Appendix: Additional Tables
Table I. Summary of Reviewed Case Reports.
Study
Study design
Sample,
diagnoses
Intervention, duration
Schwöbel
(1954)
Case report;
assessment
points: before
and after
treatment;
follow-up one
year later
Case report;
assessment
points: before
and after inpatient
treatment;
follow-ups: two
and 12 months
n=2 women (43
and 59 years);
Menière’s disease
Psychoanalysis;
duration: case 1: 1.5 years (52
hours); case 2: 3 months
n=1 woman (58
years); positional
nystagmus
(peripheral)
13 (28.3%)
n=1 man (42
years); Menière’s
disease and
anxiety
In-patient: daily
records of progress;
distance in feet
walked per day;
After discharge:
daily records of
walking and
homemaking
activities
Control over vertigo
attacks, time off
work, social activities,
coping with stress;
At discharge: able to walk
1200 feet;
Two months later: no
more usage of wheelchair;
12 months later: able to
walk and to conduct
homemaking activities
Case report;
assessment
points: before
treatment;
follow-ups:
monthly until
one year after
treatment
Case report;
assessment
points: before
and after
treatment,
follow-ups: 2,
4, and 8 weeks
Behavioural therapy (inpatient): positive and negative
reinforcement;
physical therapy (in-patient):
standing in parallel bars, walking;
duration: 55 days (in-patient);
after discharge: meetings with
physical therapist and
psychologist
Behavioural treatment:
relaxation techniques twice daily;
meditation; when anxious: graded
behavioural tasks; biofeedback;
duration: 12 months
One year after treatment:
more control over vertigo
and Menière attacks; less
anxiety; not many time off
work; better stress coping
abilities
11 (23.9%)
Behavioural treatment:
education about BPV; selfmonitoring; gaze-fixation;
desensitization; biofeedbackassisted relaxation training; stress
management; cognitive
strategies;
duration: 9 weeks
Psychophysiologic
measures;
recordings: frequency
and severity of dizzy
spells; activity and
well-being
After treatment: reduced
frequency and severity of
dizzy spells; reduced
muscle tension; increased
peripheral blood flow;
increased confidence in
ability to manage dizzy
spells; increased social
16 (34.8%)
Fowler et
al. (1971)
Elwood et
al. (1982)
Shutty et
al. (1991)
n=1 woman (26
years); mild head
injury after
accident, BPV,
and avoidance
Measurements
Results
After treatment: no vertigo
symptoms, no social
withdrawal, happy mood,
working
Quality
assessment
ratinga
11 (23.9%)
1
Andersson
& Yardley
(1998)
Case report;
assessment
points: before
and after
treatment;
follow-up:
three months
n=1 woman (68
years); dizziness,
fear of falling, and
avoidance
CBT and VR: education about
dizziness; balance / movement
exercises; relaxation for difficult
situations; positive / negative
thoughts; vicious circles;
expectations;
duration: 10 weeks (five
sessions, one phone call)
Hägnebo
et al.
(1998)
Case report;
assessment
points: before
and after
treatment;
follow-ups: 3,
6, 10, and 24
months
n=1 woman (62
years); Menière’s
disease and
anxiety / worries
Sareen
(2003)
Case report,
assessment
points: before
and after
treatment;
follow-up: 6
months
Case report;
assessment
points: before
treatment,
after
behavioural
therapy and
after vestibular
therapy
n=1 woman (35
years); dizziness,
anxiety, and
avoidance
CBT: relaxation training;
desensitization of anxietyprovoking situations; cognitive
restructuring; behavioural task
setting; enhancement of bodily
awareness;
duration: 9 weeks (in addition: 2
Booster sessions at 6 months
after treatment)
Behavioural treatment:
education about dizziness; daily
exposure to dizziness;
Duration: 4 sessions
Whitney et
al. (2005)
n=1 man (37
years); fear of
heights and
dizziness
Behavioural therapy: exposure
to virtual height scenes; duration:
8 sessions;
Followed by vestibular therapy:
exercises; duration: 8 weeks
Questionnaire:
VHS; neurootological testing:
eye movements,
reflexes, caloric test,
dynamic
posturography;
behaviour
provocation test
Clinical interview;
recordings: number
of vertigo attacks and
of positive / negative
events
activities; less
psychological distress;
Follow-ups: increased
activity and well-being
After treatment:
improved balance,
equilibrium score, and
behaviour provocation;
Pre to post to follow-up:
Improved VHS
18.5 (40.2%)
After treatment: no more
vertigo attacks;
At 24 months: no more
vertigo attacks; normal
social functioning, less
worries
19 (41.3%)
episodes of dizziness
After treatment: no more
dizziness;
Follow-up: maintained
improvement
9 (19.6%)
Expert interview;
questionnaires:
CAQ, ATHQ, SitQ,
IIRS, DHI; SF-36,
behavioural
avoidance test;
optic flow testing
After behavioural
therapy: reduced anxiety
and avoidance of heights;
increased quality of life;
persistent symptoms of
dizziness and discomfort of
space and motion;
After vestibular therapy:
reduced anxiety and
avoidance of heights; less
17.5 (38.0%)
2
Goto et al.
(2008a)
Goto et al.
(2008b)
Sardinha
et al.
(2009)
Case report;
assessment
points: before
and during
treatment;
follow-ups: 6
and 9 months
Case report;
assessment
points: before
and during
treatment;
follow-ups: 6
and 9 months
n=1 man (51
years); Menière’s
disease, anxiety,
and insomnia
Psychotherapy and AT (three
times daily); duration: 6
sessions, every three weeks
Questionnaires:
SDS, STAI, CMI, Y-G
n=1 woman (37
years); PPV,
anxiety, insomnia,
headache, and
tinnitus
Medication: antidepressant,
herbal medicine;
Psychotherapy and AT (three
times daily); duration: 6 sessions
(à 45 minutes), every three weeks
Questionnaires:
SDS, STAI, CMI,
MAS, MOCI
Case report;
assessment
points: before
and during
treatment
n=1 man (17
years); vestibular
neuritis and
subsequently PPV
Cognitive-behavioural therapy:
cognitive interventions, making
plans for the future, information
about associations between
avoidance / hypervigilance and
problem maintenance, increase of
activities, exposure to avoided
activities; duration: 18 weeks
(one session per week)
Patient’s reports:
frequency and
intensity of dizziness
episodes, anxiety,
mood, well -being,
activities
perceived dizziness
handicap; less visually
dependent; improved
quality of life; better daily
functioning
After a few weeks: no
more vertigo, tinnitus, and
insomnia;
At follow-ups: no more
vertigo and insomnia
After 2 weeks: symptoms
slightly improved,
medication was stopped;
After a few weeks: no
more dizziness, insomnia,
and headache;
Follow-ups: no more
dizziness, insomnia, and
headache
At the end of treatment:
no more dizziness,
increased activities and
well-being
13 (28.3%)
13 (28.3%)
11 (23.9%)
a
The quality assessment rating score (Moncrieff et al., 2001) could range between 0 (very poor study quality) and 46 (excellent study quality); in parentheses the
proportion (in per cent) is reported.
Abbreviations: AT=autogenic training; ATHQ=Attitudes Towards Heights Questionnaire; BPV=benign positional vertigo; CAQ=Cohen Acrophobia Questionnaire;
CBT=Cognitive-behavioural therapy; CMI=Cornell Medical Index; IIRS=Illness Intrusiveness Ratings Scale; DHI=Dizziness Handicap Inventory; MAS=Manifest
Anxiety Scale; MI=Mobility Inventory; MOCI=Maudsley Obsessional-Compulsive Inventory; PPV=Phobic postural vertigo; SitQ=Situational Characteristics
Questionnaire; SDS=Self-rating Depression Scale; STAI(-t)=State-Trait Anxiety Inventory (trait form); VHS=Vertigo Handicap Scale; VR=vestibular rehabilitation;
Y-G=Yatabe-Guilford personality test
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Table II. Summary of Reviewed Psychotherapy or Follow-up Studies.
Study
Study design
Sample, diagnoses
Control
group
Intervention, duration
Measurements
Results
Huppert et
al. (2005)
Follow-up
study;
assessment
points: before
treatment;
follow-up: 5 to
15 years
N=303 were sent a
questionnaire
 n=106 (35%)
completed it (n=42
women, n=64 men;
mean age 44.3
years); PPV
No
Self-reported
changes:
symptom-free /
considerably
improved, no
change
Symptom-free or
considerably
improved: 75%,
independently of
age, sex, prior
organic vertigo, or
other subsequent
therapies;
most improvement
within the first year
after initial
treatment;
Heinrichs et
al. (2003)
Psychotherapy
study (natural
design);
assessment
points: before
treatment;
follow-ups: 6
weeks and one
year
Initially: n=398
(n=266 women,
n=132 men; mean
age 35.5 years);
vertigo and
agoraphobia
6 weeks post:
n=398 (100%)
One year post:
n=300 (75.4%)
No
Initial: self-controlled
behavioural therapy:
explanation of PPV;
decoupling of catastrophic
thoughts; exposure to
vertigo triggering
situations; regular
physical activity;
duration: 2-3 sessions;
During follow-up period:
psychotherapy (not
specified);
pharmacotherapy,
physiotherapy; alternative
therapies;
CBT (individualized):
Information about the
disorder and therapy
procedure; intensive invivo exposure with anxiety
triggering stimuli up to 12
hours daily; self-control
period; duration: > 3
weeks
Questionnaires:
BAI, BDI, BSQ,
ACQ, MI, SCL-90-R
After 6 weeks:
improvement in all
measurements;
After one year:
effects remained
stable
Quality
assessment
ratinga
21 (45.7%)
21.5 (46.7%)
a
The quality assessment rating score (Moncrieff et al., 2001) could range between 0 (very poor study quality) and 46 (excellent study quality); in parentheses the
proportion (in per cent) is reported.
Abbreviations: ACQ=Agoraphobic Cognitions Questionnaire; BAI=Beck Anxiety Inventory; BDI=Beck Depression Inventory; BSQ=Body Sensation
Questionnaire; CBT=Cognitive-behavioural therapy; MI=Mobility Inventory; PPV=Phobic postural vertigo; SCL-90(-R)=Symptom Checklist 90 (revised);
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