Structured care for a condition that demands consistency.
If chronic dizziness has quietly reshaped how you live, you are not imagining it, and you are not out of options. PPPD responds to structured, stepwise treatment. These programs give your nervous system the time and support it needs to feel steady again.
If This Sounds Like You
You've been told everything looks normal.
The tests came back clear. Someone, maybe more than one someone, has used the word "anxiety." And yet the floor still tilts, the busy aisle still swims, and you have started quietly building your days around a symptom no one else can see.
- A constant sense of swaying, rocking, or unsteadiness, even when you're perfectly still.
- Grocery stores, screens, scrolling, patterned floors, crowds, all harder than they should be.
- The exhaustion of holding it together in public, then coming home wrung out.
- A world that keeps getting a little smaller as you learn which places to avoid.
- The low, constant hum of dread, waiting for the next wave to arrive.
Here is what often goes unsaid: PPPD runs on a loop. The more the nervous system rehearses the threat, the more practised it becomes at producing the dizziness, and the more the avoidance quietly grows. Left to run on its own, the pattern tends to entrench rather than fade.
That is not a reason to panic. It is the reason a structured, stepwise approach works so well, and the honest reason that starting sooner is gentler than starting later. There is less to unwind when the loop has had less time to practise.
Why This Is Hard To Find
In Ontario, very few actually understand PPPD.
Most people spend months, sometimes years, passed between providers and handed clear scans before anyone names PPPD, let alone treats it properly. Specialized psychotherapy focusing on it barely exists.
Balens Psychotherapy exists to close that gap: a structured, evidence-based PPPD pathway, built and delivered by a Registered Nurse Psychotherapist who has made this condition her focus, for people the system has too often left to manage alone.
Edna Bonsu · Registered Nurse Psychotherapist
The Clinical Rationale
Why a program model & not session by session?
PPPD responds to structure. The therapeutic approaches used in treatment are stepwise by design, including cognitive behavioural therapy and graded exposure. Each session builds directly on the last, and meaningful progress depends on consistency, pacing, and time.
A program model is more than a pricing decision, it's a clinical one. It ensures you have the continuity needed to do this work properly, with built-in monitoring, a clear arc from assessment to discharge, and supported follow-up once active treatment ends.
The right program will depend on the nature and severity of your symptoms, your current level of functioning, and how much time your nervous system needs to feel safe again. That conversation begins at the initial consultation.
CBT for PPPD is a sequential process. Skills compound. The exposure hierarchy builds gradually. Dropping in and out disrupts that progression.
Predictability is itself therapeutic for a nervous system stuck in threat-detection. Regular sessions provide an anchor point during a disorienting process.
Progress doesn't stop at discharge. Rooted Check-ins (30 minutes) at three and six months monitor how gains are holding and address anything that resurfaces, included in every program at no additional cost.
Program Components
What every program includes.
All three programs share the same clinical framework. The difference is the number of individual therapy sessions and the depth of monitoring that becomes possible over time.
Comprehensive Initial Assessment
A 90-minute session to map your history, understand your symptoms in full, and establish a shared treatment plan before therapy begins.
Individual Therapy Sessions
50-minute sessions grounded in the CBT for PPPD framework, paced to your symptom severity and readiness for exposure work. Where clinically relevant, other psychotherapy modalities, including Internal Family Systems (IFS), may be woven in to support the emotional and somatic dimensions of recovery.
Discharge Planning Session
A structured final session to consolidate gains, build a maintenance plan, and prepare you for life after active treatment ends. You leave with a personalised toolbox, including strategies, practices, and a plan for what to do if symptoms resurface.
Rooted Check-ins
30-minute follow-up appointments at 3 months (all programs) and 6 months (Bloom and Thrive). We don't disappear at discharge, this continued care is built into every program at no additional cost.
What Treatment Looks Like
The arc of a program, phase by phase.
Every program moves through the same clinical arc. The number of sessions in each phase scales with the program, more room means a slower, more thorough progression. What stays the same is the structure.
Phase 01
Assessment
A 90-minute intake to map the full picture: symptom history, triggers, current functioning, prior treatment, and what's already been tried. Treatment planning begins here.
Phase 02
Psychoeducation
Understanding the PPPD maintenance loop, what keeps the nervous system stuck and why, is the first therapeutic move. It reframes the experience and makes the work that follows legible.
Phase 03
Skills Building
Nervous system regulation tools, grounding practices, thought monitoring, and the CBT framework for dizziness. Built incrementally, practised between sessions.
Phase 04
Graduated Exposure
Systematic, paced work through situations and sensations that have been avoided. The hierarchy is built together and moved through at a pace the nervous system can tolerate.
Phase 05
Consolidation
Reviewing gains, addressing setbacks, adjusting the plan where needed. In Bloom and Thrive, the treatment plan is formally revised mid-program to reflect where things actually are.
Phase 06
Discharge Planning
A structured final session to consolidate gains, build a relapse prevention plan, and prepare for life after active treatment. You leave with a clear map, not a goodbye.
Phase 07
Rooted Check-ins
Follow-up at 3 and 6 months post-discharge. Not a formality, a genuine checkpoint to catch anything that has shifted and confirm that gains are holding.
Between sessions. The work doesn't pause when the session ends. Clients leave each session with clear practice, and the program is structured to support that between-session work as part of the clinical design.
Treatment Programs
Choose your pathway.
Each program is a full arc of care, from the first assessment through discharge to follow-up. PPPD rarely resolves on its own, and the loop it runs on gets more practised with time, so the real question isn't whether to begin, but how much room your nervous system needs to do this work properly.
Sprout is designed for those earlier in their PPPD journey, or for those who are still managing most of daily life despite their symptoms. You may not yet be significantly avoiding situations, but the dizziness is present and it is starting to ask questions you do not have answers to. You may have some prior therapy experience, possibly including CBT, which means the framework will not be entirely new territory. This program builds the foundational layer: understanding what is driving your symptoms, beginning to work with the nervous system rather than against it, and establishing a structured starting point for the work ahead.
Includes
Bloom is for those whose symptoms are moderate but entrenched. Avoidance has started to build, certain environments or situations have become reliably difficult, and the anxiety around dizziness is taking up real mental space between episodes. The exposure work that is central to PPPD treatment needs room to be done properly, and Bloom provides it. Rushing that process tends to backfire, and seven sessions give enough space to begin to pace the hierarchy carefully, consolidate gains between sessions, and adjust the approach as the nervous system responds. If you're not sure where you land, this is the pathway most PPPD work has the room it needs.
Includes
Thrive is our most expansive pathway, designed for those whose PPPD has significantly impacted daily functioning. Your world may have gotten noticeably smaller, avoidance is likely significant, and anticipatory anxiety around symptoms may be high. This might be a long-standing presentation, or the symptom picture may be complex enough that an unhurried approach is what the nervous system actually needs. Eleven sessions provide the time to move through the exposure hierarchy at a pace that builds genuine tolerance rather than pushing through, to address setbacks without losing ground, and to do deeper trauma-informed work where that is clinically relevant. The arc is longer by design.
Includes
All sessions are hst exempt and direct billing may apply.
Not sure you're ready to commit? The first step is always a free 20-minute consultation. The right program is decided together once there's a full picture of your symptoms. Or take the 1-minute program finder to see where you'd likely start.
Not Sure Where to Start
Find your starting point.
The recommendation is made collaboratively at the initial consultation, once there is a full picture of your symptoms, history, and current level of functioning. If you are uncertain, this short questionnaire can help point you in the right direction, no commitment, no pressure.
Program finder
Not sure which pathway is right for you?
These eight questions are designed to give you a starting point, a sense of which program is likely to offer the right level of support given where you are right now with your symptoms.
There are no right or wrong answers. Answer as honestly as you can, based on how things have actually been and not how you hope they'll be or think they should be.
This tool does not provide a diagnosis, clinical assessment, or medical advice. The final recommendation is always made collaboratively at your initial consultation, once there is a full picture of your history and symptoms.
"Specialized psychotherapy for PPPD barely exists. That's not okay, not for a condition that can quietly dismantle someone's entire world. I'm here to fill that gap, and to show up properly for people the system has already let down."Edna Bonsu · Registered Nurse Psychotherapist · Balens Psychotherapy
Ready to Begin
The first step is a conversation.
Book a free 20-minute consultation to talk about what's been happening and whether Balens Psychotherapy is the right fit. Virtual across Ontario, in-person in Vaughan. Direct billing available through Telus e-claims.