MM102 - Predicting Persistent Dizziness: Contributions of Intolerance of Uncertainty, Anxiety, and Depression

Abstract: Persistent dizziness after vestibular insult is a common clinical challenge, with growing recognition of psychological contributors to chronicity. Anxiety and depression have been widely studied, yet intolerance of uncertainty (IU) may represent an underappreciated cognitive factor contributing to perseveration of symptoms. This presentation reviews existing literature on the roles of anxiety, depression, and IU in chronic dizziness, emphasizing IU’s relevance across chronic health conditions. Emerging data from our cohort, assessed with the IUS-12, GAD-7, and PHQ-9, suggest IU may independently influence dizziness persistence. Integrating IU into clinical frameworks may advance prediction, prevention, and intervention strategies for long-term vestibular disability.

Summary: Rationale and Purpose
Chronic dizziness after an acute vestibular insult is a multifaceted condition that often extends beyond the resolution of the peripheral disorder. A growing body of research highlights the contribution of psychological factors to symptom persistence, with anxiety and depression consistently associated with worse outcomes. However, less attention has been given to the cognitive construct of intolerance of uncertainty (IU), defined as difficulty tolerating ambiguous or unpredictable situations. IU has been shown to exacerbate worry and avoidance behaviors in anxiety-related conditions, but its role in chronic dizziness is not well understood. The purpose of this presentation is to review the literature linking psychological factors to persistent vestibular symptoms and to introduce emerging data suggesting a unique contribution of IU.

Literature Review
Studies have consistently demonstrated that elevated anxiety and depression scores are common among individuals with persistent vestibular symptoms, even after peripheral recovery. For example, patients with vestibular migraine, persistent postural-perceptual dizziness (PPPD), and chronic subjective dizziness often score higher on validated measures such as the GAD-7 and PHQ-9 compared to controls. These associations suggest that psychological distress is both a consequence and a perpetuating factor in dizziness.

IU, although less frequently studied in vestibular populations, has been identified as a transdiagnostic risk factor across anxiety, depression, and somatic symptom disorders. Elevated IU has been linked to symptom amplification, hypervigilance, and maladaptive coping, all of which are relevant to chronic dizziness. Conceptually, patients with high IU may interpret residual vestibular sensations as threatening, reinforcing cycles of avoidance and disability. Despite these theoretical links, there is little empirical work directly addressing IU in vestibular recovery, representing a gap in the literature.

Emerging Data
In our ongoing study, adults with a documented vestibular insult completed the Intolerance of Uncertainty Scale–12 (IUS-12), the Generalized Anxiety Disorder–7 (GAD-7), and the Patient Health Questionnaire–9 (PHQ-9). Preliminary trends suggest that while elevated anxiety and depression are common among individuals reporting persistent dizziness, IU may independently predict symptom chronicity. Specifically, higher IUS-12 scores appear more strongly associated with the persistence of dizziness than either anxiety or depression alone. Although analysis is not yet complete, these findings align with theoretical models and provide early empirical evidence that IU deserves focused attention in vestibular research.

Innovation and Importance
This work highlights the potential value of examining IU as a cognitive risk factor for chronic dizziness. By situating IU alongside more commonly studied constructs such as anxiety and depression, the project broadens our understanding of the psychological landscape influencing vestibular recovery. If supported by further data, IU screening could be incorporated into vestibular rehabilitation practice, allowing clinicians to identify at-risk patients early and tailor interventions accordingly. Interventions targeting IU, including cognitive-behavioral therapy and acceptance-based approaches, could be explored as adjuncts to traditional vestibular rehabilitation.

Brief Summary of Clinical Takeaways: The clinical takeaway for this session is an understanding of what intolerance of uncertainty is, how it is measured clinically, and how it may influence chronic dizziness.

Assumptions: Attendees should be familiar with common conditions associated with chronic dizziness, including persistent postural perceptual dizziness (PPPD) and migraine variants. Familiarity with psychological questionnaires is also benficial.