Treatment of phobic postural vertigo

Abstract

In balance clinic practice, phobic postural vertigo is a term used to define a population with dizziness and avoidance behavior
often as a consequence of a vestibular disorder. It has been described as the most common form of dizziness in middle aged
patients in dizziness units. Anxiety disorders are common among patients with vestibular disorders. Cognitive–behavioral therapy
is an effective treatment for anxiety disorders, and vestibular rehabilitation exercises are effective for vestibular disorders.
This study compared the effect of additional cognitive–behavioral therapy for a population with phobic postural vertigo with
the effect of self–administered vestibular rehabilitation exercises.

39 patients were recruited from a population referred for otoneurological investigation. Treatment effects were evaluated
with the Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression
Scale. All patients had a self treatment intervention based on education about the condition and recommendation of self exposure
by vestibular rehabilitation exercises. Every second patient included was offered additional cognitive behavioral therapy.

Fifteen patients with self treatment and 16 patients with cognitive– behavioral treatment completed the study. There was significantly
larger effect in the group who received cognitive behavioral therapy than in the self treatment group in Vertigo Handicap
Questionnaire and the Hospital Anxiety and Depression scale and its subscales.

Cognitive–behavioral therapy has an additional effect as treatment for a population with phobic postural vertigo.A multidisciplinary
approach including medical treatment, cognitive–behavioral therapy and physiotherapy is suggested.