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Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)
A licensed copy of the Whalley & Cane (2017) cognitive behavioral model of persistent postural-perceptual dizziness which describes a framework to address the core components and symptoms of PPPD.
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Overview
Persistent postural-perceptual dizziness (PPPD) is a chronic dizziness which is believe to be maintained, at least in part, by psychological factors. This model offers clinicians insights into the psychophysiological mechanisms responsible for the onset and persistence of dizziness. The model has parallels with health anxiety models, providing a framework for understanding PPPD presentations, and guiding targeted behavioral and cognitive interventions.
Why Use This Resource?
This resource serves as a useful psychological tool for practitioners managing PPPD. It provides:
- A comprehensive framework for understanding PPPD.
- Facilitates psychoeducation and enhanced client understanding of their condition.
- Can inform assessment and case conceptualisation.
- Guides the use of appropriate interventions.
Key Benefits
Understanding
Clear identification of psychological factors sustaining dizziness.
Assessment
Framework for evaluating dizziness-related beliefs and behaviors.
Intervention
Supports development of tailored cognitive-behavioral strategies.
Who is this for?
Persistent Postural-Perceptual Dizziness (PPPD)
Characterized by persistent dizziness and visual sensitivity.
Health Anxiety
Individuals with excessive worry about their balance and perceived physical health.
Integrating it into your practice
01
Learn
Understand more about the cognitive behavioral model of PPPD.
02
Template
Use the model as a template to organize your case formulations.
03
Educate
Use your knowledge of the model to explain maintenance processes to clients.
04
Discuss
Engage clients in discussions about their beliefs and behaviors.
05
Tailor
Customize interventions based on individual maintenance mechanisms.
06
Reflect
Use in supervision to discuss formulation and treatment plans.
Theoretical Background & Therapist Guidance
Whalley and Cane’s (2017) Cognitive Behavioral Model of Persistent Postural-Perceptual Dizziness (PPPD) proposes that psychological factors play a key role in the maintenance of chronic dizziness symptoms. It suggests that the way individuals interpret and respond to sensations of dizziness can significantly influence symptom persistence. In particular, threat-based appraisals — such as viewing dizziness as a sign of serious illness or imminent danger — can trigger anxiety and physiological arousal, which in turn amplify the experience of dizziness.
Over time, individuals often develop coping strategies that unintentionally maintain or worsen their symptoms. These may include excessive monitoring of balance-related sensations, hypervigilance, avoidance of certain environments or movements, and reliance on safety behaviors such as holding onto furniture or avoiding crowds. While these strategies may feel protective in the short term, they can prevent habituation, reinforce threat interpretations, and reduce confidence in the body’s ability to self-regulate. This creates a self-perpetuating cycle in which dizziness is anticipated, monitored for, and more readily experienced.
Therapeutically, the model provides a practical framework for helping clients understand the links between their beliefs, attention, and behaviors. Treatment often involves psychoeducation about the benign nature of normal dizziness, cognitive work to challenge catastrophic appraisals, and behavioral experiments to reduce avoidance and safety behaviors. Therapists can also support clients to shift their focus away from internal monitoring and toward external engagement, which can help recalibrate attentional systems and reduce symptom intensity. The model encourages a collaborative, curious, and validating stance to support clients in regaining a sense of control and confidence in daily life.
What's inside
- Graphical depiction of the model.
- Insights into key maintenance mechanisms.
- Guidelines for using the information with clients resource.
FAQs
PPPD stands for persistent postural-perceptual dizziness, a chronic dizziness condition with psychological maintenance factors.
It highlights the role of cognitive appraisals, behavioral adaptations, and attentional strategies in sustaining dizziness symptoms.
Therapists can utilize it to guide case conceptualizaton, inform treatment planning, facilitate psychoeducation, and structure interventions targeting maladaptive beliefs and behaviors.
How This Resource Improves Clinical Outcomes
By applying the model, therapists and clients benefit from:
- Targeted interventions focusing on common maintenance mechanisms.
- Enhanced client engagement through increased understanding of their condition.
- Improved treatment outcomes by addressing core psychological features.
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References And Further Reading
- Whalley, M. G., & Cane, D. A. (2017). A cognitive-behavioral model of persistent postural-perceptual dizziness. Cognitive and Behavioral Practice, 24(1), 72-89.
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