Cognitive Behavioral Therapy (CBT)
This information is intended as a general introduction to this topic. As each person is affected differently by balance and dizziness problems, speak with your health care professional for individual advice.
Increased anxiety goes hand in hand with many balance and dizziness disorders. Cognitive behavioural therapy (CBT) can be an effective tool for developing strategies to move forward with your life despite your symptoms.
CBT is the most commonly recommended therapy for treating anxiety. It is a type of talk therapy (psychotherapy). It usually lasts for a relatively short period of time and is focused on a specific goal.
CBT is focused on the relationship between your thoughts (cognition) and behaviour. Cognition includes your conscious thoughts (which are under your control), your automatic thoughts (which may not be under your control) and your core beliefs (known as schemas). CBT teaches you how to:
- notice and identify your thoughts and beliefs
- consider your thoughts and beliefs from different viewpoints
- change your behaviour patterns
For many dizzy people, it is helpful to do CBT concurrently with vestibular rehabilitation therapy. To maximize effectiveness, make sure everyone on your healthcare team has a good understanding of your balance and dizziness diagnosis and treatment plan.
Evidence-based research has shown CBT results in good, long-lasting improvement in anxiety levels and is at least as effective as anti-anxiety medication. A smaller dose of anti-anxiety medication may suffice when used in combination with CBT. The improvement in anxiety made with CBT tends to last longer than gains made by medication alone.
CBT typically is done over 5 to 20 structured, problem-focused and goal-oriented sessions. Treatment focuses on learning and practicing new skills to understand and think about your anxiety.
Research indicates CBT done with a qualified CBT therapist offers the most benefits. Some practitioners offer group sessions. However, if your anxiety is mild, using self-help tools can be helpful. Anti-anxiety medication combined with CBT may be needed for severe anxiety. Talk with your doctor about what treatment approach may best work for you.
CBT may not work for everyone. It is unlikely that someone who has a negative outlook of talk therapy or is unwilling to accept that they must take responsibility for change will derive much benefit from CBT.
How to find a CBT therapist
It is important to work with an experienced therapist who has specific training in CBT. Look for someone who meshes with your personality. You can either ask your doctor to refer you to a health professional who has expertise in CBT or find a therapist on your own.
The following can offer more help and support for affected individuals and their families.
Cognitive Behavioural Therapy: An Information Guide [PDF]
Download a 62-page booklet written by Dr. Neil A. Rector a clinical psychologist and research scientist at Sunnybrook Health Sciences Centre in Toronto.
Here to Help
A coalition of mental health non-profit agencies in BC. Offers a number of patient resources about anxiety.
A counselling and therapy app that connects users with a convenient, less-costly (pricing plans are described as being about 80% lower than traditional office-based appointments) and confidential way to deal with issues such as anxiety, stress, depression and chronic health conditions. Available for iOS and Android.
Though designed to help teens and young adults cope with anxiety, much of the content of this app is useful to adults as well. Rather than trying to avoid anxious feelings, Mindshift stresses the importance of how your think about anxiety. Available for iOS and Android.
Uses the foundation of CBT and provides over 200 mood improvement activities. Developed by clinical psychologists. The journal feature helps users to reflect on their day, note any distressing thoughts, and document how they were overcome. Available for iOS.
Provides CBT-based exercises and symptom tracking to help with stress and anxiety. Available for iOS, Android and web. (Formerly called Pacifica.)
Self-Help for Anxiety Management (SAM)
Developed in collaboration with a research team from the University of the West of England in Bristol, this app prompts users to build their own 24-hour anxiety toolkit and learn 25 different self-help techniques. The “Social Cloud” feature enables users to confidentially connect with other users online for additional support. Available for iOS and Android.
Most of the titles listed are available for loan through public libraries in Canada. If your local library does not own a copy, ask for it to be sent from another library through interlibrary loan.
A practical reference to using cognitive behaviour therapy to change negative thoughts and emotions presents a range of exercises for managing destructive feelings and bolstering self-esteem, in a guide that covers such additional topics as problem solving and communication.
Cited as “The Most Influential Cognitive-Behavioral Therapy Publication” by the British Association for Behavioural and Cognitive Psychotherapies, this classic book has helped many to conquer anxiety through CBT.
Written by the founder of CBT together with a fellow cognitive therapy expert. Includes worksheets and exercises designed to help people get on top of anxiety at their own pace, one step at a time, either independently or guided by a therapist.
Written by a psychologist with over 40 years experience in using CBT to treat anxiety and depression. Intended for independent use or guided by a therapist.
Asmundson GJ, Denev J, Nilsson J, & Larsen, HC. A controlled trial of cognitive behavior therapy combined with vestibular rehabilitation in the treatment of dizziness. 2006. Behav Res Ther. 44(9):1265-73. Available from: https://bit.ly/2UCiEm5
[CAMH] Cognitive behavioural therapy. Available from: https://bit.ly/2DuAtc1
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research. 2012. 36(5), 427–440. Available from: https://bit.ly/2k097m5
Johansson M, Akerlund D, Larsen HC, Andersson G. Randomized controlled trial of vestibular rehabilitation combined with cognitive-behavioral therapy for dizziness in older people. (2001). Otolaryngol Head Neck Surg. 125(3):151-6. Available from: https://bit.ly/2VENLKI
Naber CM, Water-Schmeder O, Bohrer PS et al. Interdisciplinary treatment for vestibular dysfunction: the effectiveness of mindfulness, cognitive behavioral techniques, and vestibular rehabilitation. (2011). Otolaryngol Head Neck Surg. 2011. 145(1):117-24. Available from: https://bit.ly/2FT2hb6
Philippot P, Nef F, Clauw L, Romrée M and Segal Z. A randomized controlled trial of mindfulness‐based cognitive therapy for treating tinnitus. Clinical Psychology and Psychotherapy. 2012. 19: 411-419. Available from: http://bit.ly/2OA49tn
Yu Y C, Xue H, Zhang Y X, Zhou J. Cognitive behavior therapy as augmentation for sertraline in treating patients with persistent postural-perceptual dizziness. BioMed Research International. 2018, 8518631. Available from: https://bit.ly/2OXVCRe
Page updated August, 2019.