Dizziness, vertigo, and anxiety create a vicious cycle. The short answer is yes; vertigo can be caused by stress. However, typically dizziness is caused by stress, not true vertigo. Even if you do not consider yourself to be an anxious or stressed person, there is a high likelihood that you will experience stress and/or anxiety after getting vestibular symptoms. This is because of the close relationship between the stress and anxiety center and the vestibular system.
What is Vertigo?
Vertigo is the incorrect perception that you or the room around you is moving or spinning. This can be in the form of room-spinning vertigo, typically from Benign Paroxysmal Positional Vertigo, or BPPV, or from Meniere’s Disease or Vestibular Migraine. Vertigo is not all dizziness, however many of us incorrectly name our sensations vertigo even when they are ‘dizzy’ by definition. Dizziness accounts for: lightheadedness, heavy-headedness, bouncy, floaty, and other terminologies. It’s important to distinguish the two different sensations as it can help your doctor or other healthcare provider determine an accurate diagnosis. Stress can be a factor causing vertigo and dizziness alike.
What Regulates Anxiety and Dizziness?
The Limbic system is made up of the amygdala, hippocampus, and hypothalamus; it regulates emotion and processes memory (1). Additionally, it is responsible for fear & aggression, and joy & excitement. The limbic system is tightly bound to the vestibular system through many synapses, so when you begin to get dizzy, you may start to feel stressed or anxious simultaneously. Research has shown that when pigs are given a lesion in their vestibular systems, they immediately begin to produce the stress hormone cortisol (2). Additionally, in a study done on people, when caloric testing is performed (which makes you dizzy), levels of stress hormones increased significantly, and those who are prone to motion sickness had already-elevated stress hormone levels (2). Our brains are not structured to endure lengthy durations of trauma or stress, which causes the link between anxiety and dizziness.
Neurons that fire together, wire together. – Donald Hebb
We have many neurons firing in our brains and nervous system; this is how our body functions. Our brains are plastic – meaning that our brains can learn and change constantly, as much as we need them, to suit our current needs. I’m going to repeat it: neurons that fire together, wire together. This phrase was coined by neuropsychologist Donald Hebb and describes how neuronal pathways form through reinforcement. If you’ve ever tried to learn a new skill, whether it was driving, playing violin, typing, or doing schoolwork, you likely noticed that the more you did something, the better you became at your new skill. The same rule goes for anything. If you find you are feeling dizzy and then immediately becoming anxious, or stressful thoughts begin to enter your head, it can make the dizziness increase exponentially. Neurons that fire for dizziness and then immediately cause anxiety wire together. This creates the dizzy-anxious-dizzy cycle.
Donald Hebb goes further into talking about why we should practice gratitude, which I think is vital for those with vestibular disorders. Wiring dizzy sensations with gratitude, or other positive sensations, can actually decrease dizziness overall.
How to Break the Dizzy-Anxious-Dizzy Cycle?
Dizziness can absolutely be caused by stress and, as we discussed above, if a stressed or anxious neuron is fired, over and over, at the same time as a dizzy neuron, the two will wire together. Breaking the cycle can be difficult, especially if it’s rooted deep within your brain from years of repetition. The gold standard for dizziness related to anxiety is vestibular rehabilitation therapy, cognitive-behavioral or acceptance and commitment therapy, and medical care.
Vestibular Rehabilitation Therapy and Anxiety
After a vestibular diagnosis, you may feel like you never want to move again – the less you move, the less dizzy you feel, right? Unfortunately, that line of thinking is false and disproven. However, that also means you are able to move freely and as much as possible! If movement feels scary to you, like you might fall over, or trigger a dizzy episode, vestibular rehabilitation therapy is right for you! Vestibular rehabilitation therapy provides a safe environment to help you return to movement without triggering severe symptoms. Being able to move with a vestibular physical therapist to perform functional movements shows your brain that you are safe, secure, and calm. This will remind your brain that moving does not have to make you feel dizzy, and regardless of your diagnosis, it will slowly recalibrate your brain to receive vestibular inputs correctly
If you have specific questions about Vestibular rehabilitation therapy, click here for more information.
Psychological Therapy and Anxiety
We think about going to therapy for typical stress, depression, and anxiety. However, we don’t consider going to therapy for vestibular needs nearly enough. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are both excellent kinds of therapy that work to decrease dizziness and improve function. Research shows that patients with chronic dizziness, especially PPPD, make improvements with therapy, especially when combined with vestibular rehabilitation therapy (3). Although there is not a randomized control trial at this time, the pilot study showed great results.
My favorite resource for all things dizziness-related therapy is Dr. Emily Kolstenik. She has two courses, Breaking the Dizzy-Anxious-Dizzy cycle, and Committing to Balance. One is a mini-version of the other, and they are both excellent resources for you if you’re looking to learn more about the vestibular system, decrease anxiety, improve your self-awareness in a healthy way, and decrease your dizziness symptoms.
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(1) Gamba P. Vestibular-limbic relationships: Brain mapping. Insights Depress Anxiety. 2018; 2: 007-013. DOI: 10.29328/journal.ida.1001006
(2) Saman, Y., Bamiou, D., Gleeson, M., & Dutia, M. B. (1AD, January 1). Interactions between stress and vestibular compensation – A Review. Frontiers in Neurology. Retrieved October 5, 2021, from https://www.frontiersin.org/articles/10.3389/fneur.2012.00116/full#h3.
(3) Kuwabara, J., Kondo, M., Kabaya, K., Watanabe, W., Shiraishi, N., Sakai, M., Toshishige, Y., Ino, K., Nakayama, M., Iwasaki, S., & Akechi, T (2020, June 11). Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study. Science Direct. Retrieved October 5, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0196070920303033?via%3Dihub.