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Systematic Review

Anxiety-Related Functional Dizziness: A Systematic Review of the Recent Evidence on Vestibular, Cognitive Behavioral, and Integrative Therapies

by
Rosario Ferlito
1,
Francesco Cannistrà
1,
Salvatore Giunta
1,
Manuela Pennisi
1,
Carmen Concerto
2,
Maria S. Signorelli
2,
Rita Bella
3,
Maria P. Mogavero
4,
Raffaele Ferri
4 and
Giuseppe Lanza
4,5,*
1
Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
2
Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
3
Department of Medical and Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, University of Catania, 95123 Catania, Italy
4
Clinical Neurophysiology Research Unit, Sleep Research Centre, Oasi Research Institute-IRCCS, 94018 Troina, Italy
5
Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy
*
Author to whom correspondence should be addressed.
Life 2026, 16(1), 159; https://doi.org/10.3390/life16010159 (registering DOI)
Submission received: 31 December 2025 / Revised: 12 January 2026 / Accepted: 15 January 2026 / Published: 18 January 2026
(This article belongs to the Special Issue Advances on Physiotherapy and Functional Rehabilitation in Chronic Conditions)
Versions Notes

Abstract

Background: Functional dizziness and persistent postural-perceptual dizziness (PPPD) involve mutually reinforcing vestibular symptoms and anxiety. Non-pharmacological interventions, such as vestibular rehabilitation therapy (VRT) and cognitive behavioral therapy (CBT), aim to address both mechanisms, yet their overall effectiveness remains unclear. Methods: We systematically examined randomized controlled trials (RCTs) published between 2000 and 2025 that evaluated VRT, CBT, or multimodal approaches for adults with functional or chronic dizziness (including PPPD and related functional dizziness constructs) accompanied by significant anxiety. Twelve RCTs (513 participants) met the criteria, involving individuals with PPPD, chronic subjective dizziness, chronic vestibular disorders with prominent anxiety, and residual dizziness after benign paroxysmal positional vertigo. Results: Conventional VRT delivered in clinic or as structured home-based programs produced small-to-moderate improvements in dizziness-related disability versus usual care. Combining VRT with CBT or psychologically informed components yielded larger and more consistent reductions in disability and maladaptive dizziness-related beliefs. CBT-based interventions reduced anxiety and dizziness-related distress compared with supportive controls. Emerging modalities, including virtual-reality-based VRT, non-invasive neuromodulation, and heart-rate-variability biofeedback, showed potential, although they were limited by small samples and methodological issues. Most trials had some risk-of-bias concerns and evidence certainty ranged from very low to moderate. Conclusions: Integrated multimodal rehabilitation shows promise, although larger, high-quality RCTs using standardized procedures and outcome measures are required.
Keywords: persistent postural-perceptual dizziness; anxiety; vestibular rehabilitation; cognitive behavioral therapy; systematic review; randomized controlled trials persistent postural-perceptual dizziness; anxiety; vestibular rehabilitation; cognitive behavioral therapy; systematic review; randomized controlled trials

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MDPI and ACS Style

Ferlito, R.; Cannistrà, F.; Giunta, S.; Pennisi, M.; Concerto, C.; Signorelli, M.S.; Bella, R.; Mogavero, M.P.; Ferri, R.; Lanza, G. Anxiety-Related Functional Dizziness: A Systematic Review of the Recent Evidence on Vestibular, Cognitive Behavioral, and Integrative Therapies. Life 2026, 16, 159. https://doi.org/10.3390/life16010159

AMA Style

Ferlito R, Cannistrà F, Giunta S, Pennisi M, Concerto C, Signorelli MS, Bella R, Mogavero MP, Ferri R, Lanza G. Anxiety-Related Functional Dizziness: A Systematic Review of the Recent Evidence on Vestibular, Cognitive Behavioral, and Integrative Therapies. Life. 2026; 16(1):159. https://doi.org/10.3390/life16010159

Chicago/Turabian Style

Ferlito, Rosario, Francesco Cannistrà, Salvatore Giunta, Manuela Pennisi, Carmen Concerto, Maria S. Signorelli, Rita Bella, Maria P. Mogavero, Raffaele Ferri, and Giuseppe Lanza. 2026. "Anxiety-Related Functional Dizziness: A Systematic Review of the Recent Evidence on Vestibular, Cognitive Behavioral, and Integrative Therapies" Life 16, no. 1: 159. https://doi.org/10.3390/life16010159

APA Style

Ferlito, R., Cannistrà, F., Giunta, S., Pennisi, M., Concerto, C., Signorelli, M. S., Bella, R., Mogavero, M. P., Ferri, R., & Lanza, G. (2026). Anxiety-Related Functional Dizziness: A Systematic Review of the Recent Evidence on Vestibular, Cognitive Behavioral, and Integrative Therapies. Life, 16(1), 159. https://doi.org/10.3390/life16010159

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