Why anxiety and fear of symptoms keeps dizziness going- and how to break that cycle
If you’re suffering from a vestibular disorder, chances are that you’ve had an encounter (or two, or many!) with fear and anxiety somewhere along the way. As miserable as this experience is, know that you’re not alone: the link between fear, anxiety and dizziness symptoms is well-documented both by research and many patient stories you can find through VeDA and elsewhere.
In this article, you’ll learn about “danger mode” in the brain and how that can keep you stuck in a fear-anxiety-symptom loop. You’ll also learn some tools that can help you break out of it, resulting in lower fear, anxiety and symptoms. Most importantly, you’ll hear directly from two people with vestibular disorders, Megan and Maya, about their experiences with breaking the fear-anxiety-symptom loop.
“Danger Mode” in the Brain
Your autonomic nervous system controls many of the autonomic functions in your body (breathing, heart rate, body temperature, etc.). It responds to changes in your needs or environment by adjusting these functions. This system has two primary branches: the sympathetic branch and the parasympathetic branch.
When you need to take action, whether that’s to respond to an email or run away from a predator, the sympathetic branch activates the “fight or flight” response in your body. You might notice your breathing and heart rates speeding up, your digestion changing (speeding up or slowing down) and your hands and feet getting colder as blood is sent to the parts of your body that keep you alive. When the event is very dangerous or stressful, the response to the event is correspondingly intense. You may recognize this response as the physical sensation of anxiety, or “danger mode,” in your body.
While this response is entirely normal, it is typically limited in time. When the need to act has passed, the parasympathetic branch takes over and you go into “rest and digest” mode.
Vestibular Disorders and “Danger Mode”
When you have a vestibular disorder, your body can go into “danger mode.” That is, because your brain is not getting the information it expects from your balance system, it thinks you are in danger. This is also an expected and normal function of your body. If your brain is not sure what’s going on around you, it wants you to stop moving so you can stay safe. Thankfully, with time, the brain will typically adapt to any changes in your balance system, and the danger mode response subsides.
However, for some people, danger mode stays active. In these cases, the body is still on high alert, and people can suffer from physical sensations of anxiety as well as anxious thoughts. This elevated level of anxiety interferes with the brain’s natural process of adaptation, and in some cases, causes the brain to become overly sensitive to sensations in the body. This can happen for people with vestibular issues of any origin- even if the original vestibular issue is resolved.
Patient Perspectives: What it’s Like to be Stuck in “Danger Mode”
Megan began feeling her vestibular symptoms in May 2019. Within a few months, they were constant and highly debilitating. Eventually, she was diagnosed with probable vestibular migraine and persistent postural-perceptual disorder (PPPD). At her most symptomatic, Megan was stuck at home, unable to work, drive or even walk for longer than a few minutes. She describes feeling full of fear and symptoms constantly.
Maya’s symptoms started in November 2018. Like Megan, Maya also describes periods of intense and highly debilitating symptoms of dizziness, visual disturbances, rocking and more. Maya received multiple diagnoses, including cervicogenic dizziness and POTS. At the peak of her symptoms, Maya was bedridden.
Why Out-of-Control “Danger Mode” Leads to Persistent Symptoms
Your brain’s job is to let you know when something important is happening. You can think of it as having a master remote control and being able to turn the volume up and down on various sensations based on what it thinks is important. Therefore, if your brain becomes too alert and sensitive to balance-related sensations, it will turn the volume up on them. This causes people to have increased and often prolonged symptoms. These increased and prolonged symptoms are not coming directly from the vestibular system; rather, they are the result of the brain’s overactive response to sensations in the body. In other words, your brain now has a program, or a “neural circuit” that expects and intensifies dizziness.
Why Does Danger Mode Stay Active?
You might be surprised to learn that in many cases, the cause of “danger mode” is not always the vestibular disorder itself. While research on vestibular conditions clearly indicates that a history of anxiety makes it more likely that you will experience anxiety and/or prolonged symptoms with your vestibular condition, you may not have a history of anxiety at all. Anxiety is not the only cause of danger mode. Research on similar chronic conditions such as chronic pain and fibromyalgia indicates that many people who experience chronic symptoms related to danger mode have very good reasons for being in danger mode. Many of these people had periods of significant stress that made their nervous systems extra alert. Both Megan and Maya report periods of extreme stress that preceded their symptoms. Some people with persistent symptoms also have histories of significant and/or childhood traumatic experiences that taught their nervous systems to become extra sensitive to danger.
Danger vs. Safety
Whether your “danger mode” response was the result of the symptoms themselves or stressful past experiences, it is clear that putting the brain back in “safety mode” is an important step in resolving prolonged vestibular symptoms and anxiety. When your brain thinks that you are safe, the brain will no longer be looking for and turning the volume dial up on body sensations. In other words, when your nervous system believes that you are safe, your anxiety- and your symptoms- will come down.
Here’s Maya’s perspective: “My goal was to calm and regulate my nervous system, so it would stop sending danger mode signals and keep the symptoms going. Knowledge was the most important first step. I read books, watched videos, and found an online community for support. This solidified to my brain that there was nothing physically wrong with me, that my nervous system was doing exactly what it was meant to do, just a little bit too well. And most importantly, that it wasn’t permanent.”
As Maya points out, teaching the brain to come out of danger mode can be accomplished through several means, but the simplest one is to teach your brain to react differently to symptoms and body sensations. The first and most important part of this process is understanding why it is happening. You can find a lot more information on the concepts in this article on the Steady Coach YouTube channel. However, because you are suffering from a disorder that affects your body, it can also be helpful to use your body as a tool in recovery. For this purpose, we’ll focus on two body-based tools called parasympathetic breathing and somatic tracking.
Somatic tracking is a process of spending time focusing on your symptoms without reacting to them. You look at them like a curious observer and describe them, noticing how they change. This may go against your instincts and be hard to practice when the symptoms are so uncomfortable. It may feel counterintuitive. But with practice, this exercise teaches your brain that the symptoms and sensations are not dangerous. Over time, your brain will learn that it is safe to turn the volume dial down on the symptoms.
Maya shares her thoughts on somatic tracking: “It was so powerful in teaching my brain to overcome the fear of symptoms and to view them with curiosity. I spent so much energy avoiding and pushing away the symptoms, unknowingly adding to the fear and danger signals I was sending my brain. Somatic tracking allowed me to break that cycle and look at the symptoms as unpleasant sensations, nothing to fear.”
Here’s what Megan has to say about somatic tracking: “This exercise made me feel like I could handle the symptoms even if they were bad and it made me less afraid of the symptoms overall. After doing this exercise daily, I felt like the symptoms didn’t bother me as much in my day-to-day life. It was like my body and brain were learning that the symptoms were safe and I didn’t need to be so afraid of them anymore.”
You can find a guided somatic tracking exercise specifically for chronic dizziness on the Steady Coach YouTube channel.
You can also find this track (with slightly higher volume of the spoken guidance) on Insight Timer, a free meditation app.
Remember how we discussed that the autonomic nervous system controls functions like breathing? That system is constantly monitoring what is happening in your body and environment and adjusting your body functions accordingly. This means that if you send messages to your nervous system via your body that you are safe, it can turn down the danger response in your brain. In other words, if you can activate your “rest and digest” system on purpose, this can help bring you out of “danger mode.”
Your breathing system contains many connections to your autonomic nervous system. When you purposely breathe in a particular pattern, this can change which branch of your autonomic nervous system is active. Parasympathetic breathing involves taking an inhale that activates your diaphragm (often called belly breathing, though there are some differences) and then slowly exhaling while constricting your breath on the way out (as if you were trying to clear your throat). This sends a message to your brain that you are safe and not in danger.
Megan says, “I remember the turning point was when I actually managed to stop a panic attack in its tracks with the parasympathetic breathing. The symptoms were so bad in that moment, and I could feel my nervous system firing up. However, I put into practice what I had learned, and after a few minutes I felt calm. The symptoms raged on in that moment however I felt so powerful. I was watching the symptoms without fear. From then on, I felt like nothing could stop me from getting completely back to normal! Each time after that got easier and eventually the exercise would bring the intensity of the actual symptoms down, not just the emotions. It took some time, but it really was the most powerful tool I’ve used. I continue to use it in my daily life just to help keep my nervous system calm.”
You can find a short instructional video on parasympathetic breathing and how to use it on the Steady Coach YouTube channel.
Common Questions and Concerns
I don’t feel better right away! Does that mean it isn’t working for me?
Megan says, ”When I tried to use the parasympathetic breathing to calm the panic attacks, it didn’t work the first few times. However, I kept trying because Dr. Yonit reassured me that I was still benefiting from the exercise even if I didn’t feel any physical changes in the moment.” And, as you read above, Megan was eventually able to see huge reductions in both her fear response and symptoms using this technique.
Maya says, “After years of stress, it takes time for the brain and system to learn to get out of danger mode. Nothing about this journey has been linear. It was challenging remaining patient, especially through the ups and downs of the healing process. Despite all of the improvement and progress I made, in those low points I would think that maybe I was different, maybe I would never get better. It was highly challenging getting back to living my life because the danger mode just wanted me to hide away safe and alone at home. It was a choice between two hard places – staying with these symptoms forever or leaving my comfort zone and returning to life.”
The solution is to keep at it! Even if you don’t feel changes right away, over time, the messages of safety you are sending your brain will build up and start to help.
I hate the symptoms! How do I stay neutral about them?
As Megan explains, “The main challenge [doing somatic tracking] was that my body felt like it was trying to fight the changes I was making. My brain was used to panicking about the symptoms!”
Megan’s experience is very normal, and you may find that happens to you, too. That said, even if the symptoms don’t budge in response to the exercise, consistently giving your brain messages of safety about the symptoms will change its autonomic reaction to them- bit by bit.
It’s hard to focus and my mind wanders. Does that mean it’s not working?
This is completely normal. Our minds are used to thinking all day, every day. In fact, it is a very good brain exercise to notice that your attention has wandered. Just notice that has occurred and bring your focus back to your symptom(s). You are still getting the benefit of the exercise.
How often should I do this type of exercise?
If you are very alarmed by your symptoms, I encourage you to do somatic tracking regularly. It won’t hurt you if you do it often, but keep in mind that you don’t want to obsess about your symptoms and constantly try to “fix” them. A good rule of thumb is 1-3 times a day. For patients who are bedridden, it might be a good idea to do it more often. For people who are living relatively active lives, less often is perfectly fine. You can use a guided version or turn on some relaxing music and do it on your own.
Parasympathetic breathing is something you can practice throughout the day when you notice your symptoms increasing (either on their own or in response to a trigger) or when you feel tension in your body. It can be very tricky to learn how to spot tension in your body at first, so you might just plan regular breaks during which you can do parasympathetic breathing for 30-60 seconds and then resume activity. Again, you can find more recommendations about how to use this on the Steady Coach YouTube channel.
Addressing Danger Mode is Worth It!
Megan says, “Since addressing “the danger mode,” my symptoms and my quality of life have changed dramatically. After 2 months of doing this every single day I began to feel like I could go out and do more things such as grocery shopping, going to restaurants, meeting up with my friends in coffee shops etc. Within about 5 months of all of this work, I was back to working part time, I passed my driving test and bought my first car and I started going to the gym. I never thought I’d be able to do these things again! It has been about 9 months now since beginning my healing journey and my life is completely different to the way it was during the worst of PPPD. I am living a fairly normal life now.”
And Maya shares, “When I let go of physical “fixes” and began addressing my stress and the danger mode my system was stuck in, that was the only time I began to see actual changes to my symptoms and their intensity. I have been doing this work for only a few months and have gone from bedridden to getting a job and returning to university. I have gone camping, celebrated birthdays, and worked on getting my driver’s license. I no longer experience anxiety and panic attacks. Apart from the symptom improvement, my inner world has changed immensely. My relationship with myself and others has improved dramatically; I am much more confident and aware of myself and the world around me. I am compassionate and emotionally connected and have found peace in old wounds. I have realized this is not only a symptom journey but a life journey.”
To learn more about practical tools for addressing danger mode and its contributions to your symptoms, here are some resources:
- The Steady Coach YouTube channel
- The Way Out by Alan Gordon
- Unlearn Your Pain by Howard Schubiner
- The Body Keeps the Score by Bessel van der Kolk
Huge thank you to Megan and Maya, who so generously agreed to share their incredible stories and experiences so that others can benefit. You can find out more about Megan and her journey on her YouTube channel.
By Dr. Yonit Arthur, AuD
Dr. Yo is an audiologist and strength coach who specializes in helping people with chronic dizziness disorders. Her mission is to provide free and low-cost resources to people around the world who are suffering from these disorders. She releases weekly educational content via her YouTube channel, The Steady Coach, and also created and hosts a comprehensive, step-by-step course on chronic dizziness disorders that is entirely free.