Cognitive behavioral therapy for anxiety-related dizziness

Patients with chronic subjective dizziness (CSD) that is related to anxiety may substantially benefit from a short course of cognitive behavioral therapy (CBT), report researchers.

Furthermore, such benefits may not only occur immediately after treatment but may be maintained for 1 to 6 months afterwards, say Alison Mahoney (St Vincent's Hospital, New South Wales, Australia) and colleagues.

In a study including 44 patients who were referred for CSD treatment for unexplained dizziness, 43.2% met current standard criteria for generalized anxiety disorder, 36.4% for major depressive disorder, 38.6% for panic disorder, 6.8% for dysthymia, and 2.3% for social phobia, while 20.5% did not meet criteria for any disorder.

"As CBT is an effective treatment for anxiety disorders, it has potential application in the treatment of anxiety-related dizziness," explain Mahoney et al.

Treatment involved three weekly sessions providing education about dizziness, behavioral experiments regarding the impact of attention on dizziness symptoms, exercises aimed at reducing avoidance and safety behaviors, strategies for responding to dizziness, and encouragement to resume normal lifestyle regardless of the presence of dizziness symptoms.

As reported in the American Journal of Otolaryngology, analysis of patients' questionnaire data showed significant improvements immediately after treatment in scores for the Dizziness Symptoms Inventory, the Dizziness Handicap Inventory, and the Safety Behaviors Inventory, compared with before treatment.

Consistent with the researchers' hypothesis, these effects were maintained at 1 and 6 months post-treatment. "Effects sizes from pre-treatment to 6 months follow-up for reductions in dizziness symptoms, disability, and functional impairment were large," they say.

Furthermore, the reduction in physical symptoms and related disability observed in the current study was comparable to those reported for other treatments, including selective serotonin reuptake inhibitors and vestibular rehabilitation. "However, they were achieved following a very brief and noninvasive treatment," points out the team.

Mahoney et al also report that baseline anxiety scores were the best predictor for longer-term disability, while the severity of pre-treatment dizziness symptoms or avoidance behaviors were not significant predictors.

"As patients with high levels of pretreatment anxiety showed higher levels of disability at 6 months post treatment, it is possible that interventions that target anxiety in a more focused way could further improve long-term treatment outcomes," concludes the team.

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