Journal of Neurology

, 254:1189 | Cite as

One-year follow-up of cognitive behavioral therapy for phobic postural vertigo

  • Johan HolmbergEmail author
  • Mikael Karlberg
  • Uwe Harlacher
  • Måns Magnusson



Phobic postural vertigo is characterized by dizziness in standing and walking despite normal clinical balance tests. Patients sometimes exhibit anxiety reactions and avoidance behavior to specific stimuli. Different treatments are possible for PPV, including vestibular rehabilitation exercises, pharmacological treatment, and cognitive behavioral therapy. We recently reported significant benefits of cognitive behavioural therapy for patients with phobic postural vertigo. This study presents the results of a one-year follow-up of these patients.


Swedish translations of the following questionnaires were administered: (Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale) were administered to 20 patients (9 men and 11 women; mean age 43 years, range 23–59 years) one year after completion of cognitive behavioral therapy.


Test results were similar to those obtained before treatment, showing that no significant treatment effects remained.


Cognitive behavioral therapy has a limited long-term effect on phobic postural vertigo. This condition is more difficult to treat than panic disorder with agoraphobia. Vestibular rehabilitation exercises and pharmacological treatment might be the necessary components of treatment.

Key words

dizziness anxiety posture vestibular disorder 


  1. 1.
    Bakker A, van Balkom AJ, Spinhoven P, Blaauw BM, van Dyck R (1998) Follow-up on the treatment of panic disorder with or without agoraphobia: a quantitative review. J Nerv Ment Dis 186:414–419CrossRefPubMedGoogle Scholar
  2. 2.
    van Balkom AJ, Bakker A, Spinhoven P, Blaauw BM, Smeenk S, Ruesink B (1997) A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments. J Nerv Ment Dis 185:510–516CrossRefPubMedGoogle Scholar
  3. 3.
    Brandt T (1996) Phobic postural vertigo. Neurology 46:1515–1519PubMedGoogle Scholar
  4. 4.
    Brandt T, Huppert D, Dieterich M (1994) Phobic postural vertigo: a first follow-up. J Neurol 241:191–195CrossRefPubMedGoogle Scholar
  5. 5.
    Holmberg J, Karlberg M, Fransson PA, Magnusson M (2003) Phobic postural vertigo: body sway during vibratory proprioceptive stimulation. Neuroreport 14:1007–1011CrossRefPubMedGoogle Scholar
  6. 6.
    Holmberg J, Karlberg M, Harlacher U, Rivano-Fischer M, Magnusson M (2005) Treatment of phobic postural vertigo A controlled study of cognitive-behavioral therapy and self-controlled desensitization. J NeurolGoogle Scholar
  7. 7.
    Huppert D, Strupp M, Rettinger N, Hecht J, Brandt T (2005) Phobic postural vertigo-a long-term follow-up (5 to 15 years) of 106 patients. J Neurol 252:564–569CrossRefPubMedGoogle Scholar
  8. 8.
    Jacob RG, Whitney SL, Detweiler-Shostak G, Furman JM (2001) Vestibular rehabilitation for patients with agoraphobia and vestibular dysfunction: a pilot study. J Anxiety Disord 15:131–146CrossRefPubMedGoogle Scholar
  9. 9.
    Jacobson GP, Newman CW (1990) The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg 116:424–427PubMedGoogle Scholar
  10. 10.
    Krafczyk S, Schlamp V, Dieterich M, Haberhauer P, Brandt T (1999) Increased body sway at 3.5–8 Hz in patients with phobic postural vertigo. Neurosci Lett 259:149–152CrossRefPubMedGoogle Scholar
  11. 11.
    Mendel B, Bergenius J, Langius A (1999) Dizziness symptom severity and impact on daily living as perceived by patients suffering from peripheral vestibular disorder. Clin Otolaryngol Allied Sci 24:286–293CrossRefPubMedGoogle Scholar
  12. 12.
    Pavlou M, Lingeswaran A, Davies RA, Gresty MA, Bronstein AM (2004) Simulator based rehabilitation in refractory dizziness. J Neurol 251:983–995CrossRefPubMedGoogle Scholar
  13. 13.
    Querner V, Krafczyk S, Dieterich M, Brandt T (2002) Phobic postural vertigo. Body sway during visually induced roll vection. Exp Brain Res 143:269–275CrossRefPubMedGoogle Scholar
  14. 14.
    Staab JP, Ruckenstein MJ, Amsterdam JD (2004) A prospective trial of sertraline for chronic subjective dizziness. Laryngoscope 111:1637–1641CrossRefGoogle Scholar
  15. 15.
    Yardley L, Burgneay J, Andersson G, Owen N, Nazareth I, Luxon L (1998) Feasibility and effectiveness of providing vestibular rehabilitation for dizzy patients in the community. Clin Otolaryngol Allied Sci 23:442–448CrossRefPubMedGoogle Scholar
  16. 16.
    Yardley L, Luxon L (1994) Treating dizziness with vestibular rehabilitation. Bmj 308:1252–1253PubMedGoogle Scholar
  17. 17.
    Yardley L, Masson E, Verschuur C, Haacke N, Luxon L (1992) Symptoms, anxiety and handicap in dizzy patients: development of the vertigo symptom scale. J Psychosom Res 36:731–741CrossRefPubMedGoogle Scholar
  18. 18.
    Yardley L, Putman J (1992) Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study. Clin Otolaryngol Allied Sci 17:231–236CrossRefPubMedGoogle Scholar
  19. 19.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta psychiatr scand 67:361–370CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2007

Authors and Affiliations

  • Johan Holmberg
    • 1
    Email author
  • Mikael Karlberg
    • 1
  • Uwe Harlacher
    • 2
  • Måns Magnusson
    • 1
  1. 1.Dept. of Otorhinolaryngology, Head & Neck SurgeryLund University HospitalLundSweden
  2. 2.Lund-Orup Rehabilitation CentreLund University HospitalLundSweden

Personalised recommendations