慢性めまいの治療戦略としての認知行動療法

抄録

Dizziness is a commonly reported symptom that often becomes chronic. This article describes the basic concepts of cognitive behavioral therapy (CBT) and the clinical presentation of patients with dizziness from a CBT perspective, followed by a report on the practice of CBT for patients with chronic dizziness at our department. Finally, we discuss the usefulness and limitations of CBT as a treatment strategy for chronic dizziness and compare them with those of other treatment methods.

CBT is a treatment method in which the therapist organizes the patient’s problems and attempts to improve or solve them by teaching the patient problem-solving skills and self-control training. In CBT, the pathology of chronic dizziness is understood through the cognitive-behavioral model and fear-avoidance model. Chronic dizziness patients suffer from characteristic cognitive and behavioral problems that arise from experiencing the dizziness symptom. CBT is aimed at resolving these cognitive and behavioral issues in an attempt to improve the patients’ symptoms and enhance the patients’ quality of life.

Our research group developed and implemented a CBT program for a group of chronic dizziness patients. The results showed improvements in anxiety, depression, dizziness-related functional impairment, and dizziness exacerbation factors, with no adverse events observed. CBT can contribute to improvement of the dizziness symptom by modifying the patients’ attention to and evaluation of their own dizziness.

Comparison of CBT with other treatments revealed that the results of CBT were comparable to those of pharmacotherapy and that CBT may share some commonalities with vestibular rehabilitation. CBT is a broad-spectrum intervention based on a model of symptom exacerbation and maintenance, regardless of the cause. Although this article reports the treatment efficacy of CBT in our practice and suggests that it may yield outcomes comparable to pharmacotherapy, evidence in Japan still remains limited.