Appendix: Additional Tables

Table I. Summary of Reviewed Case Reports.

Study / Study design / Sample, diagnoses / Intervention, duration / Measurements / Results / Quality assessment ratinga
Schwöbel (1954) / Case report;
assessment points: before and after treatment; follow-up one year later / n=2 women (43 and 59 years); Menière’s disease / Psychoanalysis;
duration: case 1: 1.5 years (52 hours); case 2: 3 months / After treatment: no vertigo symptoms, no social withdrawal, happy mood, working / 11 (23.9%)
Fowler et al. (1971) / Case report;
assessment points: before and after in-patient treatment; follow-ups: two and 12 months / n=1 woman (58 years); positional nystagmus (peripheral) / Behavioural therapy (in-patient): positive and negative reinforcement;
physical therapy (in-patient): standing in parallel bars, walking;
duration: 55 days (in-patient); after discharge: meetings with physical therapist and psychologist / In-patient: daily records of progress; distance in feet walked per day;
After discharge: daily records of walking and homemaking activities / At discharge: able to walk 1200 feet;
Two months later: no more usage of wheelchair;
12 months later: able to walk and to conduct homemaking activities / 13 (28.3%)
Elwood et al. (1982) / Case report;
assessment points: before treatment; follow-ups: monthly until one year after treatment / n=1 man (42 years); Menière’s disease and anxiety / Behavioural treatment: relaxation techniques twice daily; meditation; when anxious: graded behavioural tasks; biofeedback;
duration: 12 months / Control over vertigo attacks, time off work, social activities, coping with stress; / One year after treatment: more control over vertigo and Menière attacks; less anxiety; not many time off work; better stress coping abilities / 11 (23.9%)
Shutty et al. (1991) / Case report;
assessment points: before and after treatment, follow-ups: 2, 4, and 8 weeks / n=1 woman (26 years); mild head injury after accident, BPV, and avoidance / Behavioural treatment: education about BPV; self-monitoring; gaze-fixation; desensitization; biofeedback-assisted relaxation training; stress management; cognitive strategies;
duration:9 weeks / Psychophysiologic measures; recordings: frequency and severity of dizzy spells; activity and well-being / After treatment: reduced frequency and severity of dizzy spells; reduced muscle tension; increased peripheral blood flow; increased confidence in ability to manage dizzy spells; increased social activities; less psychological distress;
Follow-ups: increased activity and well-being / 16 (34.8%)
Andersson & Yardley (1998) / Case report;
assessment points: before and after treatment; follow-up: three months / n=1 woman (68 years); dizziness, fear of falling, and avoidance / CBT and VR: education about dizziness; balance / movement exercises; relaxation for difficult situations; positive / negative thoughts; vicious circles; expectations;
duration: 10 weeks (five sessions, one phone call) / Questionnaire: VHS; neuro-otological testing:eye movements, reflexes, caloric test, dynamic posturography; behaviour provocation test / After treatment:
improved balance, equilibrium score, and behaviour provocation;
Pre to post to follow-up:
Improved VHS / 18.5 (40.2%)
Hägnebo et al. (1998) / Case report;
assessment points: before and after treatment; follow-ups: 3, 6, 10, and 24 months / n=1 woman (62 years); Menière’s disease and anxiety / worries / CBT: relaxation training; desensitization of anxiety-provoking situations; cognitive restructuring; behavioural task setting; enhancement of bodily awareness;
duration: 9 weeks (in addition: 2 Booster sessions at 6 months after treatment) / Clinical interview;
recordings: number of vertigo attacks and of positive / negative events / After treatment: no more vertigo attacks;
At 24 months: no more vertigo attacks; normal social functioning, less worries / 19 (41.3%)
Sareen (2003) / Case report,
assessment points: before and after treatment; follow-up: 6 months / n=1 woman (35 years); dizziness, anxiety, and avoidance / Behavioural treatment: education about dizziness; daily exposure to dizziness;
Duration: 4 sessions / episodes of dizziness / After treatment: no more dizziness;
Follow-up: maintained improvement / 9 (19.6%)
Whitney et al. (2005) / Case report;
assessment points: before treatment, after behavioural therapy and after vestibular therapy / n=1 man (37 years); fear of heights and dizziness / Behavioural therapy: exposure to virtual height scenes; duration: 8 sessions;
Followed by vestibular therapy: exercises; duration: 8 weeks / Expert interview;
questionnaires: CAQ, ATHQ, SitQ, IIRS, DHI; SF-36, behavioural avoidance test;
optic flow testing / After behavioural therapy: reduced anxiety and avoidance of heights; increased quality of life; persistent symptoms of dizziness and discomfort of space and motion;
After vestibular therapy: reduced anxiety and avoidance of heights; less perceived dizziness handicap; less visually dependent; improved quality of life; better daily functioning / 17.5 (38.0%)
Goto et al. (2008a) / Case report;
assessment points: before and during treatment; follow-ups: 6 and 9 months / n=1 man (51 years); Menière’s disease, anxiety, and insomnia / Psychotherapy and AT (three times daily); duration: 6 sessions, every three weeks / Questionnaires: SDS, STAI, CMI, Y-G / After a few weeks: no more vertigo, tinnitus, and insomnia;
At follow-ups: no more vertigo and insomnia / 13 (28.3%)
Goto et al. (2008b) / Case report;
assessment points: before and during treatment; follow-ups: 6 and 9 months / n=1 woman (37 years); PPV, anxiety, insomnia, headache, and tinnitus / Medication: antidepressant, herbal medicine;
Psychotherapy and AT (three times daily); duration: 6 sessions (à 45 minutes), every three weeks / Questionnaires: SDS, STAI, CMI, MAS, MOCI / After 2 weeks: symptoms slightly improved, medication was stopped;
After a few weeks: no more dizziness, insomnia, and headache;
Follow-ups: no more dizziness, insomnia, and headache / 13 (28.3%)
Sardinha et al. (2009) / Case report;
assessment points: before and during treatment / n=1 man (17 years); vestibular neuritis and subsequently PPV / Cognitive-behavioural therapy: cognitive interventions, making plans for the future, information about associations between avoidance / hypervigilance and problem maintenance, increase of activities, exposure to avoided activities; duration: 18 weeks (one session per week) / Patient’s reports: frequency and intensity of dizziness episodes, anxiety, mood, well -being, activities / At the end of treatment: no more dizziness, increased activities and well-being / 11 (23.9%)

aThe quality assessment rating score (Moncrieff et al., 2001) could range between 0 (very poor study quality) and 46 (excellent study quality); in parentheses the proportion (in per cent) is reported.

Abbreviations: AT=autogenic training; ATHQ=Attitudes Towards Heights Questionnaire; BPV=benign positional vertigo; CAQ=Cohen Acrophobia Questionnaire; CBT=Cognitive-behavioural therapy; CMI=Cornell Medical Index; IIRS=Illness Intrusiveness Ratings Scale; DHI=Dizziness Handicap Inventory; MAS=Manifest Anxiety Scale; MI=Mobility Inventory; MOCI=Maudsley Obsessional-Compulsive Inventory; PPV=Phobic postural vertigo; SitQ=Situational Characteristics Questionnaire; SDS=Self-rating Depression Scale; STAI(-t)=State-Trait Anxiety Inventory (trait form); VHS=Vertigo Handicap Scale; VR=vestibular rehabilitation; Y-G=Yatabe-Guilford personality test

Table II. Summary of Reviewed Psychotherapy or Follow-up Studies.

Study / Study design / Sample, diagnoses / Control group / Intervention, duration / Measurements / Results / Quality assessment ratinga
Huppert et al. (2005) / Follow-up study;
assessment points: before treatment; follow-up: 5 to 15 years / N=303 were sent a questionnaire
n=106(35%) completed it(n=42 women, n=64 men; mean age 44.3 years); PPV / No / Initial: self-controlled behavioural therapy: explanation of PPV; decoupling of catastrophic thoughts; exposure to vertigo triggering situations; regular physical activity; duration: 2-3 sessions;
During follow-up period: psychotherapy (not specified); pharmacotherapy, physiotherapy; alternative therapies; / Self-reported changes: symptom-free / considerably improved, no change / Symptom-free or considerably improved: 75%, independently of age, sex, prior organic vertigo, or other subsequent therapies;
most improvement within the first year after initial treatment; / 21 (45.7%)
Heinrichs et al. (2003) / Psychotherapy study (natural design);
assessment points: before treatment; follow-ups: 6 weeks and one year / Initially: n=398 (n=266 women, n=132 men; mean age 35.5 years); vertigo and agoraphobia
6 weeks post: n=398 (100%)
One year post: n=300 (75.4%) / No / CBT (individualized):Information about the disorder and therapy procedure; intensive in-vivo exposure with anxiety triggering stimuli up to 12 hours daily; self-control period; duration: > 3 weeks / Questionnaires: BAI, BDI, BSQ, ACQ, MI, SCL-90-R / After 6 weeks: improvement in all measurements;
After one year: effects remained stable / 21.5 (46.7%)

aThe quality assessment rating score (Moncrieff et al., 2001) could range between 0 (very poor study quality) and 46 (excellent study quality); in parentheses the proportion (in per cent) is reported.

Abbreviations: ACQ=Agoraphobic Cognitions Questionnaire; BAI=Beck Anxiety Inventory; BDI=Beck Depression Inventory; BSQ=Body Sensation Questionnaire; CBT=Cognitive-behavioural therapy; MI=Mobility Inventory; PPV=Phobic postural vertigo; SCL-90(-R)=Symptom Checklist 90 (revised);

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