Psychotherapy in dizziness: A systematic review

Gabriele Schmid (1) , Peter Henningsen (1) , Marianne Dieterich (2) , Heribert Sattel (1) , Claas Lahmann (1)

1 Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts d. Isar, Techn. Universitaet
2 Department of Neurology, Ludwig-Maximilians-Universitaet, Klinikum Großhadern

Background: About 30-50% of complex dizziness disorders are organically not sufficiently explained or related to a psychiatric disorder. Of patients with such dizziness disorders, 80% are severely impaired by dizziness in their daily lives; nevertheless, they are often not diagnosed and treated adequately. Objectives: This review aims to give a systematic overview of psychotherapeutic approaches and their efficacy regarding the treatment of dizziness that is medically not sufficiently explained or related to a psychiatric disorder. Methods: We conducted a systematic literature search in Medline, PSYNDEX, and PsycINFO and included in this systematic review (randomized) controlled trials (RCTs) concerning psychotherapy in patients with dizziness medically not sufficiently explained or associated with a psychiatric disorder. If possible we used Hedges' g to express the effect sizes (ES) of the treatment. We assessed heterogeneity using the Q statistic. Results: We included three (R)CTs. All studies used cognitive-behavioural treatment methods in combination with relaxation techniques or vestibular rehabilitation. All studies suggested that psychotherapy may provide improvement. The mean ES in the treatment groups was 0.46 (95% CI 0.05; 0.88) for dizziness-related outcome, 0.10 (-0.44; 0.64) for anxiety, and 0.17 (-0.24; 0.58) for depression, whereas in the control groups the mean dizziness-related ES was -0.04 (-0.44; 0.37), anxiety-related ES was -0.03 (-0.43; 0.38), and depression-related ES was -0.02 (-0.42; 0.38). The quality of the studies was average. The sample sizes were small, however, and there was a lack of long-term studies. Conclusion: This systematic review provides some preliminary evidence that psychotherapy may be effective concerning patients with dizziness that is medically not sufficiently explained or due to a psychiatric disorder. The results should be replicated in larger samples and follow-up RCTs.

Mots clés: SYSTEMATIC REVIEWS

Gabriele Schmid, Peter Henningsen, Marianne Dieterich, Heribert Sattel, Claas Lahmann. Psychotherapy in dizziness: A systematic review. Journal of Neurology, Neurosurgery and Psychiatry, 2011, 82 (6), pp.601. ⟨10.1136/jnnp.2010.237388⟩. ⟨hal-00613262⟩