STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness

Abstract

Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (Q H/V ), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: Q H/V = 0.31 versus controls: Q H/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles.

Figure 1

Schematic illustration of postural control. (a) Healthy controls; black vectors in x-, y-, and z-directions indicate physiological body sway activity; (b) SVD patients at baseline; the dotted vectors indicate normal values (healthy controls) and white vectors pathological body sway with reduced horizontal sway and increased vertical sway of the SVD patients. (c) Improvement of postural control after the therapy.

Figure 2

Illustration of absolute and cumulative sway path values in meter/minute (m/min) over the time course of each examination condition. The black columns represent the healthy controls, the hashed columns the patients before PTI, and the white columns the patients after PTI ((a) x-axis in m/min, (b) y-axis in m/min, and (c) z-axis in kN/min). The various conditions of posturographic measurements are displayed along the x-axis of (a–c) (conditions (1)–(10)).