A Cognitive-Behavioural Model of Persistent Postural-Perceptual Dizziness

Persistent postural-perceptual dizziness (PPPD; previously termed chronic subjective dizziness) is a frequently observed disorder in patients who present with dizziness to Audiology, Ear Nose and Throat, or Neurology clinics. The primary symptoms are persistent non-vertiginous dizziness, and hypersensitivity to motion and visual stimuli. These occur ether in the absence of any active neuro-otologic illness or, where an episodic vestibular disorder exists, symptoms cannot be fully explained by the disorder alone. Diagnosis is necessarily multidisciplinary and proceeds by identification of primary symptoms and exclusion of other neurological or active medical disorders requiring treatment. Psychological processes are implicated in the development and maintenance of PPPD, with similarities to cognitive models of health anxiety and panic
disorder, and there is evidence that cognitive behavioural therapy is an effective treatment.
A cognitive behavioural model of PPPD is presented along with a case example. It is suggested that dizziness becomes persistent when it is processed as a threat, and that it is maintained by: (1) unhelpful appraisals, (2) avoidance and safety behaviours, and (3) attentional strategies including selective attention to body
sensations associated with dizziness. Once PPPD is identified techniques for its effective treatment fall within the skills mix of qualified cognitive behavioural therapists or vestibular clinical scientists who have received additional training in cognitive and behavioural treatment.