Breaking the Dizzy-Anxious Cycle: Understanding and Overcoming

By Cheryl Wylie, MSc (PT)

In the intricate dance between our minds and bodies, there exists a profound connection between anxiety and dizziness. This symbiotic relationship often manifests as a dizzy-anxious cycle, where sensations of dizziness trigger anxiety which in turn fuels further dizziness. Understanding this cycle is crucial to breaking free from its grip and reclaiming control over our mental and physical well-being. In this blog post, we'll explore the dizzy-anxious cycle, its underlying mechanisms, and strategies for breaking free from its grasp.

Before we dive in, I want to let you know the breakdown of this blog has been summarized into a simple handout for easy reference. Get the handout HERE!

The Dizzy-Anxious Cycle Unveiled

Dizziness, along with vertigo, is a symptom that is caused by a mismatch of information in our sensory nervous system. The mismatch is alarming for our brains, so it triggers dizziness to let us know about this confusion. At the same time, it will often heighten our alarm system, trigger anxiety along side it. As anxiety sets in, your body responds with a cascade of physiological changes. Your heart races, palms sweat, and tension grips your muscles. In the midst of this turmoil, your dizziness builds as our discomfort and distress is reinforced, triggering a vicious cycle. You may find yourself caught in a loop of catastrophic thoughts—"What if I fall? What if something is seriously wrong?"—which only intensifies your feelings of panic and unease. As anxiety mounts, so does the sensation of dizziness, creating a feedback loop that seems impossible to escape.

Understanding the Mechanisms

01: Initial Dizziness

The cycle of dizziness and anxiety typically begins with an initial episode of dizziness or vertigo. This can result from various factors, including inner ear problems (such as benign paroxysmal positional vertigo, persistent postural perceptual dizziness or vestibular migraine), medication side effects, dehydration, low blood pressure, or anxiety itself.

02: Anxiety Response (Physical)

When you experience dizziness, especially if it's sudden or severe, you may naturally feel anxious or fearful. Dizziness disorders often result in a loss of our sense of orientation and where we are in space. It may feel as though we aren’t in our on bodies, have an altered perception of our world, and a sensation of imbalance or unsteadiness. This can provoke feelings of fear (specifically fear of falling or being injured), vulnerability or danger, triggering the body's stress response.

As anxiety levels increase in response to the dizziness, physiological changes occur in our body. Anxiety triggers our stress response, also know as the “fight or flight” response. This leads to the release of stress hormones like adrenaline, which can affect bodily functions, including increased heart rate and blood pressure, shallow breathing, muscle tension (especially in the neck), and heightened arousal—all of which can exacerbate feelings of dizziness or vertigo.

03: Hyperviligence and Cognitive Amplification (Cognitive)

As the cycle continues, we may find ourselves hyper-focused on our dizziness symptoms, constantly monitoring our sensations and worrying about their implications. This heightened awareness can intensify both the perception of dizziness and the associated anxiety.

Anxiety can also distort our perception and interpretation of sensory information. We may catastrophize the sensation of dizziness, interpreting it as a sign of a serious medical condition or impending danger. In addition, severe or persistent dizziness can interfere with our daily activities and quality of life, leading to frustration, irritability, and feelings of helplessness. This impairment in functioning can contribute to anxiety, as we worry about our ability to perform tasks, engage in social activities, and meet our responsibilities.

04: Avoidance Behaviours and Sensitization (Behavioural)

In an effort to cope with or avoid dizziness and anxiety, we often engage in avoidance behaviors. You may find yourself avoiding certain activities, environments, or social situations that have been associated with dizziness. Common avoidance behaviours are sleeping elevated, avoiding crowds and busy stores, and reducing your overall movement. While these behaviors may provide temporary relief, they can also perpetuate the cycle by reinforcing avoidance patterns and maintaining anxiety sensitivity.

Over time, repeated episodes of dizziness and anxiety can lead to sensitization, where you become increasingly sensitive to both physical sensations and emotional triggers associated with dizziness. This heightened sensitivity can make it easier for the cycle to recur and more challenging to break.

05: Feedback Loop

Because this all leads to increased dizziness, this reinforces your belief that something is wrong, which further amplifies your anxiety. This creates a feedback loop where anxiety worsens dizziness, and dizziness increases anxiety.

Breaking Free from the Cycle

Breaking free from the dizzy-anxious cycle requires a multifaceted approach that addresses both the physical and psychological components of anxiety and dizziness. Our goal is to inject changes into the various aspects of the cycle to help break free from this loop. Here are some strategies to consider when looking at the treatment for dizziness and anxiety:

01: Initial Dizziness

Starting at the top of the cycle, with Initial Dizziness, we can begin here with the introduction of vestibular rehabilitation therapy (VRT). VRT can address the specific reasons for your dizziness, and treatment may look like canalith repositioning maneuvers of BPPV is present, balance training, gaze stabilization exercises, optic flow training, etc. depending on your underlying disorder. Education and lifestyle changes also come into play here, especially if disorders such as vestibular migraine and PPPD are in play.  

02: Anxiety Response (Physical)

Your initial anxiety response is generally composed of very physical symptoms and changes in our nervous system. These changes stimulate our “fight and flight” system, so to break the cycle, we want to introduce activities that stimulate the opposite system, your “rest and digest” system. This looks like:

• Sitting on the floor with your back against the wall

• Diaphragmatic (belly) breathing 

• Grounding and weighting exercises (e.g. wearing a weighted vest, holding hand weights, placing hands on head, using a weighted blanket, etc.)

• Focusing on our 5 senses (sight, touch, hearing, taste, smell)

• Smelling peppermint oil or another essential oil that calms you

• Muscle relaxation and contract/relax techniques

• Body scans or Yoga Nidra

Each of these techniques helps to activate the parasympathetic nervous system, which releases chemicals that combate adrenaline and calms us. They also help to provide a sense of orientation,  which help us feel safe and secure.

03: Hyperviligence and Cognitive Amplification (Cognitive)

The third part of the cycle looks at the cognitive changes that occur with anxiety. This aspect of the loop focuses on hyperawareness of your symptoms, worry, and catastrophizing thoughts. To break the cycle here, we want to break this thought process with various strategies:

• Mindset

• Mantras (e.g. You are still, you are safe, you are okay)

• Distraction (hobbies, social activities, etc.)

• Music or art therapy

• Meditation (e.g. Calm App, Insight Timer)

• Mental games (think in categories, recite a song)

• Self-kindness and self-talk

Don't hesitate to seek support from healthcare professionals, including therapists, psychiatrists, or primary care physicians for this stage. They can provide personalized guidance, medication management, or referrals to specialized treatment programs as needed. A resource we love is Rooted Behavioural Education and her course Breaking the Dizzy-Anxious-Dizzy Cycle.  

04: Avoidance Behaviours and Sensitization (Behavioural)

The final part of the cycle is when we see behaviour changes, primarily focused on avoidance of activities and resulting increased sensitization of our dizziness. The goal here is to slowly and gently expose ourselves to activities that make us dizzy, and begin to move our bodies in gentle non-threatening ways:

• Gradual exposure therapy (e.g. to grocery stores or busy environments)

• Graded exercises (starting small and building up)

• Gentle walking program

• Lying flat training

Putting it into Practice

Breaking the dizzy-anxious cycle takes time so do not expect changes to happen overnight. We want to be thoughtful of including change actions from each area of the cycle as that will lead to the most success. And even better, can you combine various areas at the same time? Here would be a few examples:

• Meditation with body scans or muscle contract/relax techniques

• Exposure therapy in a grocery store with peppermint oil on your wrist to smell and self-talk

• Sitting against a wall while repeating a mantra

• Lying flat (or reclined) while doing diaphragmatic breathing

• Graded walking program with a weighted vest and music that makes you happy

Here is another great starting activity for breaking the dizzy-anxious cycle:

Sit with your back against a wall and legs outstretched, focusing on the solid surfaces you are touching. Place something heavy on your lap, such as your purse or a weighted blanket. Take 5 slow diaphragmatic breaths. Now repeat this mantra: I am still, I am safe, I am okay as many times as needed. When you feel ready, slowly get up.

You can do this exercise anytime you feel dizzy or have lost your sense of balance and orientation. It is also a tool you can use as you begin to gradually expose yourself to activities you may be avoiding.

Overcoming the Dizzy-Anxious Cycle

The dizzy-anxious cycle can feel overwhelming and suffocating, but it is not insurmountable. By understanding the underlying mechanisms and implementing effective coping strategies, you can break free from its grip and reclaim control over your life. Remember that healing is a journey, and progress may be gradual. Be patient and compassionate with yourself as you navigate this process and know that support and resources are available to assist you along the way. With determination and perseverance, you can overcome the dizzy-anxious cycle and emerge stronger and more resilient than before.

If you feel like you are in the dizzy-anxious cycle, please reach out or schedule a free consult today. Vestibular Physiotherapists are trained in identifying the cause of vestibular disorders and can help you work though breaking this cycle and getting you back to the activities you love.