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Table 2 Brief description of the Vestibular Rehabilitation and Cognitive Behaviour Therapy (VR-CBT) group-treatment protocol

From: Efficacy of intergrating vestibular rehabilitation and cognitive behaviour therapy in persons with persistent dizziness in primary care- a study protocol for a randomised controlled trial

Session number

Focus

Example of tasks/exercises

1

Dizziness and additional/secondary complaints

Discussion on dizziness and additional complaints.

Introducing the vicious circle that can arise between somatic symptoms and the catastrophic misinterpretation of these. Exercises: bdy awareness in sitting and standing. Habituation (nodding and head turns)

2

The ‘vicious circle’

How somatic symptoms related to both dizziness and anxiety can be appraised appropriately by mapping the relevant symptoms, thoughts and potential avoidance behaviour for each participant. Introducing the ‘fight or flight’ response, and how this may be relevant for chronic dizziness.

Exercises: body awareness in standing and walking, habituation through games with planned and unplanned head turns.

Relaxation

3

The fight or flight response

Discussion regarding experiences related to symptoms similar to the fight or flight response. How can these symptoms be appraised in relation to persistent dizziness?

Exercises: habituation and body awareness (standing balance, walking with directional changes). Reflection during and after exercises. What happened? What was your response? (every session from now).

Relaxation

4

The fight or flight response and management

Discussion: how did you respond to the fight or flight response in everyday life following the last session? Individual goal setting.

Exercises: habituation, visual acuity, walking and ball games with change of place, turning and rotation.

Relaxation

5

Relaxation

Discussion/reflection: exercises, dosage and ‘relaxation’. It is normal to be dizzy and tired after exercises

Exercises: progression of visual acuity, habituation and balance using ball during exercise. Working alone and in pairs.

Relaxation

6

Movement-induced dizziness

Any changes in relation to the dizziness circle described in the first session? Group and individual reflection.

Exercises: habituation games: in larger groups and pairs. Walking with head rotations, velocity changes and externally induced stop/start.

Relaxation

7

What next? Preparation for the future

Discussion before, reflection during, and group reflection after exercises: ‘How do I cope/deal/manage the dizziness? What thoughts are formed when I get dizzy?’

Exercises: combination of balance and habituation – Activities and games in groups and in pairs. (e.g. obstacle course, standing back to back, passing ball at different heights.).

Relaxation

8

Reflection and conclusion

Discussion: ‘What have I learnt? What will I take with me? What do I do when/if dizziness returns?’

Exercises: balance and body awareness in standing and walking, changing directions, different velocities, stop/start. Ball activities alone, in pairs and in a larger group.

Relaxation