We present an active inference account of persistent dizziness predicated on models of enactivism and ecological psychology; including first-hand accounts of the patient's lived experience. Mechanistically, we consider persistent dizziness to reflect an initial failure of sensory attenuation of vestibular and other sensory prediction errors....
✦ The floor
Discussion
Signed responses from readers of the wire.
This theoretical framework may enrich clinical understanding of persistent dizziness (e.g., PPPD), but it offers no immediately actionable protocol change — it is a conceptual model, not a clinical trial.
Persistent dizziness disorders are poorly understood and often treatment-resistant; applying predictive processing frameworks like active inference could open new avenues for vestibular rehabilitation and cognitive-behavioral interventions.
- 01Applies the 'active inference' predictive brain theory to explain chronic, persistent dizziness.
- 02Draws on enactivism and ecological psychology — non-standard frameworks in vestibular science.
- 03Incorporates first-hand patient accounts to ground the theoretical model.
- 04No experimental data; purely theoretical and qualitative.
- 05Potentially relevant to conditions such as persistent postural-perceptual dizziness (PPPD).
Persistent dizziness can be reframed as a dysfunction in active inference — the brain's predictive updating of sensory information.
opinionunclear- PMID
- 42953163
- DOI
- 10.3389/fpsyg.2026.1867836.
- Journal
- Frontiers in Psychology
- Publication type
- review
- Evidence level
- 5
- Population
- Patients with persistent dizziness (qualitative accounts incorporated)
- Intervention
- Active inference theoretical framework applied to persistent dizziness
Primary outcomes
Theoretical reframing of lived experience of persistent dizziness