Taking Back Control: The Power of Cognitive Behavioral Therapy (CBT) in Managing Chronic Dizziness Instability and recurrent or persistent vertigo are worrying conditions that can lead to leading to loss of confidence, fear of falling and social isolation. Simple activities like crossing the street or going up an escalator require body movement, and looking at moving objects can aggravate loss of balance. The balance system in the inner ear and its connections with the brain and other parts of the body are responsible for stabilizing the body. Many disorders of the inner ear can lead to vertigo, such as BPPV, where crystals become dislodged, or a viral infection of the balance nerve (vestibular neuritis). Some people continue to feel unsteady even after the main cause of dizziness has been controlled. People with chronic illnesses often develop automatic negative thoughts such as “I will never get better,” “There is no cure,” or “There is nothing I can do.” Prolonged dizziness can lead to the development of dysfunctional reactions such as fear or loss of vigilance when thinking about triggers, which can increase their dizziness. Cognitive behavioral therapy (CBT) delivered by trained psychologists is a valuable adjunct to the management of recurrent or persistent vertigo.
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In CBT, therapists empower patients to understand the connection between “what your thoughts are”, “how they make you feel”, and “how they influence your behaviour”. regarding balance issues. The goal is to replace negative thinking patterns by creating alternative belief formulations that allow them to think about their symptoms more positively. After weeks of CBT, patients gain the strength to replace disabling thoughts and worst-case thinking patterns with more functional thinking patterns, allowing them to learn new ways to perform activities that are being avoided. CBT works on a foundation of cognitive restructuring, motivating patients to challenge negative thinking patterns, avoid anticipating negative consequences, and change their dysfunctional responses to control balance more confidently. Persistent postural cognitive vertigo (PPPD) is a common chronic balance disorder characterized by persistent vestibular symptoms such as postural instability or a feeling of swaying, which is aggravated by when standing upright, moving the body or moving the visual field such as in crowded areas. This condition has shown remarkable functional recovery when the treatment plan includes CBT.
How does cognitive behavioral therapy help treat chronic vertigo?
1. Understand the triggers for vertigo: The first step in dealing with vertigo is to determine what causes it. These can be specific movements, environments, or even stressful situations. By accurately identifying these triggers, you can learn how to better manage them.2. Create replacement beliefs: CBT teaches you to replace negative thoughts with more positive and realistic ones. For example, instead of thinking “I will never get better,” you can think “I am taking steps to control my vertigo.” This change in thinking can reduce anxiety and fear related to vertigo. Patients can also learn coping strategies such as distraction techniques or positive self-talk through CBT.3. Relaxation techniques: CBT teaches progressive muscle relaxation techniques and deep breathing techniques to activate the parasympathetic nervous system. These techniques can help calm your body’s response to symptoms of vertigo, making them less intense and easier to handle.4. Exposure therapy: This involves gradually exposing yourself to situations that cause vertigo but in a controlled and safe way. Over time, exposure therapy can help desensitize you to these triggers, reducing the frequency and severity of vertigo attacks.5. Build confidence: Dizziness can shake your confidence and make you feel vulnerable. You can regain your confidence through CBT by learning coping skills and strategies to manage your symptoms effectively. CBT can be conducted as exercise sessions or online via video call. It is important to remember that CBT sessions, with their proven effectiveness, take at least 4-6 weeks to bring about significant positive changes in your life. If you suffer from chronic dizziness, remember that you are not alone. CBT, with a trained psychologist, can be a powerful tool on your journey to finding balance and regaining control of your life. (Author details: Dr. Anita Bhandari, Neurologist, ENT surgeon, Director of NeuroEquilibrium, (Neuro Equilibrium is the world’s largest research) chain of dizziness and vertigo clinics.) and Dr. Anushka Bhandari is the head of R&D at NeuroEquilibrium)
