Threat Assessment and Locomotion: Clinical Applications of an Integrated Model of Anxiety and Postural Control

 

 Buy Article Permissions and Reprints

Abstract

Interactions between anxiety and vestibular symptoms have been described since the late 1800s. Typically, they have been conceptualized as bidirectional effects of one condition on the other (i.e., anxiety disorders as a cause of vestibular symptoms and vestibular disorders as a cause of anxiety symptoms). Over the past 30 years, however, a steady progression of neurophysiological investigations of gait and stance under conditions of postural threat, neuroanatomical studies of connections between threat assessment and vestibular pathways in the brain, and clinical research on anxiety-related vestibular conditions has offered the building blocks of a more integrated model. In this newer concept, threat assessment is an integral component of spatial perception, postural control, and locomotion in health and disease. It is not imposed on the vestibular system from the outside or simply reactive to vestibular dysfunction, but an inherently necessary part of every aspect of mobility. In this article, the authors review evidence that supports this model and then use it to examine common neurotologic conditions in which anxiety-related processes play important roles—fear of falling, primary and secondary anxiety disorders in patients with vestibular symptoms, and chronic subjective dizziness.

• References

• 1 Balaban CD, Jacob RG. Background and history of the interface between anxiety and vertigo. J Anxiety Disord 2001; 15 (1-2) 27-51
  CrossrefPubMedGoogle Scholar
• 2 Kuch K, Swinson RP. Agoraphobia: what Westphal really said. Can J Psychiatry 1992; 37 (2) 133-136
  PubMedGoogle Scholar
• 3 Sklare DA, Stein MB, Pikus AM, Uhde TW. Dysequilibrium and audiovestibular function in panic disorder: symptom profiles and test findings. Am J Otol 1990; 11 (5) 338-341
  PubMedGoogle Scholar
• 4 Swinson RP, Cox BJ, Rutka J, Mai M, Kerr S, Kuch K. Otoneurological functioning in panic disorder patients with prominent dizziness. Compr Psychiatry 1993; 34 (2) 127-129
  CrossrefPubMedGoogle Scholar
• 5 Hoffman DL, O'Leary DP, Munjack DJ. Autorotation test abnormalities of the horizontal and vertical vestibulo-ocular reflexes in panic disorder. Otolaryngol Head Neck Surg 1994; 110 (3) 259-269
  CrossrefPubMedGoogle Scholar
• 6 Stein MB, Asmundson GJG, Ireland D, Walker JR. Panic disorder in patients attending a clinic for vestibular disorders. Am J Psychiatry 1994; 151 (11) 1697-1700
  PubMedGoogle Scholar
• 7 Jacob RG, Furman JM, Durrant JD, Turner SM. Panic, agoraphobia, and vestibular dysfunction. Am J Psychiatry 1996; 153 (4) 503-512
  PubMedGoogle Scholar
• 8 Jacob RG, Furman JM, Durrant JD, Turner SM. Surface dependence: a balance control strategy in panic disorder with agoraphobia. Psychosom Med 1997; 59 (3) 323-330
  CrossrefPubMedGoogle Scholar
• 9 Staab JP. Psychiatric origins of dizziness and vertigo. In: Jacobson GP, Shepard NT, , eds. Balance Function Assessment and Management. San Diego, CA: Plural Publishing; 2008: 517-541
  Google Scholar
• 10 Jacob RG, Woody SR, Clark DB , et al. Discomfort with space and motion: a possible marker of vestibular dysfunction assessed by the Situational Characteristics Questionnaire. J Psychopathol Behav Assess 1993; 15 (4) 299-324
  CrossrefPubMedGoogle Scholar
• 11 Bronstein AM. Visual vertigo syndrome: clinical and posturography findings. J Neurol Neurosurg Psychiatry 1995; 59 (5) 472-476
  CrossrefPubMedGoogle Scholar
• 12 Bronstein AM. Vision and vertigo: some visual aspects of vestibular disorders. J Neurol 2004; 251 (4) 381-387
  CrossrefPubMedGoogle Scholar
• 13 Perez-Jara J, Olmos P, Abad MA, Heslop P, Walker D, Reyes-Ortiz CA. Differences in fear of falling in the elderly with or without dizzines. Maturitas 2012; 73 (3) 261-264
  CrossrefPubMedGoogle Scholar
• 14 Viljanen A, Kulmala J, Rantakokko M, Koskenvuo M, Kaprio J, Rantanen T. Fear of falling and coexisting sensory difficulties as predictors of mobility decline in older women. J Gerontol A Biol Sci Med Sci 2012; 67 (11) 1230-1237
  CrossrefPubMedGoogle Scholar
• 15 Dunlap P, Perera S, VanSwearingen JM, Wert D, Brach JS. Transitioning to a narrow path: the impact of fear of falling in older adults. Gait Posture 2012; 35 (1) 92-95
  CrossrefPubMedGoogle Scholar
• 16 Kirkwood RN, de Souza Moreira B, Vallone ML, Mingoti SA, Dias RC, Sampaio RF. Step length appears to be a strong discriminant gait parameter for elderly females highly concerned about falls: a cross-sectional observational study. Physiotherapy 2011; 97 (2) 126-131
  CrossrefPubMedGoogle Scholar
• 17 Nagai K, Yamada M, Uemura K , et al. Effects of fear of falling on muscular coactivation during walking. Aging Clin Exp Res 2012; 24 (2) 157-161
  PubMedGoogle Scholar
• 18 Julius LM, Brach JS, Wert DM, VanSwearingen JM. Perceived effort of walking: relationship with gait, physical function and activity, fear of falling, and confidence in walking in older adults with mobility limitations. Phys Ther 2012; 92 (10) 1268-1277
  CrossrefPubMedGoogle Scholar
• 19 Marchetti GF, Whitney SL, Redfern MS, Furman JM. Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system. Arch Phys Med Rehabil 2011; 92 (11) 1884-1891
  CrossrefPubMedGoogle Scholar
• 20 Oh-Park M, Xue X, Holtzer R, Verghese J. Transient versus persistent fear of falling in community-dwelling older adults: incidence and risk factors. J Am Geriatr Soc 2011; 59 (7) 1225-1231
  CrossrefPubMedGoogle Scholar
• 21 Avineri E, Shinar D, Susilo YO. Pedestrians' behaviour in cross walks: the effects of fear of falling and age. Accid Anal Prev 2012; 44 (1) 30-34
  CrossrefPubMedGoogle Scholar
• 22 Young WR, Wing AM, Hollands MA. Influences of state anxiety on gaze behavior and stepping accuracy in older adults during adaptive locomotion. J Gerontol B Psychol Sci Soc Sci 2012; 67 (1) 43-51
  PubMedGoogle Scholar
• 23 Hadjistavropoulos T, Carleton RN, Delbaere K , et al. The relationship of fear of falling and balance confidence with balance and dual tasking performance. Psychol Aging 2012; 27 (1) 1-13
  CrossrefPubMedGoogle Scholar
• 24 Uemura K, Yamada M, Nagai K, Tanaka B, Mori S, Ichihashi N. Fear of falling is associated with prolonged anticipatory postural adjustment during gait initiation under dual-task conditions in older adults. Gait Posture 2012; 35 (2) 282-286
  CrossrefPubMedGoogle Scholar
• 25 Gusi N, Carmelo Adsuar J, Corzo H, Del Pozo-Cruz B, Olivares PR, Parraca JA. Balance training reduces fear of falling and improves dynamic balance and isometric strength in institutionalised older people: a randomised trial. J Physiother 2012; 58 (2) 97-104
  CrossrefPubMedGoogle Scholar
• 26 Tousignant M, Corriveau H, Roy PM , et al. The effect of supervised Tai Chi intervention compared to a physiotherapy program on fall-related clinical outcomes: a randomized clinical trial. Disabil Rehabil 2012; 34 (3) 196-201
  CrossrefPubMedGoogle Scholar
• 27 Karinkanta S, Nupponen R, Heinonen A , et al. Effects of exercise on health-related quality of life and fear of falling in home-dwelling older women. J Aging Phys Act 2012; 20 (2) 198-214
  PubMedGoogle Scholar
• 28 Freiberger E, Häberle L, Spirduso WW, Zijlstra GA. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc 2012; 60 (3) 437-446
  CrossrefPubMedGoogle Scholar
• 29 Staab JP, Ruckenstein MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg 2007; 133 (2) 170-176
  CrossrefPubMedGoogle Scholar
• 30 Staab JP. Chronic subjective dizziness. Continuum (Minneap Minn) 2012; 18 (5 Neuro-otology): 1118-1141
  PubMedGoogle Scholar
• 31 Halberstadt AL, Balaban CD. Selective anterograde tracing of the individual serotonergic and nonserotonergic components of the dorsal raphe nucleus projection to the vestibular nuclei. Neuroscience 2007; 147 (1) 207-223
  CrossrefPubMedGoogle Scholar
• 32 Halberstadt AL, Balaban CD. Serotonergic and nonserotonergic neurons in the dorsal raphe nucleus send collateralized projections to both the vestibular nuclei and the central amygdaloid nucleus. Neuroscience 2006; 140 (3) 1067-1077
  CrossrefPubMedGoogle Scholar
• 33 Balaban CD. Neural substrates linking balance control and anxiety. Physiol Behav 2002; 77 (4-5) 469-475
  CrossrefPubMedGoogle Scholar
• 34 Balaban CD. Projections from the parabrachial nucleus to the vestibular nuclei: potential substrates for autonomic and limbic influences on vestibular responses. Brain Res 2004; 996 (1) 126-137
  CrossrefPubMedGoogle Scholar
• 35 Kalin NH, Shelton SE, Davidson RJ, Kelley AE. The primate amygdala mediates acute fear but not the behavioral and physiological components of anxious temperament. J Neurosci 2001; 21 (6) 2067-2074
  PubMedGoogle Scholar
• 36 Waters AM, Zimmer-Gembeck MJ, Farrell LJ. The relationships of child and parent factors with children's anxiety symptoms: parental anxious rearing as a mediator. J Anxiety Disord 2012; 26 (7) 737-745
  CrossrefPubMedGoogle Scholar
• 37 Rector NA, Bagby RM, Huta V, Ayearst LE. Examination of the trait facets of the five-factor model in discriminating specific mood and anxiety disorders. Psychiatry Res 2012; 199 (2) 131-139
  CrossrefPubMedGoogle Scholar
• 38 Carpenter MG, Frank JS, Silcher CP. Surface height effects on postural control: a hypothesis for a stiffness strategy for stance. J Vestib Res 1999; 9 (4) 277-286
  PubMedGoogle Scholar
• 39 Adkin AL, Frank JS, Carpenter MG, Peysar GW. Postural control is scaled to level of postural threat. Gait Posture 2000; 12 (2) 87-93
  CrossrefPubMedGoogle Scholar
• 40 Brown LA, Frank JS. Postural compensations to the potential consequences of instability: kinematics. Gait Posture 1997; 6 (2) 89-97
  CrossrefPubMedGoogle Scholar
• 41 Davis JR, Campbell AD, Adkin AL, Carpenter MG. The relationship between fear of falling and human postural control. Gait Posture 2009; 29 (2) 275-279
  CrossrefPubMedGoogle Scholar
• 42 Davis JR, Horslen BC, Nishikawa K , et al. Human proprioceptive adaptations during states of height-induced fear and anxiety. J Neurophysiol 2011; 106 (6) 3082-3090
  CrossrefPubMedGoogle Scholar
• 43 Cleworth TW, Horslen BC, Carpenter MG. Influence of real and virtual heights on standing balance. Gait Posture 2012; 36 (2) 172-176
  CrossrefPubMedGoogle Scholar
• 44 Stins JF, Roerdink M, Beek PJ. To freeze or not to freeze? Affective and cognitive perturbations have markedly different effects on postural control. Hum Mov Sci 2011; 30 (2) 190-202
  CrossrefPubMedGoogle Scholar
• 45 Adkin AL, Frank JS, Carpenter MG, Peysar GW. Fear of falling modifies anticipatory postural control. Exp Brain Res 2002; 143 (2) 160-170
  CrossrefPubMedGoogle Scholar
• 46 Young LR, Bernard-Demanze L, Dumitrescu M, Magnan J, Borel L, Lacour M. Postural performance of vestibular loss patients under increased postural threat. J Vestib Res 2012; 22 (2) 129-138
  PubMedGoogle Scholar
• 47 Brown LA, Gage WH, Polych MA, Sleik RJ, Winder TR. Central set influences on gait. Age-dependent effects of postural threat. Exp Brain Res 2002; 145 (3) 286-296
  CrossrefPubMedGoogle Scholar
• 48 Levitan MN, Crippa JA, Bruno LM , et al. Postural balance in patients with social anxiety disorder. Braz J Med Biol Res 2012; 45 (1) 38-42
  CrossrefPubMedGoogle Scholar
• 49 Hainaut JP, Caillet G, Lestienne FG, Bolmont B. The role of trait anxiety on static balance performance in control and anxiogenic situations. Gait Posture 2011; 33 (4) 604-608
  CrossrefPubMedGoogle Scholar
• 50 Lepicard EM, Venault P, Perez-Diaz F, Joubert C, Berthoz A, Chapouthier G. Balance control and posture differences in the anxious BALB/cByJ mice compared to the non anxious C57BL/6J mice. Behav Brain Res 2000; 117 (1-2) 185-195
  CrossrefPubMedGoogle Scholar
• 51 Lepicard EM, Venault P, Negroni J , et al. Posture and balance responses to a sensory challenge are related to anxiety in mice. Psychiatry Res 2003; 118 (3) 273-284
  CrossrefPubMedGoogle Scholar
• 52 Venault P, Rudrauf D, Lepicard EM, Berthoz A, Jouvent R, Chapouthier G. Balance control and posture in anxious mice improved by SSRI treatment. Neuroreport 2001; 12 (14) 3091-3094
  CrossrefPubMedGoogle Scholar
• 53 Phan KL, Coccaro EF, Angstadt M , et al. Corticolimbic brain reactivity to social signals of threat before and after sertraline treatment in generalized social phobia. Biol Psychiatry 2013; 73 (4) 329-336
  CrossrefPubMedGoogle Scholar
• 54 Kalueff AV, Jensen CL, Murphy DL. Locomotory patterns, spatiotemporal organization of exploration and spatial memory in serotonin transporter knockout mice. Brain Res 2007; 1169: 87-97
  CrossrefPubMedGoogle Scholar
• 55 Li Volsi G, Licata F, Fretto G, Mauro MD, Santangelo F. Influence of serotonin on the glutamate-induced excitations of secondary vestibular neurons in the rat. Exp Neurol 2001; 172 (2) 446-459
  CrossrefPubMedGoogle Scholar
• 56 Sugihara I, Lang EJ, Llinás R. Serotonin modulation of inferior olivary oscillations and synchronicity: a multiple-electrode study in the rat cerebellum. Eur J Neurosci 1995; 7 (4) 521-534
  CrossrefPubMedGoogle Scholar
• 57 Etkin A. Functional neuroanatomy of anxiety: a neural circuit perspective. Curr Top Behav Neurosci 2010; 2: 251-277
  PubMedGoogle Scholar
• 58 Bishop GA, Ho RH. The distribution and origin of serotonin immunoreactivity in the rat cerebellum. Brain Res 1985; 331 (2) 195-207
  CrossrefPubMedGoogle Scholar
• 59 Compoint C, Buisseret-Delmas C. Origin, distribution and organization of the serotoninergic innervation in the inferior olivary complex of the rat. Arch Ital Biol 1988; 126 (2) 99-110
  PubMedGoogle Scholar
• 60 Sladek Jr JR, Bowman JP. The distribution of catecholamines within the inferior olivary complex of the cat and rhesus monkey. J Comp Neurol 1975; 163 (2) 203-213
  CrossrefPubMedGoogle Scholar
• 61 Takeuchi Y, Sano Y. Immunohistochemical demonstration of serotonin-containing nerve fibers in the inferior olivary complex of the rat, cat and monkey. Cell Tissue Res 1983; 231 (1) 17-28
  PubMedGoogle Scholar
• 62 Charney DS, Drevets WC. Neurobiological basis of anxiety disorders. In: Davis KL, Charney D, Coyle JT, Nemeroff C, , eds. Neuropsychopharmacology: The Fifth Generation of Progress. Brentwood, TN: American College of Neuropsychopharmacology; 2002: 901-930
  Google Scholar
• 63 Tamietto M, de Gelder B. Neural bases of the non-conscious perception of emotional signals. Nat Rev Neurosci 2010; 11 (10) 697-709
  PubMedGoogle Scholar
• 64 Dieterich M, Brandt T. Functional brain imaging of peripheral and central vestibular disorders. Brain 2008; 131 (Pt 10) 2538-2552
  CrossrefPubMedGoogle Scholar
• 65 Baur V, Hänggi J, Jäncke L. Volumetric associations between uncinate fasciculus, amygdala, and trait anxiety. BMC Neurosci 2012; 13: 4
  CrossrefPubMedGoogle Scholar
• 66 Li S, Wang Y, Xu P , et al. Surface morphology of amygdala is associated with trait anxiety. PLoS ONE 2012; 7 (10) e47817
  CrossrefPubMedGoogle Scholar
• 67 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013
  Google Scholar
• 68 Jacob RG, Redfern MS, Furman JM. Space and motion discomfort and abnormal balance control in patients with anxiety disorders. J Neurol Neurosurg Psychiatry 2009; 80 (1) 74-78
  CrossrefPubMedGoogle Scholar
• 69 Perna G, Dario A, Caldirola D, Stefania B, Cesarani A, Bellodi L. Panic disorder: the role of the balance system. J Psychiatr Res 2001; 35 (5) 279-286
  CrossrefPubMedGoogle Scholar
• 70 Yardley L, Britton J, Lear S, Bird J, Luxon LM. Relationship between balance system function and agoraphobic avoidance. Behav Res Ther 1995; 33 (4) 435-439
  CrossrefPubMedGoogle Scholar
• 71 Perna G, Alpini D, Caldirola D, Raponi G, Cesarani A, Bellodi L. Serotonergic modulation of the balance system in panic disorder: an open study. Depress Anxiety 2003; 17 (2) 101-106
  CrossrefPubMedGoogle Scholar
• 72 Cevette MJ, Puetz B, Marion MS, Wertz ML, Muenter MD. Aphysiologic performance on dynamic posturography. Otolaryngol Head Neck Surg 1995; 112 (6) 676-688
  CrossrefPubMedGoogle Scholar
• 73 Redfern MS, Furman JM, Jacob RG. Visually induced postural sway in anxiety disorders. J Anxiety Disord 2007; 21 (5) 704-716
  CrossrefPubMedGoogle Scholar
• 74 Caldirola D, Teggi R, Bondi S , et al. Is there a hypersensitive visual alarm system in panic disorder?. Psychiatry Res 2011; 187 (3) 387-391
  CrossrefPubMedGoogle Scholar
• 75 Hüweler R, Kandil FI, Alpers GW, Gerlach AL. The impact of visual flow stimulation on anxiety, dizziness, and body sway in individuals with and without fear of heights. Behav Res Ther 2009; 47 (4) 345-352
  CrossrefPubMedGoogle Scholar
• 76 Erez O, Gordon CR, Sever J, Sadeh A, Mintz M. Balance dysfunction in childhood anxiety: findings and theoretical approach. J Anxiety Disord 2004; 18 (3) 341-356
  CrossrefPubMedGoogle Scholar
• 77 Skirbekk B, Hansen BH, Oerbeck B, Wentzel-Larsen T, Kristensen H. Motor impairment in children with anxiety disorders. Psychiatry Res 2012; 198 (1) 135-139
  CrossrefPubMedGoogle Scholar
• 78 Bart O, Bar-Haim Y, Weizman E, Levin M, Sadeh A, Mintz M. Balance treatment ameliorates anxiety and increases self-esteem in children with comorbid anxiety and balance disorder. Res Dev Disabil 2009; 30 (3) 486-495
  CrossrefPubMedGoogle Scholar
• 79 Eckhardt A, Tettenborn B, Krauthauser H , et al. [Vertigo and anxiety disorders—results of interdisciplinary evaluation]. Laryngorhinootologie 1996; 75 (9) 517-522
  Article in Thieme ConnectPubMedGoogle Scholar
• 80 Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord 2003; 17 (4) 369-388
  CrossrefPubMedGoogle Scholar
• 81 Clark DB, Hirsch BE, Smith MG, Furman JM, Jacob RG. Panic in otolaryngology patients presenting with dizziness or hearing loss. Am J Psychiatry 1994; 151 (8) 1223-1225
  PubMedGoogle Scholar
• 82 Grunfeld EA, Gresty MA, Bronstein AM, Jahanshahi M. Screening for depression among neuro-otology patients with and without identifiable vestibular lesions. Int J Audiol 2003; 42 (3) 161-165
  CrossrefPubMedGoogle Scholar
• 83 Persoons P, Luyckx K, Desloovere C, Vandenberghe J, Fischler B. Anxiety and mood disorders in otorhinolaryngology outpatients presenting with dizziness: validation of the self-administered PRIME-MD Patient Health Questionnaire and epidemiology. Gen Hosp Psychiatry 2003; 25 (5) 316-323
  CrossrefPubMedGoogle Scholar
• 84 Ruckenstein MJ, Staab JP. The Basic Symptom Inventory-53 and its use in the management of patients with psychogenic dizziness. Otolaryngol Head Neck Surg 2001; 125 (5) 533-536
  PubMedGoogle Scholar
• 85 Evans DL, Staab JP, Petitto JM , et al. Depression in the medical setting: biopsychological interactions and treatment considerations. J Clin Psychiatry 1999; 60 (Suppl. 04) 40-55 , discussion 56
  PubMedGoogle Scholar
• 86 Eagger S, Luxon LM, Davies RA, Coelho A, Ron MA. Psychiatric morbidity in patients with peripheral vestibular disorder: a clinical and neuro-otological study. J Neurol Neurosurg Psychiatry 1992; 55 (5) 383-387
  CrossrefPubMedGoogle Scholar
• 87 Kammerlind AS, Ledin TE, Skargren EI, Odkvist LM. Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms. Acta Otolaryngol 2005; 125 (9) 946-953
  CrossrefPubMedGoogle Scholar
• 88 Coker NJ, Coker RR, Jenkins HA, Vincent KR. Psychological profile of patients with Menière's disease. Arch Otolaryngol Head Neck Surg 1989; 115 (11) 1355-1357
  CrossrefPubMedGoogle Scholar
• 89 Celestino D, Rosini E, Carucci ML, Marconi PL, Vercillo E. Ménière's disease and anxiety disorders. Acta Otorhinolaryngol Ital 2003; 23 (6) 421-427
  PubMedGoogle Scholar
• 90 Eggers SDZ, Staab JP, Neff BA, Goulson AM, Carlson ML, Shepard NT. Investigation of the coherence of definite and probable vestibular migraine as distinct clinical entities. Otol Neurotol 2011; 32 (7) 1144-1151
  CrossrefPubMedGoogle Scholar
• 91 Best C, Eckhardt-Henn A, Tschan R, Dieterich M. Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes. Results of a prospective longitudinal study over one year. J Neurol 2009; 256 (1) 58-65
  CrossrefPubMedGoogle Scholar
• 92 Boleas-Aguirre MS, Sánchez-Ferrandiz N, Guillén-Grima F, Perez N. Long-term disability of class A patients with Ménière's disease after treatment with intratympanic gentamicin. Laryngoscope 2007; 117 (8) 1474-1481
  CrossrefPubMedGoogle Scholar
• 93 Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Menière's disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113 (3) 181-185
  CrossrefPubMedGoogle Scholar
• 94 Brandt Th, Dieterich M. Phobischer Attacken-Schwank-swindel, ein neues Syndrom?. Munch Med Wschr 1986; 128: 247-250
  PubMedGoogle Scholar
• 95 Huppert D, Strupp M, Rettinger N, Hecht J, Brandt T. Phobic postural vertigo—a long-term follow-up (5 to 15 years) of 106 patients. J Neurol 2005; 252 (5) 564-569
  CrossrefPubMedGoogle Scholar
• 96 Kapfhammer HP, Mayer C, Hock U, Huppert D, Dieterich M, Brandt T. Course of illness in phobic postural vertigo. Acta Neurol Scand 1997; 95 (1) 23-28
  CrossrefPubMedGoogle Scholar
• 97 Staab J, Rohe D, Eggers S, Shepard N. Anxious, introverted personality traits in chronic subjective dizziness. Abstract presented at the 56^th Annual Meeting of the Academy of Psychosomatic Medicine; November 12, 2009; Las Vegas, NV. Available at: http://www.apm.org/ann-mtg/2009/index.shtml . Accessed July 16, 2011
  PubMedGoogle Scholar
• 98 Staab JP, Ruckenstein MJ, Solomon D, Shepard NT. Serotonin reuptake inhibitors for dizziness with psychiatric symptoms. Arch Otolaryngol Head Neck Surg 2002; 128 (5) 554-560
  CrossrefPubMedGoogle Scholar
• 99 Staab JP, Ruckenstein MJ, Amsterdam JD. A prospective trial of sertraline for chronic subjective dizziness. Laryngoscope 2004; 114 (9) 1637-1641
  CrossrefPubMedGoogle Scholar
• 100 Staab JP. Clinical clues to a dizzying headache. J Vestib Res 2011; 21 (6) 331-340
  CrossrefPubMedGoogle Scholar
• 101 Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope 2003; 113 (10) 1714-1718
  CrossrefPubMedGoogle Scholar
• 102 Horii A, Mitani K, Kitahara T, Uno A, Takeda N, Kubo T. Paroxetine, a selective serotonin reuptake inhibitor, reduces depressive symptoms and subjective handicaps in patients with dizziness. Otol Neurotol 2004; 25 (4) 536-543
  CrossrefPubMedGoogle Scholar
• 103 Simon NM, Parker SW, Wernick-Robinson M , et al. Fluoxetine for vestibular dysfunction and anxiety: a prospective pilot study. Psychosomatics 2005; 46 (4) 334-339
  CrossrefPubMedGoogle Scholar
• 104 Horii A, Uno A, Kitahara T , et al. Effects of fluvoxamine on anxiety, depression, and subjective handicaps of chronic dizziness patients with or without neuro-otologic diseases. J Vestib Res 2007; 17 (1) 1-8
  PubMedGoogle Scholar
• 105 Horii A, Kitahara T, Masumura C, Kizawa K, Maekawa C, Kubo T. Effects of milnacipran, a serotonin noradrenaline reuptake inhibitor (SNRI) on subjective handicaps and posturography in dizzy patients. Abstract presented at the XXVth Congress of the Barany Society; March 31–April 3, 2008; Kyoto, Japan. Available at: http://www.acplan.jp/barany2008/ . Accessed July 9, 2011
  PubMedGoogle Scholar
• 106 Tschan R, Best C, Beutel ME , et al. Patients' psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease. J Neurol 2011; 258 (1) 104-112
  CrossrefPubMedGoogle Scholar
• 107 Best C, Eckhardt-Henn A, Tschan R, Dieterich M. Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes. Results of a prospective longitudinal study over one year. J Neurol 2009; 256 (1) 58-65
  CrossrefPubMedGoogle Scholar
• 108 Godemann F, Schabowska A, Naetebusch B, Heinz A, Ströhle A. The impact of cognitions on the development of panic and somatoform disorders: a prospective study in patients with vestibular neuritis. Psychol Med 2006; 36 (1) 99-108
  CrossrefPubMedGoogle Scholar
• 109 Alessandrini M, D'Erme G, Bruno E, Napolitano B, Magrini A. Vestibular compensation: analysis of postural re-arrangement as a control index for unilateral vestibular deficit. Neuroreport 2003; 14 (7) 1075-1079
  PubMedGoogle Scholar
• 110 Monzani D, Marchioni D, Bonetti S , et al. Anxiety affects vestibulospinal function of labyrinthine-defective patients during horizontal optokinetic stimulation. Acta Otorhinolaryngol Ital 2004; 24 (3) 117-124
  PubMedGoogle Scholar
• 111 Krafczyk S, Tietze S, Swoboda W, Valkovic P, Brandt T. Artificial neural network: a new diagnostic posturographic tool for disorders of stance. Clin Neurophysiol 2006; 117 (8) 1692-1698
  CrossrefPubMedGoogle Scholar
• 112 Brandt T, Strupp M, Novozhilov S, Krafczyk S. Artificial neural network posturography detects the transition of vestibular neuritis to phobic postural vertigo. J Neurol 2012; 259 (1) 182-184
  CrossrefPubMedGoogle Scholar
• 113 Balaban CD, Jacob RG, Furman JM. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Rev Neurother 2011; 11 (3) 379-394
  CrossrefPubMedGoogle Scholar
• 114 Staab JP. Behavioral aspects of vestibular rehabilitation. NeuroRehabilitation 2011; 29 (2) 179-183
  PubMedGoogle Scholar
• 115 Holmberg J, Karlberg M, Harlacher U, Rivano-Fischer M, Magnusson M. Treatment of phobic postural vertigo. A controlled study of cognitive-behavioral therapy and self-controlled desensitization. J Neurol 2006; 253 (4) 500-506
  CrossrefPubMedGoogle Scholar
• 116 Holmberg J, Karlberg M, Harlacher U, Magnusson M. One-year follow-up of cognitive behavioral therapy for phobic postural vertigo. J Neurol 2007; 254 (9) 1189-1192
  CrossrefPubMedGoogle Scholar
• 117 Edelman S, Mahoney AE, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. Am J Otolaryngol 2012; 33 (4) 395-401
  CrossrefPubMedGoogle Scholar
• 118 E J Mahoney A, Edelman S. , D Cremer P. Cognitive behavior therapy for chronic subjective dizziness: longer-term gains and predictors of disability. Am J Otolaryngol 2013; 34 (2) 115-120
  CrossrefPubMedGoogle Scholar