Physical health and emotional health are not two separate systems but are intimately intertwined -- known as the mind-body connection. Maybe you have heard this term in passing during a yoga class or on social media. The mind-body connection, a science-backed concept, has a powerful impact on our well-being at every level. Mental health has the power to impact our physical health and vice versa. But what does this really mean for us? Can caring for our mental health help us live better with a physical condition? For many people, yes. Therapy doesn’t diagnose a vestibular disorder or treat its medical cause. It can help with the distress, fear, avoidance, and life disruption that often come with one, alongside medical care and vestibular rehabilitation, and for some conditions, such as tinnitus-related distress, psychological treatment is a recommended part of care.
What is the Vestibular System?
The vestibular system controls our stability, and our stability influences how we stand, walk, and move through the world, adapting to our physical environment. This system, which involves structures in our inner ears and pathways in the brain, is one of the main sensory systems that provide our brains with information about balance, motion, and the location of our head and body in reference to the rest of our world. Meanwhile, our central nervous system (our brain and our spinal cord) performs the sensory integration of vestibular, visual, and somatosensorial pathways to control our equilibrium or balance.
Have you ever struggled with vertigo after being on a boat - feeling like you are rocking back and forth for hours after getting off? Or maybe you struggle with chronic dizziness, which causes you to hyperfocus on your physical symptoms and look around the room to check for how things look. Having a vestibular condition can sometimes feel like a terrifying out-of-body experience, especially if you also experience migraine auras or your dizziness is a chronic part of your medical condition.
While feeling these vestibular sensations, you may experience heightened anxiety or panic wash over you. This is actually a common experience for those who struggle with vestibular disorders. There is actually something physiologically happening inside of you called the stress-response cycle. When your nervous system detects a threat (such as the world around you spinning!), your stress hormones, such as adrenaline and cortisol get released. Our brains are tuned to notice threats, so our attention shifts toward the symptom, and we may start to worry or scan for the next episode. For some people, that worry and watchfulness can make dizziness feel more intense or harder to cope with, and can lead to avoiding activities. This doesn’t mean anxiety caused the condition. It means a cycle can develop that is worth addressing.
Understanding this connection can help us to take action steps to reduce our anxiety when we begin to experience physical symptoms. One way to address the anxiety side of this cycle is to work alongside a therapist who specializes in Cognitive Behavioral Therapy for vertigo, especially if you struggle with anxiety and vestibular symptoms. Cognitive behavioral therapy (CBT) can be an effective tool for developing strategies to move forward with your life and cope with your symptoms.
Research on anxiety disorders in general shows that CBT is an effective treatment for anxiety. The evidence for specific dizziness conditions is more mixed. The UK’s NICE guidelines recommend psychological approaches, including CBT, for tinnitus-related distress. For persistent postural-perceptual dizziness (PPPD), CBT and vestibular rehabilitation are commonly used, but a 2023 Cochrane review found too little high-quality research to draw firm conclusions about non-drug treatments. Results vary by condition and by person. So how could CBT help in the context of dizziness or a vestibular migraine?
At the heart of CBT is the idea that we can ease anxiety by understanding the relationship between our thoughts, feelings, and behaviors. Because our anxiety and vestibular symptoms are so interrelated, what makes the most sense is adopting an integrative treatment approach. For example, seeing a mental health therapist to help with your anxiety as well as finding a compassionate vestibular rehabilitation therapist or physical therapist to work on your balance systems.
Anxiety and dizziness have a reciprocal relationship, which can sometimes create a loop of chronic symptoms. If you are exhausted by this frustrating and sometimes debilitating cycle: therapists in the collective have experience with both vestibular disorders and anxiety and are here to support you.
If you are thinking that CBT could be particularly helpful for you, psychotherapy could be a great next step in your healing journey. The psychologists at Telegraph Psychology Collective (formerly North Berkeley Counseling Collective) are independently licensed, affiliated psychologists trained in CBT for anxiety, with experience helping people living with vertigo, vestibular migraine, tinnitus, PPPD, and other vestibular conditions. Therapists in the collective offer in-person therapy in Berkeley and Kensington, and online therapy in California, Hawaii, Virginia, and Florida.