What Actually Helps Persistent Postural-Perceptual Dizziness (PPPD)?

Living with PPPD can feel like being stuck in a loop. The dizziness doesn’t spin, but it lingers. You may feel off-balance, floaty, or anxious in busy places or when you’re simply trying to stand still. The good news? Research shows there are ways out of that loop.

So what really helps PPPD?

The most effective treatments for PPPD are vestibular rehabilitation therapy (VRT), cognitive behavioral therapy (CBT), and in some cases, medications like SSRIs or SNRIs.

1. Vestibular Rehabilitation Therapy (VRT)

VRT is a specialized form of physical therapy designed to retrain your balance system. It’s the first-line treatment for PPPD and has been shown to significantly reduce dizziness severity and improve quality of life. Exercises are tailored to your specific symptoms and may include balance work, head movements, walking exercises, or visual desensitization for those with visual vertigo (Choi et al.; Nada et al.; Suica et al.).

2. Cognitive Behavioral Therapy (CBT)

CBT addresses the psychological and emotional side of PPPD. It helps break the cycle of anxiety, hypervigilance, and body sensitivity that often feeds into persistent symptoms. CBT can be used alone or alongside VRT and has shown strong results in reducing symptom burden and improving daily functioning (Trinidade & Goebel; Das et al.; Wang et al.).

3. Medications (SSRIs/SNRIs)

In more complex cases or when anxiety is prominent, medications like SSRIs and SNRIs can be helpful. While research is still evolving, clinical experience suggests these medications can support recovery by calming the nervous system and reducing overactivation in the brain’s balance and emotion networks (Sun & Xiang; Webster et al.).

A Whole-Person Approach

At Balens Therapy, we focus on CBT tailored to PPPD, combined with nervous system regulation and holistic care. We work with you to ease anxiety, challenge unhelpful thought patterns, and gently reconnect with your body in a way that feels safe. While we don’t provide VRT ourselves, we’re happy to collaborate with your care team to make sure your support plan is truly comprehensive.

We also integrate nature-informed therapy where appropriate — using mindfulness, grounding, and natural metaphors to help you feel more steady in your own skin.

You don’t have to live in constant dizziness.

Book your free 20-minute consultation with Balens Therapy and let’s explore your next step toward balance and healing.

📍Serving clients across Ontario, virtually.

Works Cited

Choi, S.Y., et al. “Effect of Vestibular Exercise and Optokinetic Stimulation Using Virtual Reality in Persistent Postural-Perceptual Dizziness.” Scientific Reports, vol. 11, no. 1, 2021, p. 14437. https://doi.org/10.1038/s41598-021-93940-z.

Nada, E.H., et al. “Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness.” Annals of Otology, Rhinology, and Laryngology, vol. 128, no. 4, 2019, pp. 323–29. https://doi.org/10.1177/0003489418823017.

Suica, Z., et al. “Comparative Effectiveness of Non-Pharmacological Treatments in Patients With Persistent Postural-Perceptual Dizziness.” Frontiers in Neurology, vol. 15, 2024, p. 1426566. https://doi.org/10.3389/fneur.2024.1426566.

Trinidade, A., and J.A. Goebel. “Persistent Postural-Perceptual Dizziness.” Otology & Neurotology, vol. 39, no. 10, 2018, pp. 1291–1303. https://doi.org/10.1097/MAO.0000000000002010.

Das, S., et al. “Persistent Positional Perceptual Dizziness in Clinical Practice.” Neurological Sciences, vol. 44, no. 1, 2023, pp. 129–35. https://doi.org/10.1007/s10072-022-06353-9.

Wang, A., et al. “Persistent Postural-Perceptual Dizziness in Children and Adolescents.” Otology & Neurotology, vol. 42, no. 8, 2021, pp. e1093–e1100. https://doi.org/10.1097/MAO.0000000000003212.

Sun, L., and K. Xiang. “A Review on the Alterations in the Brain of Persistent Postural-Perceptual Dizziness Patients.” Reviews in the Neurosciences, vol. 31, no. 6, 2020, pp. 675–80. https://doi.org/10.1515/revneuro-2019-0109.

Webster, K.E., et al. “Pharmacological Interventions for Persistent Postural-Perceptual Dizziness.” Cochrane Database of Systematic Reviews, vol. 3, 2023, CD015188. https://doi.org/10.1002/14651858.CD015188.pub2.