Cognitive Case Conceptualization and Treatment of Anxiety Disorders: Implications of the Looming Vulnerability Model

This article describes an approach to cognitive case conceptualization and treatment that is based on the “looming vulnerability” model of anxiety. The model assumes that much of what produces anxiety for people in everyday life, as well as in cases of pathological anxiety, is “looming” from their point of reference, or changing dynamically and step-by-step in time to become increasingly risky. That is, they have a “sense of looming vulnerability” to threat—perceptions of threat as moving toward an endpoint or rapidly rising in risk. Anxious individuals manifest biases in their primary cognitive appraisals (a painful sense that perceived threats are rapidly approaching, changing, or escalating in risk), and in consequence, feel “pressed” to urgently cope with or neutralize the looming threat. The net result of their sense of urgency is that they often select maladaptive, rigid coping strategies (e.g., avoidance and escape) and underestimate their personal efficacy to effectively deal with the oncoming dynamic threats (i.e., biased secondary appraisal). We suggest that anxiety is often based on dynamic, story-like scripts, called progressive threat scripts. The present article identifies several ways that cognitive therapists can conceptualize, identify, and modify features of patients’ mental simulations of present or developing threat (i.e., distance, motion, speed, and perspective). The article also addresses several features of anxious patients’ response to threat that are relevant to cognitive case conceptualization and treatment (i.e., generating alternative simulations, time structuring, proactive coping, and the enhancement of dynamic personal efficacy for dealing with rapidly rising risk).