The added efficacy of cognitive behavioral therapy in the rehabilitation of persistent postural perceptual dizziness

Introduction The chronic subjective dizziness (CSD) or the unexplained dizziness is known as PPPD since 2007, when Ruckenstein declared the new acronym. This disorder incorporates a long-lasting clinical condition that presents the main characteristics of ongoing non-specific dizziness that cannot be accounted for by any existing medical issue. Vestibular rehabilitation exercises proved effective in the management of different vestibular disorders. Methods 80 patients diagnosed with PPPD were divided into two groups that were matched in age and gender. 40 patients were included in each group. Group I was rehabilitated using the vestibular rehabilitation exercises (VRT) protocol, and group II was rehabilitated using the combined cognitive behavioral therapy/ vestibular rehabilitation therapy (CBT/VRT) protocol. An assessment was done before the start of the program, once during the program, and after finishing the rehabilitation schedule using the dizziness handicap inventory (DHI) and vertigo symptom scale (VSS-SF) scales. Results Non-statistically significant differences were found between groups as regards demographic data and the pre-rehabilitation impact of dizziness, as noted from DHI and VSS-SF results. 6 weeks after the start of the program, improvement of the physical and total score of DHI was noted in group I, while in group II, the emotional sub-score was also significantly improved. At the end, improvement of all scores was reported with the added effect of CBT to VRT noted in the significant improvement of emotional and anxiety sub-scales. Conclusions CBT could be of help in alleviating anxiety usually accompanying dizziness, and hence can be used effectively in patients with PPPD.