PPPD Support · Ontario
Persistent Postural-Perceptual Dizziness.
You are not imagining this.
You are not making this up. You are not exaggerating. And you are definitely not the only one. If you have been told “all your tests came back normal” while the dizziness continues to shape your day, this page is for you.
Understanding the Condition
What PPPD actually is, in plain language.
PPPD is real, researched, and recognised in the ICD-11. It is not “just anxiety,” and it is not a made-up label for symptoms no one could be bothered to explain.
01 / Definition Symptoms that last three months or more, and don’t follow the usual rules.
PPPD is a chronic vestibular condition characterised by dizziness, unsteadiness, or a non-spinning sensation of swaying or rocking, present on most days for three months or more.
Symptoms worsen with upright posture, active or passive motion, and complex visual environments: grocery aisles, scrolling on a phone, traffic, crowds, patterned floors, fluorescent lighting. They often ease when lying down.
02 / Triggers The event that started it usually heals. The brain’s response sometimes doesn’t.
PPPD almost always follows something that disrupted the balance system: BPPV, vestibular neuritis, a concussion, labyrinthitis, a panic attack, or significant illness. The original event resolves, but the nervous system adaptations it triggered do not.
03 / Diagnosis Normal test results are part of the picture, not a reason to dismiss you.
PPPD is a clinical diagnosis. Vestibular function tests, MRIs, and bloodwork typically return without abnormalities. The Bárány Society established criteria in 2017; it is listed in the ICD-11. Absence of findings is not evidence that nothing is wrong.
04 / Mechanism The nervous system gets stuck in high-alert, and the brain starts leaning too hard on vision.
Threat-detection circuits stay elevated. The brain over-weights visual input trying to stabilise balance, which is why busy visual scenes feel overwhelming. Attention locks onto internal sensation. The loop is maintained by the very things that feel like common sense: hyper-vigilance, avoidance, body-scanning. Each of these is targetable in therapy.
05 / Outlook PPPD symptoms can decrease. Proper care changes the trajectory.
Recovery is possible. Evidence supports a multi-modal approach: vestibular rehabilitation, CBT, and where appropriate, medication prescribed by a physician (SSRIs and SNRIs have the strongest evidence). Outcomes are meaningfully better when the condition is named early and addressed from multiple angles.
How Balens Psychotherapy Helps
Therapy that understands the loop, and works with it.
PPPD is not a condition to push through, and it is not a condition to wait out. What it responds to is informed, patient, evidence-based care from people who have taken the time to understand it.
Being Properly Understood
Sessions begin with the thing most people arrive missing: a clinician who already knows what PPPD is, how it feels, and why the symptoms are doing what they’re doing. No pitching. No performance. Just a clear starting place.
Evidence-Based CBT for PPPD
CBT is the most studied psychological intervention for PPPD. We work with the catastrophic predictions, the body-checking habits, and the avoidance patterns that keep the nervous system on alert.
Nervous System Regulation
We integrate breathing work, grounding practice, interoceptive retraining, and where it fits, nature-based regulation. The aim is a nervous system that can tolerate stillness, motion, and uncertainty about both.
Honest About Scope
Edna does not provide vestibular rehabilitation. That is physiotherapy delivered by trained vestibular physios. What she provides is psychotherapy that runs alongside your vestibular rehab, GP care, and any medication your physician recommends.
Collaborative, Not Siloed
PPPD care tends to go best when clinicians talk to each other. Edna is happy to coordinate with your vestibular physio, family doctor, ENT, or neurologist where that helps.
Meeting You Where You Are
Some people arrive within months of their first episode. Others have lived with PPPD for years. Both are valid starting points. Sessions are virtual across Ontario or in-person in Vaughan.
The Therapeutic Frame
An integrative, culturally sensitive approach drawn from the modalities with evidence behind them.
Our work draws primarily on CBT for the core loop, with elements of DBT for distress tolerance, Motivational Interviewing for gradual behavioural change, Solution-Focused approaches for the week-to-week, and person-centred, strength-based framing throughout. Where clinically relevant, other psychotherapy modalities — including Internal Family Systems (IFS) — may be woven in to support the emotional and somatic dimensions of recovery. Trauma-informed care is the baseline, not a module.
“PPPD sits at the intersection of the nervous system and lived experience. The most effective care holds both — the biological reality of the condition and the human weight of what it takes from you day to day.”
Balens Psychotherapy / Clinical FocusResearch shows PPPD responds best to a set number of structured sessions rather than open-ended therapy. Our programs are structured with that research in mind.
See Treatment ProgramsTreatment Programs
The right amount of room for where you are right now.
PPPD is a chronic condition maintained by patterns in the nervous system. A structured program gives those patterns the consistent, sustained attention they need to change.
The loop takes time to unwind
The threat-detection, visual-dependence, and body-scanning patterns that maintain PPPD developed over months. Repeated sessions are where new habits take root and the nervous system learns to trust the ground again.
CBT requires practice between sessions
The evidence for CBT in PPPD is built on consistent work: thought records, gradual exposure, interoceptive exercises. A program gives you the sustained space to practise, adjust, and consolidate between sessions, with Edna tracking progress alongside you.
Continuity reduces the burden on you
With a program, you are not re-establishing context or re-explaining your history each time. Edna holds the arc of your progress, which frees the session for the actual work. For a condition that already demands so much energy, that continuity matters.
Sprout
4 Sessions
Earlier in your PPPD journey, still managing most of daily life. You may have some prior therapy experience, possibly including CBT — meaning the framework won’t be entirely new territory.
- Psychoeducation on PPPD and the maintenance loop
- CBT framework introduction
- Nervous system regulation tools
Bloom
7 Sessions
Symptoms are moderate but present. You’ve started avoiding certain situations or environments, and the anxiety around dizziness is taking up real mental space. Exposure work done too quickly tends to backfire — Bloom gives you enough sessions to pace it properly and let gains consolidate before moving forward.
- Graduated exposure hierarchy
- Cognitive restructuring for catastrophic thinking
- Interoceptive retraining
Thrive
11 Sessions
Your world has gotten noticeably smaller. Avoidance is significant, anticipatory anxiety is high, and daily functioning is genuinely impacted. This might have been going on for a long time, or the presentation is complex enough that an unhurried approach is what’s needed.
- Everything in Bloom, sustained over a longer arc
- Deeper trauma-informed work where relevant
- Relapse prevention and maintenance planning
Although not comprehensive, general single sessions are available for those who prefer a more flexible approach. If you have questions about which format suits your situation, get in touch first.
Next Step
Ready to talk it through with someone who gets it?
Book a session with Edna. Virtual across Ontario, in-person in Vaughan. Direct billing available for many insurers.
Resources & Referrals
Free downloads & vestibular therapists we work with.
We’ve put together a set of free educational handouts on PPPD — grounding techniques, CBT tools, thought-reframing worksheets — alongside a directory of vestibular physiotherapists we actively coordinate care with. All in one place.
Free handouts
Unlock with your email. No pitch.
Vestibular therapist directory
Clinicians we know and coordinate with.
Peer-reviewed literature
For the deeply curious.
Ready When You Are
Recovery starts with someone who already knows the terrain.
If you’ve been managing PPPD on your own, or bouncing between clinicians who didn’t quite get it, this is a place to stop and be properly heard. Book a session or reach out first, whatever feels right.