Cognitive-Behavioral Therapy (CBT) for Two Patients with Persistent Postural- Perceptual Dizziness (PPPD)

Abstract

We report two patients with Persistent Postural- Perceptual Dizziness (PPPD) who were successfully treated by Cognitive Behavioral Therapy (CBT) after initially showing limited responses to vestibular rehabilitation and pharmacotherapy. The vestibular symptoms and psychiatric status were evaluated by the Dizziness Handicap Inventory (DHI) and Hospital Anxiety and Depression Scale (HADS), respectively, before and after six sessions of biweekly CBT intervention. The difficulties and abilities in handling activities of daily living as assessed by medical interviews improved in both patients, suggesting the effectiveness of CBT for PPPD. However, the results of assessment by the DHI/HADS differed between the two patients. Patient 1 showed improvement in the score on the DHI, but not in that on the HADS, whereas Patient 2 showed improvement in the score on the HADS, but not on that in the DHI. Given that both the patients reported improvements in the difficulties and abilities in handling the activities of daily living, we consider that the different results of assessment by the DHI may suggest the need for use of more appropriate measures to evaluate the quality of life after CBT than the DHI. These results might also suggest that CBT may not always exert equal effects on the psychiatric status and vestibular symptom status.