Managing Dizziness with Mindfulness The following information explains how mindfulness can be used as a tool to help manage chronic dizziness caused by balance organ disorders Contents What is dizziness, how is it caused and what are the symptoms? Chronic Dizziness How can I apply my mindfulness skills to help my dizziness? Breathworks Mindfulness for Health Participant Comments Case Studies Breathworks Mindfulness for Health Resources Modifications to the Mindfulness for Health programme for patients with chronic dizziness Poetry Links to other specific dizziness web resources What is dizziness, how is it caused and what are the symptoms? Dizziness can be caused by a variety of different medical disorders. It is important that you seek the advice of your GP (or other medical professional) if you suffer from dizziness so that a diagnosis can be made. Once this has occurred your GP will be able to tell you whether they feel that mindfulness will be useful for you. If you experience dizziness please do not start mindfulness without having first sought a diagnosis for your dizziness. One of the common causes of dizziness is that caused by dysfunction of one or both of the balance organs (or vestibular system) which are located next to the organs of hearing (cochleae) in the inner ear. Fig. 1 Fig. 2 Images courtesy of GoodlifeGR.com and vetsci.co.uk Fig. 1 - The balance organs (in purple) are part of the inner ear and comprise three semicircular canals, the utricle and the saccule. They lie next to the organ of hearing or cochlea (also in purple). Fig. 2 - Enlarged version of the balance organ and organ of hearing (cochlea) collectively known as the labyrinth. When you move, the two balance organs act as motion sensors and feed information up to the brain. This information is integrated with visual information and information from the muscles and joints (proprioceptive information) so you know where you are in space and whether you are still or moving. The brain in turn sends signals down to the postural muscles to keep you upright, and to our eyes so we can see when we move (gaze stabilization). When something goes wrong with the balance system patients normally report acute spinning (rotatory vertigo) of variable duration (depending on the vestibular disorder). The spinning can also sometimes occur with other symptoms such as vomiting, migraine headache, hearing difficulties, noises in the ears (tinnitus) and a feeling of pressure in the ears. Some patients will not report spinning, but rather severe loss of balance or imbalance when moving. Vestibular problems can often be helped with a variety of management options depending on their cause. These include exercises, therapeutic manoeuvres, dietary changes, medication, and more rarely with surgery. Chronic Dizziness Chronic dizziness occurs when either a patients experiences multiple discrete episodes of spinning, (for example Menieres disease or migraine associated dizziness) or when a patient experiences constant low level dizziness, (persistent postural perceptual dizziness or PPPD). The latter often develops secondary to an acute vestibular problem and is exacerbated when standing and moving and in busy environments such as supermarkets. For more information on the causes of vestibular dizziness please visit the Menieres and Vestibular.com websites. Although treatments do exist for chronic dizziness, these do not work in all patients, and sometimes symptoms persist for months or years. Many patients will also develop secondary psychological difficulties such as anxiety or depression, and may feel that their lives are being controlled by their vestibular disorder, radically altering their lifestyle because of it. Anxiety can in turn exacerbate patient's dizziness, and a vicious circle can result. Some patient will also develop neck stiffness or pain (due to restriction of head movement) which can exacerbate dizziness. Research into treatments for chronic dizziness is ongoing and it may be that different treatments are needed for different patients. Depending on the cause of your dizziness, mindfulness may be used in combination with a variety of other treatments such as balance retraining (vestibular rehabilitation) exercises, dietary modifications, cognitive behavioural therapy and medication. How can I apply my mindfulness skills to help my dizziness? It is important to note that depending on the cause of your dizziness, mindfulness is not a cure for dizziness, (although in many cases symptoms are reduced). Mindfulness offers a variety of skills to help you minimize the negative impacts that dizziness may have on your life. One of the aims of mindfulness for chronic dizziness is to help you begin to lead a life where you feel that your dizziness is no longer 'in control of you'. Instead of putting your life on hold until you get rid of your dizziness, mindfulness will help you live a life that is meaningful to you, even if your dizziness continues. It will help you gently turn towards your dizziness, becoming more accepting of it, rather than fighting or trying to get rid of it, which often serves to exacerbate your symptoms. Mindfulness can help you be more aware of any unhelpful thoughts (eg 'I will never get better'), feelings (eg anxiety and depression) and behaviours (eg avoidance of going out) accompanying your dizziness. These can sometimes be triggered without you being aware of them, and feelings such as anxiety can often exacerbate the sensations of dizziness. Once more aware of these you then have the choice of how to respond to such emotions and behaviours. Over time you may choose, and learn how not to get caught up in such understandable yet unhelpful negative thoughts.You can may also choose to gently change unhelpful behaviours such as avoiding going out (for fear of a dizzy attack). For more information on how vicious cycles leading to exacerbation of dizziness, and how mindfulness can help see: Mindfulness For Dizziness Patient Info Many patients with dizziness get into a 'boom and bust cycle'. This is where they will do lots of activities ('boom') on a relatively symptom-light day, only to 'bust' the next day (and often for several days afterwards) with a resultant increase in symptoms. Pacing diaries (where you monitor what you are doing in a day and whether activities exacerbates or diminishes your symptoms) can be useful if you are one of these people. They may also help identify if there are any triggers to chronic dizziness. A component of the Mindfulness for Health (MfH) programme (the recommended programme for chronic dizziness) is compassion towards yourself. The author of this page has noted many of her patients have low self-compassion, spending little time on themselves, and blaming themselves for their dizziness. This again is unhelpful, and the MfH programme may help you be more aware of this, and in turn decide Uwhether this is helpful, or whether to choose to work on being kinder to yourself. Research/Case histories on the use of mindfulness for chronic dizziness Unlike pain, there has been little formal research on mindfulness for dizziness. However there is good evidence of the benefits of mindfulness for other chronic illnesses, and early studies (Naber et al 2011) on mindfulness for dizziness appear to report benefits. Although this is an area where more research is needed, many clinicians continue to use mindfulness with good effect. For an example of the results of ten patients with chronic dizziness who were offered support from the author of this page through completion of the mindfulness for health book (some with additional management techniques) please see the following article titled Mindfulness and Dizziness-Audacity Comments from some of these patients A patient with dizziness from a number of different causes said:"I feel mindfulness has been life-changing in a positive way. It has made me more reflective and aware of everything in my life" A patient with acute spinning attacks which then led to panic attacks felt mindfulness helped her accept her symptoms and feel more in control:"I think that mindfulness has helped me focus and stay in / take control of the panic attacks I now get as well as the dizziness. It's accepting them, even embracing them, and experiencing them, it helps make me feel stronger by allowing them to come out." Another patient with recurrent episodic vertigo felt it helped with acceptance "stopping the rot before it goes too far", helping her realise when she is 'fighting' and when would be better 'to accept.' A patient with recurrent uncontrolled attacks of spinning felt the programme had 'helped her take control' rather than 'sit passively' and provided her with a 'good insight into how to cope with the condition better' and ability to find 'the positive in the negative.' Case studies 1. Patient with persistent postural perceptual dizziness (PPPD) and associated anxiety This patient presented with a history of an acute attack of spinning (vestibular neuritis) which had subsequently progressed to PPPD (chronic dizziness present all the time). Initial management strategies such as vestibular rehabilitation exercises, help with sleep and the use of cognitive behavioural therapy techniques helped a little, but symptoms persisted. At this point mindfulness was suggested. The patient completed the mindfulness for health programme (with the support of a clinician who tailored it to her individual needs). Although her dizziness continued, she subsequently achieved her main goal of getting back to play golf where she won a competition, and also returned to work full- time. On completion of the programme she reported: How I was then: 'December 2014: I arrived at the balance clinic depressed, anxious and scared, not really understanding what was going on with me and unable to get a grip on any aspect of my life. I was just about getting through half a day at work, not leaving the house for any other reason if I really didn't have to and I had no energy at all' How I am now: June 2015 – 'Back living life to the full, still feeling dizzy/catch up sensation but in a place that I can now cope with my condition that being from a position of understanding as to why I am feeling the way I do, and with strategies in place that will help me maintain where I am and hopefully help me reduce my symptoms still further over time'. You can listen to the patient here describing her experience: 2. Patient with ongoing balance organ problem and stress This patient presented with a complicated case history of two balance organ problems, possible migraine and severe stress caused by her dizziness as she tried to continue her her work as a teacher. At her first appointment she reported movement-evoked dizziness, a near constant muzzy head, anxiety and stress. She reported that she had handed in her notice due to the way she was being treated at school, had stopped going to the gym, 'felt a failure' and that she 'wasn't a good mother' She reported that she was scared that she was going to have another attack of acute dizziness. Her rehabilitation consisted of a number of different techniques (differentiation of different types of dizziness and strategies of what to do for each, thought diaries and vestibular rehabilitation) followed by completing the mindfulness for health programme. Her goals for her overall rehabilitation plan were: Getting back to 'normality' = back to work (even if in the context of ongoing symptoms) Increase energy levels To lessen anxiety Get back to running= 'freedom' And for the MfH programme: To be more aware of my thoughts and to challenge them To be more aware of my body and when I'm doing too much Get back to teaching even if my dizziness continues 'Surf the wave of my symptoms', non-reactance towards these Increase self-compassion At her final appointment she told me that she had got a supply job teaching and she no longer experienced dizziness. She had met all her goals. She said: 'I feel mindfulness has been life changing in a positive way. It has made me more reflective and aware of everything in my life' 'I am now living in the moment rather than four weeks ahead' (the latter of which had been causing increased stress) 'I am more aware that my body is telling me to slow down and that I'm doing too much' The components of MfH that she had particularly found useful were: Mindfulness in general but especially mindful movement Secondary symptom information and how 'these are normal but can be controlled' Not all thoughts are facts. Habit releasers: 'I have been able to enjoy environment more' Compassionate acceptance- of her dizziness and being kinder to herself: 'I've always beaten myself up and not cared for myself, putting others first. Learnt to look after myself need to be kind to myself too' Breathworks Mindfulness for Health resources Mindfulness for Health (book) Mindfulness for Health course Mindfulness for Health online Modifications to the Mindfulness for Health programme for patients with chronic dizziness Meditations The MfH programme suggests that meditations are practised with eyes gently closed. Some patients with chronic dizziness report an increase in their symptoms when they close their eyes. If this is you, then it is suggested you keep your eyes open with your gaze gently resting on an object. Some patients with dizziness associated with anxiety find focusing on the breath is difficult, some noticing an initial increase in symptoms. If this is you then either start by trying a shorter breathing meditation (e.g. five minute breathing space) or try a different type of meditation (such as the body scan or listening to sounds meditation). Gradually try and build up to the full ten minute breathing anchor meditation. Five minute breathing space Body Scan Sounds and thoughts meditation Mindful movement Many patients will find that their dizziness is increased with some of the mindful movements (in particular ones including head movement) or that their neck feels stiff. Chronically dizzy patients may also find that their standing balance tends to be less good (especially if on one leg such as the picking fruit exercise requires). If this is you then please do ensure your safety. Ensure you wear supportive shoes or trainers, and hold on to a chair if you feel imbalanced. Work at your soft (not hard) edge as the programme asks you to do. Part of one of the treatment for dizziness (vestibular rehabilitation) consists of gently evoking symptoms to help the brain recalibrate, so these movements will not cause harm, even if they provoke dizziness. Compassionate acceptance meditation Following the use of the MfH programme with ten patients, the author of the page sought feedback of how patients had found the programme. In particular many patients reported that the language of the compassionate acceptance meditation sometimes gave rise to an increased perception of their dizziness. In conjunction with the author of the programme, Vidyamala Burch, and the clinician, a 'compassionate acceptance meditation for dizziness' was written. Following patient feedback this was then recorded by Vidyamala. This is available for patients with chronic dizziness who are completing the MfH programme by their clinician or MfH programme lead contacting Breathworks as long as they have seen a medical professional about their dizziness and a diagnosis has been made - [email protected]. Even with the dizzy-specific compassionate acceptance meditation, many patients find it frightening to come closer to their dizziness. This understandable fear in turn may exacerbate your dizziness. If this is you, remember to turn towards your dizziness bit by bit. If your symptoms become too difficult then return to the anchor of your breath, or focus on the stability that your feet on the floor and your seat on the ground or chair provide you. In time you may be able to learn to breathe into your dizziness, wherever you feel it, softening around its unpleasantness, and in turn lessening its impact. Remember acceptance takes many week, months or sometimes years to find. It also tends to go in cycles- you are able to accept a little, then your symptoms may get worse again and your resistance resurfaces and your acceptance lessens. A Breathworks teacher who has suffered from 12 years of chronic illness summarises nicely: "Even once acceptance happens, it is also a cycle, like boom and bust. I accept, all is fine, I then have a period of resistance and have to come to acceptance once more" Poetry Poetry often is used to express how patients can benefit from mindfulness. The following poem by Geoff Clay (2010) talks about dizziness: The Morning It is the morning... I am so tired...The sun is shining... My body hurts...The sky is crystal blue... My head spins...The air is cool... I cannot breathe...The breeze caresses... My skin is warm...The flowers are beautiful... The pain is not so bad...The garden breathes for me... I feel so alive...The spinning will not last... The birds are singing...Beauty surrounds me... I will sleep later...Now I will meditate. Links to other specific dizziness web resources Seeking balance - This is an Australian website and its author Joey Remenyi has developed a programme (delivered face to face or online) that has been specifically tailored for patients with dizziness. Menieres Society - Menieres disease is a specific type of balance organ problem. However this society (with charitable status) provides information and support for patients with all types of inner ear dizziness, and tries to raise awareness of balance organ problems in general. It encourages the setting up of self-help groups, produces a quarterly magazine and has a thriving face book group. Vestibular Disorders Association - This is an American website with useful information on balance disorders and treatments. Page Author: Debbie Cane, MSc CS Senior clinical scientist and lecturer Manage Cookie Preferences