Effects of Cognitive Behavior Therapy on Persistent Postural-Perceptual Dizziness

Abstract

Cognitive behavior therapy (CBT) is a recommended treatment option for persistent postural-perceptual dizziness (PPPD). However, evidence of its efficacy is insufficient. This study examined the therapeutic effects of CBT for PPPD. We conducted the study from October 2020 to September 2021. The subjects were 13 patients who had been diagnosed as having PPPD (aged 20 years or older; mean age 45.5 years; range 20 to 78 years) and who wished to undergo CBT because conventional medical treatments and vestibular rehabilitation had been ineffective. Seven patients had preceding vestibular disorders. Four had taken selective serotonin reuptake inhibitors (SSRI) for comorbid psychiatric disorders before their first visit to our hospital. We designed a CBT intervention for PPPD that consisted of eight sessions. A clinical psychologist conducted the intervention once or twice a month for approximately 40 minutes a session. We compared the patients’ scores on the Dizziness Handicap Inventory (DHI), the Hospital Anxiety and Depression Scale (HADS), the State-Trait Anxiety Inventory (STAI), and the Cognitive Bias Scale (CBS) before and after the eight CBT intervention sessions. The DHI-P (physical) and STAI scores improved significantly after CBT. Among the six CBS items, fortune teller error, should thinking, mind reading, and personalization improved significantly after CBT. We concluded that CBT is effective for PPPD and reduces patients’ coexisting anxiety.