title: Looming threat-processing style in a cancer cohort.
abstract: OBJECTIVE
  Looming threat-processing style, where threats are perceived to be progressing (looming) at a frightening velocity, is implicated in anxiety vulnerability. This study aims to validate a new measure of looming, the looming cancer, and explore its clinical correlates in a chronic lymphocytic leukemia (CLL) cohort.
  
  
  METHODS
  In a cross-sectional design, 105 CLL patients completed the Looming Cancer Scale, Looming Cognitive Style Questionnaire (LCSQ), SF-36, Beck Anxiety Inventory (BAI) and Beck Depression Inventory II (BDI-II).
  
  
  RESULTS
  Exploratory factor analysis reduced the 20-item Looming Cancer Scale to a 10-item version, which demonstrated good psychometric properties (Cronbach's alpha=.926). Convergent validity was demonstrated by Pearson correlation with the LCSQ (0.418), BAI (0.380), BDI-II (0.336) and the mental component score of the SF-36 (-0.434) (all P<.001). Divergent validity was demonstrated by a lack of correlation with the SF-36 physical component score and cross tabulation frequencies of high and low loomers. High vs. low loomers showed significantly more anxiety (31% vs. 13%), depression (23% vs. 2%) and mixed anxiety-depression (18% vs. 2%). An area under the receiver operating characteristic curve analysis revealed high sensitivity (82%) and specificity (69%) in detecting mixed anxiety-depression using a cutoff score of >/=20/30.
  
  
  CONCLUSIONS
  The Looming Cancer Scale is a valid measurement of looming cognitive style and is the first time that the looming construct has been studied in a cancer cohort. The importance of this research lies in its potential to identify populations vulnerable to developing anxiety, depression and mixed anxiety-depression symptoms.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. levint@mskcc.org
authors.forename: Tomer T
authors.initials: TT
authors.lastname: Levin
authors.forename: John H
authors.initials: JH
authors.lastname: Riskind
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Li
mesh_terms: D000328:Adult; D000339:Affect; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D003071:Cognition; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000453:epidemiology* / Q000523:psychology*; D008297:Male; D011594:Psychometrics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires