Balance Disorders: Dizziness & Vertigo


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Dizziness, vertigo and balance disorders may originate in the inner ear, brain, vascular or nervous system and can be mild to debilitating. Learn more about the types, symptoms and causes of balance disorders. Diagnostic and treatment options such as vestibular rehabilitation and cognitive behavioral therapy will be discussed

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Balance Disorders: Dizziness & Vertigo

  1. 1. Balance Disorders: Dizziness and Vertigo Treatment of Associated Anxiety Presented by: Gina Byrnes, MSW, LCSW, ACT January 30, 2014
  2. 2. Anxiety and Dizziness : The Connection • Chronic Dizziness or Vertigo associated with Vestibular Disorders is often accompanied by secondary psychological problems including: • Anxiety or fear • Hyperventilation • Phobic avoidance of situations or movements associated with dizziness
  3. 3. Anxiety and Dizziness: The Connection • Anxiety: “An emotional state experienced when a person anticipates threat or is threatened in some way” • Anxiety is a normal part everyday life typically unpleasant, but manageable it quickly decreases once the fear is faced • Anxiety becomes problematic when there is a misperception of the danger involved, and the threat is exaggerated
  4. 4. Anxiety and Dizziness: The Connection Three Components of Anxiety Physiological – heart racing, shakiness, dizziness tingling in hands or feet, shakiness Cognitive – What we tell ourselves, think about and pay attention to when anxious Behavioral - What we do or how we respond Escape/Avoidance & Coping
  5. 5. Anxiety and Dizziness: The Connection Similar presentation between Anxiety associated with Vestibular Disorders and Panic Disorder • • • • Certain Situations trigger fear of Panic/Dizziness Preoccupation with Physiological Symptoms Catastrophic Thinking Strategies Intended to Prevent Panic/Dizziness start to Take Over Daily Life – Avoidance/Escape & Safety Behaviors
  6. 6. Treatment Approach – Cognitive Therapy Addresses the Misperception and Overestimation of Threat Anxious Thinking Change Focus on Likelihood of Serious Threat/Danger Normalized Thinking Focus on Realistic Likelihood Process Focus on Inability to Cope, Helplessness & Vulnerability of Various Outcomes Focus on Ability to Cope & Problem –Solve Challenging Circumstances Intense Anxiety Minimal Anxiety From The Anxiety and Worry Workbook: The Cognitive Behavioral Solutin, David A. Clark and Aaron T. Beck p. 98, 2012, The Guilford Press
  7. 7. Treatment Approach – Cognitive Therapy • Catch the Anxious Thought What is the first thing that went through my mind when I started feeling anxious? What was the situation (Who What When Where) • Identify any possible Thinking Errors Overestimation – overestimating likelihood of something bad happening Catastrophizing – Assuming the worst possible outcome Maladaptive Thinking – Technically correct but not helpful and add to anxiety
  8. 8. Treatment Approach – Cognitive Therapy Evaluating the Anxious Thoughts for Accuracy 1.Do I know for certain that (feared outcome) will happen, is happening? 2.Am I 100% sure that ………(I will get dizzy, fall, become incapacitated)? 3.Does (being dizzy) really mean that (I will lose control, be embarrassed)? 4.What evidence do I have that…..(I cannot leave the house, I cannot drive)? From Group Cognitive Therapy of Anxiety: A Transdiagnostic Treatment Manual by Peter J. Norton. Copyright 2012 by the Guilford Press.
  9. 9. Treatment Approach – Cognitive Therapy Evaluating the Anxious Thoughts for Accuracy(cont.) 5.Is there another explanation for ………(my discomfort, feeling unsteady) besides………….(a vertigo attack, loss of control, etc.) 6.What are the chances that ……(what I fear) will actually happen/has actually happened? 7.If I did………(have an episode of dizziness) what is the worst that would really happen? 8.If …………….did happen, how bad would it be? From Group Cognitive Therapy of Anxiety: A Transdiagnostic Treatment Manual by Peter J. Norton. Copyright 2012 by the Guilford Press.
  10. 10. Treatment Approach – Cognitive Therapy Developing a more Reasonable Alternative Response • “I’ve been through vertigo before, I know I can handle it” • “The worst thing that can happen is I will be uncomfortable and need to make some temporary adjustments” • “Just because it feels bad, doesn’t always mean it is bad” • “I can handle more than I think I can” • “Even though I’m afraid to drive, my doctor says I can”
  11. 11. Treatment Approach – Behavioral Therapy Planning to Face the Fear- Exposure Therapy • Addresses the Avoidance/Escape Behavior that increase anxiety • Practice both in session and out – activities one associates with dizziness or even bring on dizziness symptoms • Develop greater tolerance and/or symptoms diminish as anxiety diminishes
  12. 12. REFERENCES • • • • • • • • Abramowitz, J.S.; Deacon, B.J. , Whiteside, S.P.H.; (2011) Exposure Therapy for Anxiety, Guilford Press. Clark, D.A., Beck, A.T.; (2012) The Anxiety and Worry Workbook: The Cognitive Behavioral Solution; Guilford Press. Norton, P.J., (2012) ; Group Cognitive Behavioral Therapy: A Transdiagnostic Approach; Guilford Press. Holmberg, J.; Karlberg, M.; Harlacher, U.; Rivano-Fischer, M. Magnusson, M.; Treatment of Phobic Postural Vertigo: A Controlled Study of Cognitive Behavioral Therapy and self-controlled Desensitization. Journal of Neurology, 2006; 253: 500-506. Holmberg, J.; Karlberg M.; Harlacher U.; Magnusson M; One Year Follow-up of Cognitive Behavioral Therapy for Phobic Postural Vertigo. Journal of Neurology, 2007; 254: 1189-1192 Johansson, M. Akerlund, D.; Larsen, H.C.; Andersson, G., Randomized Controlled Trial of Vestibular Rehabilitation Combined with Cognitive Behavioral Therapy for Dizziness in Older People. American Journal of Otolaryngology-Head and Neck Surgery, 2001; 125: 151-156 Mahoney, A.E.J.; Edelman, S.; Cremer, P.D.; Cognitive Behavioral Therapy for Chronic Subjective Dizziness: Longer Term Gains and Predictors of Disability; 2013, American Journal of Otolaryngology-Head and Neck Surgery, 2013; 34: 115-126. Yardley, L.; Redfern, M.S.; Psychological Factors Influencing Recovery from Balance Disorders; Journal of Anxiety Disorders, 2001; 15: 107-119.