Effectiveness of Cognitive Behavioral Therapy-Based Multimodal Interventions for Psychogenic Dizziness: A Systematic Review
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Objectives: Psychogenic dizziness is a chronic condition characterized by subjective imbalance and emotional distress, often in the absence of identifiable vestibular abnormalities. Cognitive behavioral therapy (CBT) has emerged as a promising intervention, with multimodal strategies integrating CBT with pharmacotherapy or vestibular rehabilitation (VR) being increasingly utilized. However, the overall clinical effectiveness of these interventions has not yet been clearly established. Therefore, this study aims to evaluate the clinical effectiveness of CBT-based multimodal interventions for psychogenic dizziness. Methods: This systematic review evaluated randomized controlled trials (RCTs) involving patients with psychogenic or chronic subjective dizziness, where CBT was applied either as a monotherapy or as part of a multimodal intervention. Searches were conducted in international and domestic databases to identify RCTs published from 2010 to April 2025. Data were synthesized narratively and, when possible, through meta-analysis. Risk of bias was assessed using the Cochrane criteria. Results: Eight RCTs comprising 690 participants were included. Multimodal interventions incorporating CBT demonstrated superior outcomes in dizziness severity, anxiety, and depression to monotherapies. Add-on effects of CBT were particularly evident in studies comparing CBT+VR+Drug to VR or Drug alone and in studies comparing CBT+Drug to Drug alone. Additionally, VR enhanced effects of CBT when combined. These findings suggest a synergistic effect across modalities. However, most studies exhibited limitations in methodological rigor, including inadequate reporting of randomization and blinding procedures. Conclusions: CBT-based multimodal interventions appear to be more effective than single-modality treatments in addressing both physical and psychological symptoms of psychogenic dizziness. These results support the use of individualized, integrative treatment approaches. Further high-quality, multicenter RCTs are required to validate these findings and inform clinical practice.
Abstract
Objectives: Psychogenic dizziness is a chronic condition characterized by subjective imbalance and emotional distress, often in the absence of identifiable vestibular abnormalities. Cognitive behavioral therapy (CBT) has emerged as a promising intervention, with multimodal strategies integrating CBT with pharmacotherapy or vestibular rehabilitation (VR) being increasingly utilized. However, the overall clinical effectiveness of these interventions has not yet been clearly established. Therefore, this study aims to evaluate the clinical effectiveness of CBT-based multimodal interventions for psychogenic dizziness. Methods: This systematic review evaluated randomized controlled trials (RCTs) involving patients with psychogenic or chronic subjective dizziness, where CBT was applied either as a monotherapy or as part of a multimodal intervention. Searches were conducted in international and domestic databases to identify RCTs published from 2010 to April 2025. Data were synthesized narratively and, when possible, through meta-analysis. Risk of bias was assessed using the Cochrane criteria. Results: Eight RCTs comprising 690 participants were included. Multimodal interventions incorporating CBT demonstrated superior outcomes in dizziness severity, anxiety, and depression to monotherapies. Add-on effects of CBT were particularly evident in studies comparing CBT+VR+Drug to VR or Drug alone and in studies comparing CBT+Drug to Drug alone. Additionally, VR enhanced effects of CBT when combined. These findings suggest a synergistic effect across modalities. However, most studies exhibited limitations in methodological rigor, including inadequate reporting of randomization and blinding procedures. Conclusions: CBT-based multimodal interventions appear to be more effective than single-modality treatments in addressing both physical and psychological symptoms of psychogenic dizziness. These results support the use of individualized, integrative treatment approaches. Further high-quality, multicenter RCTs are required to validate these findings and inform clinical practice.