Abstract
We conducted a non-randomized, open-label, parallel-group study on patients with persistent postural-perceptual dizziness (PPPD) to compare cognitive-behavioral therapy ([CBT] group, n = 20) received a 6-session CBT program with pharmacotherapy ([PT] group, n = 22) received serotonin-related antidepressants. Outcomes were assessed using the Dizziness Handicap Inventory (DHI), the Hospital Anxiety and Depression Scale (HADS), and the Niigata PPPD Questionnaire (NPQ). Assessments were performed before and 3 months post-treatment. There were no significant differences in patients background such as sex, age, precipitating conditions, and vestibular function tests, however, illness duration was significantly longer in the CBT group than the PT group. Both CBT and PT significantly lowered the levels of dizziness-related handicaps in daily life (DHI), depression (HADS-D), anxiety (HADS-A), and symptom exacerbations by triggers (NPQ), while two-way ANOVA revealed no treatment x time interaction. Nonetheless, CBT yielded a larger Hedges’ g effect size in improving DHI, HADS-A and NPQ than PT. While PT is reportedly sometimes discontinued due to adverse events such as vomiting, all patients in the CBT group could complete the program with no adverse effects. CBT is a potential therapy for PPPD which is safe and effective as equal to or greater than PT even for patients with prolonged illness. Clinical trial registration numbers and date of registration: UMIN-CTR: UMIN000054701, 18/06/2024