Psychological flexibility and resilience in dizziness-related disability: A cross-sectional study

Dizziness is a highly prevalent and often disabling complaint that cannot always be explained by peripheral vestibular pathology alone. Psychological factors, particularly psychological flexibility and resilience, may play an important role in shaping symptom severity and disability, yet their combined contribution remains insufficiently explored. This study aimed to examine how psychological flexibility and resilience contribute to the clinical expression of dizziness-related disability.

Ninety-eight patients with dizziness (benign paroxysmal positional vertigo, persistent postural-perceptual dizziness, chronic subjective dizziness, Ménière's disease, vestibular neuritis) and 80 matched healthy controls were included. Disability and symptom severity were assessed using the Dizziness Handicap Inventory and Vertigo Symptom Scale-Short Form. Psychological flexibility and resilience were measured with the Acceptance and Action Questionnaire-II and the Resilience Scale for Adults. Group comparisons, correlation analyses, and multivariate regression models were performed.

Psychological inflexibility was significantly associated with greater disability and symptom severity and emerged as an independent predictor in multivariate models. Psychological resilience showed significant negative correlations with outcomes but did not independently predict disability or symptom severity. Among subtypes, patients with chronic subjective dizziness (CSD) exhibited lower disability levels yet showed particularly strong associations between psychological flexibility and both disability and symptom severity.

Psychological flexibility plays an independent role in the clinical burden of dizziness, whereas resilience appears to function as a supportive resource. These findings highlight the potential relevance of incorporating psychological flexibility-focused interventions into the clinical assessment and management, particularly functional subtypes such as CSD.