Somatic tracking for PPPD: can changing how you pay attention calm chronic dizziness?

If you have persistent postural-perceptual dizziness (PPPD), you already know its cruel signature: the rocking, swaying, or floaty unsteadiness that's there almost every day, gets worse when you're upright, in busy visual environments - supermarkets, scrolling screens, patterned floors - and, most maddeningly, gets worse the more attention you pay to it. That last part isn't your imagination. It's central to how PPPD works, and it's why a technique called somatic tracking - borrowed from modern chronic-pain treatment - has become one of the most talked-about self-help practices in the PPPD community.

This guide explains the idea, gives you a step-by-step way to practise it, and - because this is a condition where hope gets sold too easily - is honest about what the evidence does and doesn't show yet.

PPPD in one paragraph: a software problem, not a hardware problem

PPPD was formally defined in 2017 by the Bárány Society as chronic dizziness, unsteadiness, or non-spinning vertigo present on most days for three months or more, made worse by upright posture, motion, and complex visual stimulation [1]. It usually starts after a triggering event - vestibular neuritis, BPPV, a migraine flare, even a panic episode or illness. The inner ear typically heals or compensates, but the brain's balance strategy doesn't stand down: it stays in the high-alert mode that was appropriate during the original crisis. The result is stiffened postural control, heavy reliance on vision, and continuous background monitoring of balance - which itself generates the sensations of unsteadiness [2]. Crucially, this makes PPPD a disorder of function - how the balance system is being run - rather than ongoing damage. That's precisely why treatments that retrain attention and threat appraisal are on the table at all.

Why attention is part of the engine

In PPPD, three loops keep the dizziness going [2]:

• Hypervigilance. The brain checks balance constantly ("am I dizzy right now? how dizzy?"), which amplifies normal sensory noise into felt unsteadiness.
• Threat appraisal. Sensations are interpreted as dangerous ("I might fall", "something is seriously wrong"), which keeps the alarm system engaged.
• Protective behaviour. Stiffening, fixating the gaze, avoiding supermarkets and screens - strategies that feel safer but actually maintain the miscalibration.

Notice what all three have in common: they're driven by how you attend to and interpret the sensation. That is the specific target somatic tracking was built for.

What is somatic tracking?

Somatic tracking is the core technique of Pain Reprocessing Therapy (PRT), developed for chronic pain that persists after tissue has healed. The practice: you attend to the sensation deliberately - but through a lens of curiosity, lightness, and safety, rather than fear and evaluation. Instead of "checking" whether the symptom is still there (threat mode), you observe its qualities - where it sits, whether it drifts, what texture it has - while reminding your brain that the signal is a false alarm, not evidence of damage.

The idea has real evidence behind it in chronic pain: in a randomized trial published in JAMA Psychiatry, 66% of people with chronic back pain treated with PRT were pain-free or nearly pain-free after four weeks of treatment, versus 20% with placebo and 10% with usual care - with gains largely maintained at one-year follow-up [3]. The mechanism proposed - unlearning a false danger signal by reappraising it as safe - maps closely onto the modern model of PPPD.

The honest evidence check for PPPD specifically

Here's the part many articles skip: somatic tracking has not yet been tested in a randomized trial for PPPD. The trial evidence above is for chronic back pain. What PPPD does have is closely adjacent, converging evidence that the same levers - attention, threat appraisal, avoidance - matter:

• Cognitive-behavioural therapy produced significant, lasting reductions in dizziness in a randomized trial for chronic subjective dizziness, PPPD's predecessor diagnosis [4].
• The UK INVEST trial found that vestibular rehabilitation infused with CBT/ACT principles - including deliberately retraining attention away from balance-monitoring - was feasible and showed promising clinical signals against gold-standard physiotherapy in PPPD [5].
• Vestibular rehabilitation itself has meta-analytic support in PPPD [6], and established treatment pathways also include SSRIs/SNRIs for some patients [2].

So the fair summary is: somatic tracking is a plausible, low-risk complement that targets mechanisms we know matter in PPPD - not a proven standalone cure, and not a replacement for vestibular rehab, therapy, or medication your clinician recommends.

How to practise somatic tracking for dizziness: a step-by-step

Adapted for vestibular symptoms, a session looks like this:

1. Set the scene for safety. Sit somewhere comfortable and stable, feet on the floor. You're not doing this mid-episode of severe spinning - start on an ordinary "background unsteadiness" day.
2. Find the sensation without flinching. Let your attention rest on the rocking, swaying, or fogginess. You're visiting it, not checking on it.
3. Get curious about its qualities. Where does it live - head, chest, behind the eyes? Does it pulse or drift? If it had a shape or colour, what would it be? Curiosity and fear are hard to run at the same time.
4. Layer in safety messages. Remind yourself, genuinely: this is a sensitive alarm, not damage. My ears and brain are intact. This feeling is uncomfortable, but it is not dangerous.
5. Keep it light and short. One to three minutes. If it helps, hold it the way you'd watch a lava lamp - mildly interested, zero stakes. Then go do something else.
6. Stop if anxiety spikes. That's not failure; it's information. Shorten the session next time, or practise when the symptom is quieter.

The mistake that undoes it: outcome pressure

The most common way somatic tracking goes wrong is using it as a clever technique to make the dizziness go away - then monitoring whether it's working. That's hypervigilance wearing a mindfulness costume, and the brain isn't fooled: attention with an agenda is still threat attention. The goal of a session is not less dizziness; it's a genuinely different relationship to the sensation. Reduction, when it comes, is a by-product. This is also why forcing yourself to track sensations all day, every day, is counterproductive - in PPPD, moment-to-moment symptom monitoring is part of the disease loop, not the cure.

The tracking paradox - and how to log symptoms without feeding them

This raises a fair question for a tracking-app blog to answer: if hypervigilance drives PPPD, should you be tracking symptoms at all? The evidence-informed answer is that how you track decides everything. Constant, reactive checking ("how dizzy am I right now?") feeds the loop. But structured, once-a-day logging serves a different purpose: it gives you and your clinician the data to see trends, test triggers like screen time, sleep, and stress, and - importantly for PPPD - documents your improvement over months, which is itself powerful reassurance for a threat-sensitive brain. We cover the method in how to track your dizziness triggers.

This is exactly how the Dizzin PPPD tracker is designed: one check-in per day, under a minute, anchored to your evening routine - then the app does the pattern-finding quietly in the background and builds a doctor-ready PDF for your next appointment. You get the evidence without the vigilance: log once, close the app, get on with your day. For a condition that improves as balance stops being the centre of attention, that's not a small design detail - it's the whole point.

Dizzin is a self-tracking tool, not a medical device. It does not diagnose or treat PPPD, and this article is not medical advice. Somatic tracking is a self-help practice, not a substitute for assessment - dizziness has many causes, and new or changing symptoms deserve a proper work-up. Talk to your clinician before changing your treatment approach.

Related reading: How to track your dizziness triggers · PPPD symptom tracker

Sources

1. Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research, 2017.
2. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Practical Neurology, 2018.
3. Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry, 2022.
4. Edelman S, Mahoney AEJ, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. American Journal of Otolaryngology, 2012.
5. Herdman D, Norton S, Murdin L, et al. The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness. Journal of Neurology, 2022.
6. Li Y, et al. Effect of vestibular rehabilitation therapy in patients with persistent postural perceptual dizziness: a systematic review and meta-analysis. Frontiers in Neurology, 2025.