Living With PPPD: Why You Feel Dizzy — and How Psychological Support Can Help

So, you’re waking up feeling dizzy and off balance? Perhaps the tests and scans have come back ‘normal’, but you can’t shake the feeling that something is not right. I get it, symptoms and sensations like this can be scary and sometimes we can feel invalidated by the lack of medical certainty.

Then PPPD gets mentioned.

So what is PPPD?

Persistent Postural Perceptual Dizziness or PPPD is a common diagnosis for those experiencing consistent dizziness. 

It usually follows on from other types of vestibular (balance system) disorders like:

·  Vestibular neuritis

·  Benign paroxysmal positional vertigo (BPPV)

·  Vestibular migraine and others

·  Illness, panic attacks or acute stress

As a result of these conditions or experiences can be a feeling of dizziness which becomes persistent i.e. experiencing it most days for 3+ months.

PPPD dizziness can feel like rocking, swaying or being on a boat. It usually feels worse when upright and when in busy environments, like shops.

The key thing to remember is PPPD is not dangerous, terminal or considered a long-term condition. However, it can feel overwhelming!

Is PPPD ‘just’ Anxiety?

It’s not “just anxiety”!

PPPD is a physical condition, considered a ‘functional neurological disorder’ – what do we mean by that? It means that the brain is struggling to send and receive balance signals in the way that it would usually. The body’s balance system is trying to right itself, often after experiencing a vestibular disorder and PPPD can be a consequence of this process.

However, anxiety can make the symptoms of PPPD feel worse. This is because anxiety is an emotion that initiates our nervous system or fight/flight response. This causes certain sensations; like sweating, fast/shallow breathing, muscle tension. Unfortunately, one of the sensations of the fight/flight response is dizziness! So PPPD and our nervous system can form a feedback loop – dizziness causes anxiety, anxiety causes dizziness.

The Brain’s Balance System

The body uses the following systems to balance:

• The Inner ear (or peripheral vestibular system)

• Visual system (eyes and brain)

• Body sensations (somatosensory system)

(there is also a part of the brain heavily involved in balance called the cerebellum, but this is not involved with PPPD).

After an initial dizziness event:

• The brain can become hypervigilant

• It over-relies on visual input

• It stays in threat mode (fight/flight)

The nervous system gets “stuck” in threat mode to protect us.

This is where psychological support becomes relevant — not because it’s “all in your head,” but because the nervous system is involved and certain psychological skills and strategies can help us with this.

How Is PPPD Diagnosed?

As always, a medical practitioner who can run tests, scans etc on the audiovestibular system is the most appropriate person to clinically diagnose. Your local ENT department is best placed to do this.

They will likely be able to rule-out any other conditions too.

Sometimes when initially visiting a healthcare professional, we can feel dismissed if our concerns are not validated or seem to be taken seriously. Try to advocate (or have a trusted family member/companion advocate for you) to be referred to a specialist in balance disorders.

Treatment for PPPD: Can It Be Cured?

Yes! Once you have been for an assessment with a qualified medical practioner, a diagnosis and treatment plan can be created.

A common route for treatment will be some vestibular rehabilitation assessment and therapy, often with a specialist vestibular physiotherapist. This can involve exercises and movements prescribed in session and for practice in your own time.

Sometimes medications are prescribed by a qualified prescriber medic, which are often SSRIs – a common form of antidepressant which can help with mood and anxiety.

And of course, psychological therapy can help too.

Where does psychological therapy come in?

Psychological therapy, particularly CBT and ACT can help understand how our reactions to PPPD can maintain distress. This can be through unhelpful thought patterns and behaviours which keep our anxiety and distress high, which in turn can create feedback loop – keeping our PPPD symptoms going.

We can use a combination of techniques like: cognitive restructuring, thought defusion, mindfulness and graded exposure to help support you.

How Psychological Support Helps PPPD

Psychological support does not mean “it’s psychological.” It means we help your nervous system feel safe again.

Calming the Nervous System

Therapy can help:

• Reduce hypervigilance

• Lower fear around symptoms

• Regulate stress responses

• Teach grounding and stabilisation techniques

When your brain feels safer, symptoms often reduce.

Breaking the Avoidance Cycle

It’s completely understandable to avoid places that make you feel worse.

But avoidance accidentally teaches your brain: “this place is dangerous.”

Psychological support helps you:

• Gradually re-enter feared environments

• Build confidence

• Retrain your balance system

• Reduce symptom sensitivity

Changing Unhelpful Thought Patterns

Common thoughts include:

• “I’m going to faint/fall over”

• “I must have something serious.”

• “I can’t cope like this.”

These thoughts increase fear — which increases dizziness.

Therapy helps you:

• Understand symptoms

• Challenge catastrophic thinking

• Build resilience

• Rebuild trust in your body

Living With PPPD: Daily Coping Strategies

There are a number of things you can do to help yourself. Firstly, reducing overall stress is a must. Making sure you are getting as much sleep as you need and exercising, even if it is gentle exercise.

We need to move the body, but often we have become avoidant of movement as we see it as a potential trigger for dizziness. Try to small, slow intentional movements, even a short walk is better than nothing.

Be mindful of visual triggers – lots of screen time, exposure to bright or fluorescent lighting, visually overstimulating places and spaces can make PPPD feel worse.

Most importantly treat yourself gently and with compassion! PPPD can be unpleasant and exhausting, so try to acknowledge this whilst utilising support for recovery.

What does recovery look like?

Remember recovery will be gradual. Some days will feel worse than others and progress is not always linear. Progress can feel slow, but builds over time.

Many people recover significantly with:

·       Vestibular rehabilitation

·       Psychological therapy

·       Sometimes medication

Final Thoughts

Your symptoms are real. Your brain is trying to protect you.

PPPD is treatable, recovery is possible and you are not alone.

If you’d like support in calming your nervous system and rebuilding confidence in your balance, help is available. Please contact us for more info.