Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis

Summary & key facts

This meta-analysis looked at six randomized trials and found that adding cognitive behavioral therapy (CBT) to usual treatments for persistent postural-perceptual dizziness (PPPD) was linked with greater short-term improvement in dizziness, anxiety, and depression scores than usual treatment alone. The review pooled results from studies found between January 2002 and November 2022 and reported statistically stronger reductions in several symptom scales when CBT was added. The authors say these results suggest benefit but note that more randomized trials are still needed to be confident about using CBT for PPPD.

Key facts:

• The review included six randomized controlled trials of CBT for persistent postural-perceptual dizziness (PPPD).
• Searches covered PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov for studies published in English from January 2002 to November 2022.
• For the Dizziness Handicap Inventory total score (DHI-Total), adding CBT showed a mean difference of -8.17 points (95% CI -10.26 to -6.09; p < 0.00001) versus conventional therapy alone.
• For anxiety measured by the Hamilton Anxiety Scale (HAMA), adding CBT showed a mean difference of -2.76 points (95% CI -3.57 to -1.94; p < 0.00001).
• For general anxiety measured by GAD-7, adding CBT showed a mean difference of -2.50 points (95% CI -3.29 to -1.70; p < 0.00001).
• For depressive symptoms measured by PHQ-9, adding CBT showed a mean difference of -2.29 points (95% CI -3.04 to -1.55; p < 0.00001).
• In subgroup analyses for DHI-Total, CBT plus vestibular rehabilitation therapy (VRT) had MD = -8.70 (95% CI -12.17 to -5.22); CBT plus SSRI had MD = -10.70 (95% CI -14.97 to -6.43); and CBT plus VRT+SSRI had MD = -6.08 (95% CI -9.49 to -2.6
• The authors used the Cochrane risk of bias tool and RevMan 5.3 for analysis and described the overall level of evidence as a systematic review of randomized controlled trials (Level I).
• The authors concluded that additional CBT may provide extra improvement for PPPD compared with conventional therapy alone, but they also stated that more randomized controlled trials are needed to confirm and guide use of CBT for PPPD.

Topics

Allergic Rhinitis and Sensitization Hearing, Cochlea, Tinnitus, Genetics Vestibular and auditory disorders

Categories

Life Sciences Neurology Neuroscience

Tags

Anxiety Cochrane Library Confidence interval Hamd Hospital Anxiety and Depression Scale Internal medicine Medicine Meta-analysis Physical therapy Psychiatry Randomized controlled trial