Acute Dizziness Management: Vestibular Regulation Tools

As vestibular therapists, we’re well-versed in adaptation, habituation, and substitution. These principles are the foundation of vestibular rehabilitation and are vital for long-term recovery. However, there seems to have been less emphasis in our field on equipping patients with acute dizziness management strategies, the tools they can use to calm symptoms when they spike, whether after doing their exercises or when caught in a visually or motion-rich environment.

That gap inspired this post. Over the years at North 49, I’ve found that teaching vestibular regulation techniques can empower patients to manage dizziness in real time, giving them confidence and control while supporting long-term neural recovery. Many of these techniques come from structured programs used in the navy and airforce to help pilots and sailors manage motion sensitivity. If it’s good enough for Top Gun, it’s worth considering in vestibular rehab.

Why Vestibular Regulation Techniques Matter

The vestibular system’s ability to adapt depends on repeated, structured input. Yet when symptoms flare, the autonomic nervous system and amygdala can become overactivated, amplifying dizziness and anxiety. Teaching patients vestibular regulation techniques helps counter this by engaging the prefrontal cortex,  the brain’s “calm centre.”

These approaches provide two key benefits:

1. Immediate symptom control: Helping patients self-regulate when dizziness increases.
2. Long-term desensitization: Reinforcing the sense of safety needed for true neural rewiring and habituation.

Together, they bridge the gap between physiological recovery and emotional regulation, an often-overlooked but essential part of vestibular rehabilitation.

What We Can Learn from Fighter Pilots

Research from the airforce and navy in Canada, the U.S., and Italy shows that structured programs combining gradual exposure, relaxation, and visualization can significantly reduce motion sensitivity. While our patients won’t be placed on a centrifuge like pilots, then spun at high speeds, the underlying principle remains the same: by pairing graded vestibular challenges with relaxation and mental rehearsal, we can use neuroplasticity to retrain the vestibular system more efficiently.

These are the same vestibular regulation techniques we can adapt clinically to help patients handle flare-ups and reduce fear of movement.

Core Vestibular Regulation Techniques for Acute Dizziness Management

1. Deep Breathing Techniques

Purpose: To calm the nervous system, improve heart rate variability, and enhance stress resilience.

Options: 

• Diaphragmatic Breathing: Inhale 4–5 s (belly rises), exhale 6–7 s. 1–2 minutes as needed.
• Resonance (Coherent) Breathing: ~6 breaths/min (inhale 5 s, exhale 5 s). 1–3 minutes.
• Box Breathing (Navy SEAL Technique): Inhale 4 s → hold 4 s → exhale 4 s → hold 4 s. 2–5 minutes.

Short sessions calm symptoms quickly, while regular practice provides cumulative benefit.

2. Palming or Visual Rest

How: Rub hands together to warm them, place palms gently over closed eyes, and breathe slowly for 1–2 minutes.
Why: Reduces visual input, often a strong dizziness trigger (especially with vestibular migraines and PPPD) and allows visual processing centres to reset. Scheduling brief visual rest breaks throughout the day can also prevent symptom buildup.

3. Grounding (5-4-3-2-1 Method)

How: Name 5 things you see, 4 things you feel, 3 you hear, 2 you smell, and 1 you taste.
Why: Diverts attention from internal sensations of dizziness to external sensory cues. This activates the prefrontal cortex, calming the amygdala. Used by the military to maintain focus during sensory overload, it works equally well for patients with motion or visual sensitivity.

Integrating Visualization and Mindset

Visualization

Borrowed from sport and aviation psychology, visualization trains the brain to process motion safely. Encourage patients to mentally rehearse moving through tasks like walking down aisles, turning their head, or riding in a car without dizziness. The brain interprets imagined motion similarly to real motion, helping reduce sensitivity. The key is the mental task has to be performed symptom free in order for neuroplasticity to have a positive effect. 

Mindset

Internal dialogue influences physiology. When dizziness increases, negative self-talk (“Why me?” “This will never get better” “My day will be ruined!") fuels sympathetic arousal. Teaching patients to acknowledge symptoms calmly (“This is part of recovery,” “My system is adjusting” “I will get better”) helps their brain interpret the situation as non-threatening, preventing escalation.

Bringing It All Together Clinically

• Normalize temporary symptom increases. Remind patients it’s part of retraining.
• Introduce vestibular regulation techniques early in care, ideally before advancing exposure tasks.
• Pair regulation breaks with habituation or adaptation exercises.
• Reinforce consistency. Recovery comes from repetition, both in movement and mindset.

These combined acute dizziness management strategies and vestibular regulation techniques help patients stay grounded, reduce avoidance, and improve confidence in daily life.

Key Takeaways for Vestibular Therapists

• Adaptation, habituation, and substitution remain the foundation, but acute dizziness management strategies or vestibular regulation strategies fill a crucial gap in real-world symptom control.
• These tools are supported by military and performance psychology research, reinforcing their validity.
• Empowering patients to self-regulate builds both neural and psychological resilience, keeping them engaged and progressing through rehabilitation.

Integrating acute dizziness management strategies and vestibular regulation techniques into clinical care bridges the gap between recovery in the clinic and control in daily life. These tools give patients the ability to steady themselves when the world spins. Helping them stay calm, confident, and in command of their recovery.