine each chain of worries as a chain of
catastrophic steps leading to disaster. The patient added herself that they felt
like a “train rushing down the track toward her.” After rating her anxiety (90
Looming Vulnerability 155

on a 100-point scale), she was asked to imagine this “train” of disasters as

slowing down. It was initially moving at 200 mph then slowed to 150 mph,
then to 100, and so, until eventually it was moving in “very small” increments
toward her, such as a train that moved down the track one inch every 10
minutes. During this, she reported that she had increasing feelings of control
and her ratings of anxiety fell from 90 to 5. She was subsequently asked to
imagine the train as rushing toward her at an absurd speed, covering hundreds
of miles each second. She spontaneously vocalized that things were “not
moving so fast” and this gave her an additional sense of control. This exercise
appeared to have a decisive impact in allieving her catastrophizing sequence.

“Time Interpolation”

Next, we illustrate this “Time Interpolation” technique with a 32-year-old

married Caucasian woman who had been in treatment for several months. This
young woman suffered from comorbid social anxiety disorder and depression, as
well as an unspecified DSM Axis II disorder. She was a paralegal and was
“panicking” about a presentation she had to give in two days to 40 attorneys,
whom she regarded as “critical and confrontational.” She reported that she
“would hate to be embarrassed and doesn’t talk well in front of people.” The
therapist asked her to generate mental images of herself and the audience prior
to and during the course of the presentation to outline the following sequence of
events: (a) She would become anxious just before speaking, (b) she would say
things she shouldn’t and jump around illogically or say things unclearly, (c) the
attorneys would frown and ask questions, (d) she would be unable to answer
these well, (e) they would look confused and displeased with her answers, and (f)
she would be humiliated and embarrassed.
The therapist slowed down the progression from one step in the sequence
to the next to increase her confidence. She was asked to imagine the
beginning of the sequence, where she first feared she would begin to feel
anxious. Then she was instructed to imagine that time stretched out infinitely
from this point to the next point in the sequence described so that she had
more than sufficient time to consider ways to cope with the events. This was
repeated for each step, as shown below.

Therapist: Now let’s slow down the movement from each scene to the next. Imagine
that once you notice you are feeling anxiety as you start your presentation, it is as if
you have forever to figure out how to handle your anxiety before it leads to anything
else. You have infinite time. And when that happens, you have forever to figure out
how to handle the next step before it leads to the next thing you fear will happen.

For example, she came to a point in this imagery exercise where she
imagined beginning to give her talk and saying things she shouldn’t or
156 Riskind, Rector, and Taylor

“jumping around.” She was asked here to picture herself having forever to
notice she was about to do it, remind herself how to handle it, and get back
on task. Similarly, when the point in the sequence was reached where she
imagined the attorneys start to ask questions, she imagined time as slowing
down so that she had forever after they asked each question to think of
appropriate responses. In the next step in the sequence, she pictured herself
as having infinite time to come up with answers when she imagined the
attorneys looking at her, confused and displeased with her answers.
She reported much less anxiety at the end of the exercise and said that her
presentation had gone well, despite a problem with her PowerPoint presen-
tation. In our view, this can be taken to mean that the intervention promoted
cognitive restructuring that helped her to approach her presentation with a
sense of greater control.

Tailoring Methods to the Unique Circumstances of Patients

The following example illustrates how therapists can think through and
flexibly tailor looming reduction to a range of circumstances. The patient, a
21-year-old Caucasian college student, was catastrophizng about an upcom-
ing tap-dancing performance for a class in her major (Riskind et al., 2005).
She suffered from overwhelming anxiety that she would be publicly humil-
iated and lose her academic scholarship because she failed her performance.
Despite four sessions of standard CBT, including a standard decatastrophiz-
ing approach to test distortions in the probability and cost of the outcomes in
her beliefs and image, she remained extremely anxious.
By the end of the fourth session, it was apparent that standard cognitive–
behavioral approaches were not working. Probing her images and fears, the
therapist learned that she feared that the dance would progress at such a rapid
pace that she could not keep up with the steps of the other dancers. Thus, she
imagined that she would fail and be humiliated because she would fall
increasingly further behind the steps of the other dancers, resulting in loss of
her academic scholarship. Before the next session with the patient, the
therapist and supervisor tailored an imagery-based, looming-reduction inter-
vention for her problems. At the following session, she was instructed to first
picture herself running through her steps in “real time,” which was defined as
the speed with which she would normally dance her routine. This normal
speed was designated as a velocity of 65 mph. Next, she was instructed to
imagine herself dancing at 5 mph, which would be “so slow and deliberate
that it would barely resemble movement at all.” To ensure sufficient task
immersion, she was instructed to imagine impersonal details in the environ-
ment, such as the particular people dancing and other elements of the room
Looming Vulnerability 157

in which she would eventually perform. As she pictured herself dancing at a

slowed down pace of 5 mph, she was asked to identify the names of the
particular moves and steps she was about to perform to instill an anchoring
point in which there was a degree of confidence and personal efficacy. She
reported that she felt that it was very easy to dance at this speed because
she had time to think about what her next step would be before she had to
execute it.
The patient was then instructed to imagine increasing her speed by
10-mph increments and to stay at any velocity until she felt “confident and
comfortable” at that speed. On reaching 65 mph (normal speed), she de-
scribed herself as confident that she could dance through the performance
quite well with few, if any, errors. Next, she was instructed to continue
increasing her speed by 10-mph increments. At 95 mph, she described her
feet as “muddy,” and on reaching 115 mph, she described her images as
“jerky, puppet-like dancing” and felt she was struggling to “stay in step” and
“really messing it up.” The imagery method then involved suggesting that she
imagine herself becoming lighter, each step was becoming “springy and
light” and that the sounds of her taps were as “sharp as a tack.” She was asked
to imagine that she could actually hear each of her individual steps in a
well-defined manner until she reached 95 mph. On processing the experience,
she reported that imagining herself dancing at excessively high speeds
significantly reduced her anxiety about the upcoming performance. As the
client phrased it, “if I can do it at that speed, then 65 mph is no problem.” She
reported greater confidence and subsequently said that her dance performance
turned out well.

DISCUSSION

Several possible questions about the limitations of looming-reduction

strategies should be briefly noted. It is possible that these strategies could
become troublesome if patients were to simply use them as safety behaviors
or repeat words or practice images without believing them. For patients who
were to simply use methods as ways of avoiding immediate feelings of
anxiety without doing further therapeutic work and changing danger beliefs,
looming reduction could have only transient, limited benefit. Looming re-
duction could also become a problem in its own right if it were to develop
into compulsive behavior by OCD patients. Therapists must obviously mon-
itor such potential risks.
One might wonder whether looming reduction simply represents a form
of thought stopping, but there is a clear distinction between them. In thought
stopping, for example, patients are taught to deliberately suppress anxiety-
158 Riskind, Rector, and Taylor

evoking thoughts, perceptions, and images. In looming reduction, in contrast,

patients are taught methods for slowing down threat progression while
keeping thoughts, perceptions, and images in mind. Furthermore, in looming
reduction, therapists and patients engage in Socratic questioning of thoughts,
which involves keeping such thoughts in the forefront of the mind and
eliciting even more thoughts.
One might also wonder whether looming reduction is at variance with a
behavioral model in which flooding and the intensification of anxiety are
necessary for real therapeutic change and habituation. From a cognitive
perspective, however, exposure works by producing changes in beliefs or
harm expectancies, and flooding may not be necessary (Salkovskis, 1991;
Wells et al., 1995). Looming reduction is regarded as a cognitively oriented
set of strategies for providing new information for restructuring and changing
beliefs, and not just habituation through flooding.
It could also be reasonably questioned whether looming reduction is
applicable to all anxiety disorders. In principle, at least, looming reduction is
relevant to all anxiety disorders, because all anxiety and fears center on the
dread of events that might happen, but have not happened yet. For example,
even in the case of PTSD, there is a component of future looming threat along
with past traumatization. Beck (1976) observed that “when such patients are
questioned, it is evident that they intermittently . . . reexperience an event in
which danger was imminent” (p. 141). As noted earlier, abnormal OCD-
related fears of contamination are related to exaggerated perceptions of the
rapid spread of contamination (Riskind & Rector, 2007; Tolin et al., 2004).
In a similar way, OCD-relevant fears of lack of symmetry and order are
related to distortions of the rapid pace of progression of dire consequences of
asymmetry and disorder, and hoarding symptoms are related to distortions of
the rapidly rising need for possessions that would be discarded (Scott, 2010).
According to the metacognitive model of emotional disorders (Wells, 2000),
beliefs about rituals—such as their efficacy in prevent anxiety or other
adverse consequences— drive such behaviors as well as symptoms. Thus,
from a looming vulnerability perspective, specific looming themes about the
rapid approach of consequences that will ensue if rituals are not performed
would be expected to figure as important. Nevertheless, it is clear that the
applicability of looming reduction requires much further examination. It is
conceivable that the model is not as well suited for understanding some forms
of anxiety or fear. For instance, one could ask whether it applies when
something damaging is already here. For example, one has a serious disease,
a house that has been foreclosed, or chronic anxiety and panic that don’t
abate. However, it is plausible to suppose in such cases that there is fear about
damage that is still yet to come. Finally, it will be important to examine
factors such as personality differences, the severity of psychopathology, or
Looming Vulnerability 159

deeply ingrained defenses that may constrain the applicability of looming

reduction.

REFERENCES

Adler, A. D., & Strunk, D. R. (2010). Looming maladaptive style as a moderator of risk factors
for anxiety, Cognitive Therapy and Research, 34, 59 – 68.
Anderson, M. L. (2010). Neural reuse: A fundamental organizational principle of the brain.
Behavioral and Brain Science, 33, 245–313.
Aspinwall, L. G., & Taylor, S. E. (1997). A stitch in time: Self-regulation and proactive coping.
Psychological Bulletin, 121, 417– 436.
Bach, D. R., Neuhoff, J. G., Perrig, W., & Seifritz, E. (2009). Looming sounds as warning
signals: The function of motion cues. International Journal of Psychophysiology, 74,
28 –33.
Bach, D. R., Schachinger, H., Neuhoff, J. G., Esposito, F., Di Salle, F., Lehmann, C., . . .
Seifritz, E. (2008). Rising sound intensity: An intrinsic warning cue activating the
amygdala. Cerebral Cortex, 18, 145–150.
Ball, W., & Tronick, E. (1971). Infant response to impending collision: Optical and real.
Science, 171, 818 – 820.
Baumeister, R. F., & Bratslavsky, E. (1999). Passion, intimacy, and time: Passionate love as a
function of change in intimacy. Personality and Social Psychology Review, 3, 49 – 67.
Beck, A. T. (1976). Cognitive therapy and emotional disorders. New York, NY: International
Universities Press.
Black, D., Riskind, J. H., & Kleiman, E. M. (2010). Lifetime history of anxiety and mood
disorders predicted by cognitive vulnerability to anxiety. International Journal of Cog-
nitive Therapy, 3, 215–227.
Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized
anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized
anxiety disorder: Advances in research and practice (pp. 77–108). New York, NY:
Guilford Press.
Brickman, P., Coates, D., & Janoff-Bulman, R. (1978). Lottery winners and accident victims:
Is happiness relative? Journal of Personality and Social Psychology, 36, 917–927.
Brown, M. A., & Stopa, L. (2008). The looming maladaptive style in social anxiety. Behavior
Therapy, 39, 57– 64.
Card, G., & Dickenson, M. H. (2008). Visually mediated motor planning in the escape response
of Drosophila. Current Biology, 18, 1300 –1307.
Carver, C. S., & Scheier, M. F. (1990). Origins and functions of Positive and Negative Affect:
A control-process view. Psychological Review, 97, 19 –35.
Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders: Science and
practice. New York, NY: Guilford Press.
Davis, J. I., Gross, J. J., & Ochsner, K. N. (2011). Psychological distance and emotional
experience: What you see is what you get. Emotion, 11, 438 – 444.
Dorfin, N. M., & Woody, S. R. (2006). Does threatening imagery sensitize distress during
contaminant exposure? Behaviour Research and Therapy, 44, 395– 413.
Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety
disorder: From science to practice. New York, NY: Routledge.
Elwood, L. S., Riskind, J. H., & Olatunji, B, O. (2011). Looming vulnerability: Incremental
validity of a fearful cognitive distortion in contamination fears. Cognitive Therapy and
Research, 35, 40 – 47.
160 Riskind, Rector, and Taylor

Elwood, L. S., Williams, N. L., Olatunji, B. O., & Lohr, J. M. (2007). Interpretation biases in
victims and non-victims and their relation to symptom development. Journal of Anxiety
Disorders, 21, 554 –567.
Ghazanfar, A. A., & Maier, J. X. (2009). Rhesus monkeys (Macaca mulatta) hear rising
frequency sounds as looming. Behavioral Neuroscience, 123, 822– 827.
Ghazanfar, A. A., Neuhoff, J. G., & Logothetis, N. K. (2002). Auditory looming perception in
rhesus monkeys. Proceedings of the National Academy of Sciences, USA, 99, 15755–
15757.
Gray, J. A. (1987). Psychology of fear and stress (2nd ed.). Cambridge, UK: Cambridge
University Press.
Griffiths, T. D., Bench, C. J., & Frackowiak, R. S. (1994). Human auditory looming perception
in rhesus monkeys. Proceedings of the National Academy of Sciences, 99, 15755–15757.
Gwilliam, G. F. (1963). The mechanism of the shadow reflex in cirripedia: I. Electrical activity
in the supraesophageal ganglion and ocellar nerve, Biological Bulletin, 125, 470 – 485.
Haikal, M., & Hong, R. Y. (2010). The effects of social evaluation and looming threat on
self-attentional biases and social anxiety. Journal of Anxiety Disorders, 24, 345–352.
Helson, H. (1964). Adaptation-level theory. New York, NY: Harper & Row.
Hofmann, S. G., & Smits, A. J. (2008). Cognitive behavioral therapy for adult anxiety
disorders: Meta-analysis of random placebo-controlled trials. Journal of Clinical Psychol-
ogy, 69, 621– 632.
Hsee, C. K., & Abelson, R. P. (1990). The velocity relation: Satisfaction as a function of the
first derivative of outcome over time. Journal of Personality and Social Psychology, 60,
341–347.
Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk.
Econometrica, 47, 263–291.
Kayed, N. S., & Van der Meer, A. (2007). Infants’ timing strategies to optical collisions: A
longitudinal study. Infant Behavior & Development, 30, 50 –59.
Landau. M. J., Meier, B. P., & Keefer, L. A. (2010). A metaphor-enriched social cognition.
Psychological Bulletin, 136, 1045–1067.
Langer, J., Wapner, S., & Werner, H. (1961). The effect of danger upon the perception of time.
American Journal of Psychology, 74, 94 –97.
Langer, J., Werner, H., & Wapner, S. (1965). Apparent speed of walking under conditions of
danger. Journal of General Psychology, 73, 291–298.
Miles, L. K., Nind, L. K., & Macrae, C. N. (2010). Moving through time. Psychological
Science, 21, 222–223.
Mühlberger, A., Neumann, R., Wieser, M. J., & Pauli, P. (2008). The impact of changes in
spatial distance on emotional responses. Emotion, 8, 192–198.
Niedenthal, P. M., Barsalou, L. W., Winkielman, P., Krauth-Gruber, S., & Ric, F. (2005).
Embodiment in attitudes, social perception, and emotion. Personality and Social Psychol-
ogy Review, 9, 184 –211.
Ortony, A., Clore, G. L., & Collins, A. (1988). The cognitive structure of emotions. Cambridge,
UK: Cambridge University Press.
Rachman, S. J., & Cuk, M. (1992). Fearful distortions. Behaviour Research and Therapy, 30,
583–589.
Reardon, J. M., & Williams, N. L. (2007). The specificity of cognitive vulnerabilities to
emotional disorders: Anxiety sensitivity, looming vulnerability and explanatory style.
Journal of Anxiety Disorders, 21, 625– 643.
Rector, N. A., Kamkar, K., & Riskind, J. H. (2008). Misappraisal of time perspective and
suicide in the anxiety disorders: The multiplier effect of looming illusions. International
Journal of Cognitive Therapy, 1, 69 –79.
Riskind, J. H. (1997a). Looming vulnerability to threat: A cognitive paradigm for anxiety,
Behaviour Research and Therapy, 35, 685–702.
Looming Vulnerability 161

Riskind, J. H. (1997b). Generalized anxiety disorder. In R. Leahy (Ed.), Practicing cognitive

therapy: A guide to interventions (pp. 123–149). Northvale, NJ: Jason Aronson.
Riskind, J. H., Abreu, K., Strauss, M., & Holt, R. (1997). Looming vulnerability to spreading
contamination in subclinical OCD. Behaviour Research and Therapy, 35, 405– 414.
Riskind, J. H., Black, D., & Shahar, G. (2010). Cognitive vulnerability to anxiety in the stress
generation process: Interaction between the looming cognitive style and anxiety sensitiv-
ity. Journal of Anxiety Disorders, 24, 124 –128.
Riskind, J. H., Hughes, M., Williams, N. L., Joiner, T. E., & Cortina, J. (2009). Looming
cognitive style: Psychometric distinctiveness and incremental predictive specificity to
anxiety and not depression. Manuscript in preparation, George Mason University,
Fairfax, VA.
Riskind, J. H., Kelly, K., Moore, R., Harman, W., & Gaines, H. (1992). The looming of danger:
Does it discriminate focal phobia and general anxiety from depression? Cognitive Therapy
and Research, 16, 1–20.
Riskind, J. H., & Kleiman, E. (2009). Looming vulnerability and fears of biological terrorism.
Unpublished manuscript, George Mason University, Fairfax, VA.
Riskind, J. H., Long, D., Duckworth, R., & Gessner, T. (2005). Clinical case study: Clinical use
of the looming vulnerability construct for social performance anxiety in a dance recital.
Journal of Cognitive Psychotherapy, 18, 361–366.
Riskind, J. H., & Maddux, J. E. (1993). Loomingness, helplessness, and fearfulness: An
integration of harm-looming and self-efficacy models of fear and anxiety. Journal of
Social and Clinical Psychology, 12, 73– 89.
Riskind, J. H., & Maddux, J. E. (1994). The loomingness of danger and the fear of AIDS:
Perceptions of motion and menace. Journal of Applied Social Psychology, 24, 432– 442.
Riskind, J. H., Moore, R., & Bowley, L. (1995). The looming of spiders: The fearful perceptual
distortion of movement and menace. Behaviour Research and Therapy, 33, 171–178.
Riskind, J. H., & Rector, N. A. (2007). Beyond belief: Incremental prediction of OCD by
looming vulnerability illusions. Journal of Cognitive Psychotherapy, 21, 243–256.
Riskind, J. H., Rector, N. A., & Cassin, S. E. (2011). Examination of the convergent validity
of looming vulnerability in the anxiety disorders. Journal of Anxiety Disorders, 25,
989 –993.
Riskind, J. H., Tzur, D.,Williams, N., Mann, B., & Shahar, G. (2007). Short-term predictive
effects of the looming cognitive style on anxiety disorder. Behaviour Research and
Therapy, 45, 1765–1777.
Riskind, J. H., & Wahl, O. (1992). Moving makes it worse: The role of rapid movement in fear
of psychiatric patients. Journal of Social and Clinical Psychology, 11, 349 –364.
Riskind, J. H., Wheeler, D. J., & Picerno, M. R. (1997). Using mental imagery with subclinical
OCD to “freeze” contamination in its place: Evidence for looming vulnerability theory.
Behaviour Research and Therapy, 35, 757–768.
Riskind, J. H., & Williams, N. L. (1999). Cognitive case conceptualization and the treatment
of anxiety disorders: Implications of the looming vulnerability model. Journal of Cogni-
tive Psychotherapy, 13, 295–316.
Riskind, J. H., & Williams, N. L. (2005). A unique vulnerability common to all anxiety
disorders: The looming maladaptive style. In L. B. Alloy & J. H. Riskind (Eds.), Cognitive
vulnerability to emotional disorders. Mahwah, NJ: Erlbaum.
Riskind, J. H., Williams, N. L., Gessner, T., Chrosniak, L. D., & Cortina, J. (2000). The
looming maladaptive style: Anxiety, danger, and schematic processing. Journal of Per-
sonality and Social Psychology, 79, 837– 852.
Riskind, J. H., Williams, N. L., & Joiner, T. E. (2006). A unique overarching vulnerability for
the anxiety disorders: The looming maladaptive style. Journal of Social and Clinical
Psychology, 25, 779 – 801.
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and
panic: A cognitive account. Behavioral Psychotherapy, 19, 6 –19.
162 Riskind, Rector, and Taylor

Schiff, W., Caviness, J. A., & Gibson, J. J. (1962). Persistent fear responses in rhesus monkeys
to the optical stimulus of “looming”. Science, 15, 982–983.
Schiff, W., & Oldak, R. (1990). Accuracy of judging time to arrival: Effects of modality,
trajectory, and gender. Journal of Experimental Psychology, Human Perception, and
Performance, 16, 303–316.
Scott, M. N. (2010). The role of the looming cognitive style as a cognitive vulnerability to
obsessive-compulsive symptoms. Dissertation Abstracts International: Section B: The
Sciences and Engineering, 71, 1354.
Tajadura-Jiménez, A., Väljamäe, A., Asutay, E., & Västfjäll, D. (2010). Embodied auditory
perception: The emotional impact of approaching and receding sound sources. Emotion,
10, 216 –229.
Taylor, S. (2006). Clinician’s guide to PTSD: A cognitive-behavioral approach. New York,
NY: Guilford Press.
Tolin, D. F., Worhunsky, P., & Maltby, N. (2004). Sympathetic magic in contamination-related
OCD. Journal of Behavior Therapy and Experimental Psychiatry, 35, 193–205.
Tzur-Bitan, D., Meiran, N., Steinberg, D., & Shahar, G. (in press). Role of the looming
maladaptive style in major depression– generalized anxiety comorbidity: A time-series
analysis. International Journal of Cognitive Therapy.
Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy.
Chichester, UK: Wiley.
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995). Social
phobia: The role of in-situation safety behaviors in maintaining anxiety and negative
beliefs. Behavior Therapy, 26, 153–161.
Wells, A., & King, P. (2006). Metacognitive therapy for generalized anxiety disorder: An open
trial. Journal of Behavior Therapy and Experimental Psychiatry, 37, 206 –212.
Williams, N. L. (2000). The cognitive interactional model of appraisal and coping: Implica-
tions for anxiety and depression (Doctoral dissertation). George Mason University,
Fairfax, VA.
Williams, N. L., Olatunji, B. O., Elwood, L. S., Connolly, K. M., & Lohr, J. M. (2006).
Cognitive vulnerability to disgust: Development and validation of the Looming of Disgust
Questionnaire. Anxiety, Stress, and Coping, 19, 365–382.
Williams, N. L., Riskind, J. H., Olatunji, B. O., & Elwood, L. S. (2004). Cognitive vulnerability
to anxiety and information processing: Implications of the Looming Maladaptive Style.
Unpublished manuscript, University of Arkansas, Fayetteville, AR.
Williams, N. L., Shahar, G., Riskind, J. H., & Joiner, T. E. (2004). The looming maladaptive
style predicts shared variance in anxiety disorder symptoms: Further support for a
cognitive model of vulnerability to anxiety. Journal of Anxiety Disorders, 19, 157–175.

Received June 15, 2011

Revision received February 28, 2012
Accepted February 29, 2012 䡲