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.

Learning how to relax your body can be an integral part of CBT. Two strategies often used by therapists are diaphragmatic breathing (also called calm breathing) and progressive muscle relaxation.

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.

Be patient – change does not happen overnight and it takes time to see the results of CBT. It is normal for some weeks to be easier and others more difficult.

CBT is not suitable or successful for everyone. If it does not work for you, move on. Talk with your doctor about what other treatment approaches may work better for you.

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.

More resources

The following can offer more help and support for affected individuals and their families.

Websites

Anxiety and Depression Association of America

Anxiety Canada

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.

Talkspace
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.

Apps

MindShift
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.

MoodKit
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.

Sanvello
Provides CBT-based exercises and symptom tracking to help with stress and anxiety. Available for iOS, Android and web. (Formerly called Pacifica.)

Self Help – Cognitive-Behavioural Therapy (CBT)
Information and strategies developed by Anxiety Canada.

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.

Books