When dizziness causes fear: how anxiety can maintain the cycle of dizziness

Dizziness is a real experience and can have various causes. In some people, it appears after a vestibular problem and, even though this may have improved, certain sensations can remain or recur.

It is then that a frequent question arises in consultations: “If I've been told there is nothing serious wrong with me, why do I still feel like this?”. The answer sometimes lies in the interaction between the vestibular system, attention, emotions and the way we interpret bodily sensations.

When the body continues to function as if there were danger.

In consultation, I frequently see people who rationally know that dizziness is not dangerous, but when it appears, they react as if it were. One patient expressed it very clearly: she knew that the sensation did not necessarily imply danger, but her body kept setting off the alarm.

This can happen because, after intense experiences of dizziness, the brain learns to pay much more attention to any signal related to balance. A small sensation of unsteadiness, a head movement or a visual change can start receiving far more attention than before. And the more we monitor, the more we detect.

The cycle of dizziness.

In these cases, a cycle can be established: Dizziness → worry → anxiety → increased attention to the body → more sensations → more worry. Avoidance can also be added to this.

If a person starts avoiding driving, going out alone, certain movements or places where they previously felt dizzy, they may feel initial relief. But that relief can also teach the brain that avoidance was necessary.

For example, in one of the patients I have supported, we worked on activities that helped her feel safe, but which also functioned as a way to avoid paying attention to the dizziness. The therapeutic question was simple: “Am I doing this because I want to do it or because I need to do it to feel safe?” That difference can be essential.

The goal is not to live without any sensation at all.

Psychological intervention does not consist of telling a person that “dizziness is all in your head”. Nor is it solely about learning relaxation techniques. The goal is to understand what is maintaining the problem and to work on modifiable variables: the interpretation of sensations, hypervigilance, safety behaviours, avoidance and the progressive recovery of activities.

Of course, this must be integrated with medical evaluation and, when necessary, with vestibular rehabilitation. Because recovering does not always mean making every sensation disappear. Sometimes it means being able to say: “Dizziness may appear, but I no longer need to organise my life around it.”

And perhaps that is one of the most important goals of treatment: that dizziness stops deciding what you can or cannot do.