PPPD — persistent postural-perceptual dizziness — is a formally defined, criteria-based diagnosis: the constant swaying, rocking, non-spinning dizziness that stays after whatever started it has healed. It is not anxiety, though it's mislabeled that way constantly. MindForge provides instrumented rule-in evaluation and graded retraining for PPPD in Dallas. Start with a free 15-minute call.
MindForge doesn't bill insurance — by design. Direct-pay is what makes an individualized, intensive program possible rather than care shaped by billing codes. HSA/FSA and financing options exist, and a written Good Faith Estimate precedes any commitment.
What PPPD is
After a vestibular event, a migraine flare, a concussion — sometimes an anxiety episode — the balance system can get stuck in threat mode: over-relying on vision, over-monitoring posture, treating ordinary environments as unstable. The result is chronic (months-plus) unsteadiness, worse upright, worse in motion, worse in visually busy places — codified in international diagnostic criteria (Bárány Society, 2017) [1]. PPPD is one of the most common causes of chronic dizziness — on the order of 15–20% of patients at specialty dizziness clinics, most commonly ages 30–50, the majority women [2].
"Your tests are normal — it's anxiety"
The classic PPPD story: normal MRI, normal ear tests, an anxiety label, and years of daily symptoms with no plan. Two corrections, from the research. First, PPPD is the diagnosis your normal tests point toward when the pattern fits — a functional re-weighting problem, real and named; relief tends to arrive with the name, and research on chronic-dizziness patients documents exactly that [3]. Second, anxiety coexisting with PPPD is expected — constant unsteadiness is anxiogenic — and it will never be used here to re-dismiss you. The evaluation documents the pattern; the name does the vindicating.
How we evaluate PPPD: the Discovery Day
The MindForge Discovery Day — comprehensive neurological evaluation + report of findings + care plan. PPPD battery: structured discriminator intake separating PPPD from VM and MdDS patterns, validated instruments (DHI, PPPD-specific questionnaire, visual-dependence measures), and the full objective set — VNG-class oculomotor testing, vestibular function testing, posturography including head-position and visual-condition manipulations — because ruling the pattern IN requires ruling active peripheral disease OUT. Same-day findings, written GFE, routing by name where the data points elsewhere.
Treatment: the PPPD Intensive
Failed generic advice: the anxiety full-stop, or a home-exercise printout that flares symptoms and gets abandoned. Counter-thesis: PPPD responds to graded, individually dosed retraining that re-weights the system — reducing visual over-reliance, rebuilding confident automatic posture, desensitizing motion and visual complexity progressively rather than by flooding. Recent systematic reviews of vestibular-rehabilitation-based programs for PPPD report significant improvement on dizziness-handicap measures [4] — heterogeneous protocols, framed as such, no cure vocabulary. The program: vestibular adaptation and gaze training · graded visual-motion exposure guided by your visual-dependence testing · balance re-education de-emphasizing visual crutches · rotational work where tolerated · sub-threshold conditioning · cervical care where drivers coexist · FM support for sleep and stress physiology · pacing that never floods. Where medication (physician-managed) or CBT is part of your picture, we coordinate — the literature supports additive benefit [4], and integration beats turf.
The format itself has published support: in the largest reported test of this care model, a week-long intensive outpatient program combining vestibular retraining, medication guidance, and cognitive-behavioral work produced improvements that held at six-month follow-up across 305 PPPD patients [5]. That is the architecture here — with the layer a standardized program cannot add: your retraining is dosed from your instrumented findings, paced to your own flare threshold, and re-measured against your own baseline rather than a protocol average.
Program pricing is shared on your free 15-minute call (exact quote + GFE at the wrap). The timeline: graded retraining works in weeks-to-months, not days.
What treatment looks like: Discovery Day → concentrated weeks, progressions measured against your baseline → re-test. (What to expect.)
Costs: DD = one fixed fee, shared on your call · program pricing on the same call + GFE · ways to pay. Schedule: 15-min call / (214) 730-6463 → Discovery Day scheduled live on your call → program typically within days · travelers.
Frequently asked questions
Is PPPD real?
Yes — formally defined criteria since 2017 [1]; it's one of the most common chronic-dizziness diagnoses [2].
Is it anxiety?
No — it coexists with anxiety and is not caused by "being anxious"; the pattern is diagnosable and the retraining is physical.
Why am I worse in stores and on screens?
Visual over-weighting — the system leaning on vision it can't trust; measurable, trainable.
Will it go away on its own?
Untreated PPPD tends to persist — that's the "persistent"; graded retraining is the evidence-supported path [4].
PPPD vs MdDS?
MdDS is constant rocking that improves in motion, after travel; PPPD is exacerbated by motion and visual complexity — see the MdDS page.
Is there treatment on the Discovery Day?
No — it's a diagnostic day.
Do you take insurance?
We're direct-pay, with superbills provided — see ways to pay.
Sources: [1] Staab et al., Bárány Society consensus criteria, J Vestib Res (2017). [2] PPPD prevalence in tertiary dizziness care ~15–20% of referred dizziness — among the top three diagnoses in specialty vestibular consultation (Staab, J Vestib Res, 2017; Staab, Persistent Postural-Perceptual Dizziness, in Disorders of the Vestibular System, ch. 12). [3] Naming/validation effect in chronic dizziness (Smith et al., Health Expectations, 2024). [4] VRT-based programs for PPPD: 2025 SR/MAs (PMC12504085; PMC12347945) — significant DHI improvement, heterogeneous protocols; CBT-additive meta-analysis (2024). [5] Week-long intensive multimodal outpatient program for PPPD — individualized combinations of vestibular rehabilitation, medication, and cognitive-behavioral therapy with sustained benefit at 6-month follow-up, n=305 (Axer et al., reviewed in Staab JP, Persistent Postural-Perceptual Dizziness, Disorders of the Vestibular System, Springer).