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Abstract Objective To investigate whether additional Cognitive Behavior Therapy (CBT) combined with conventional therapy improves outcomes for patients with Persistent Postural-Perceptual Dizziness (PPPD) compared with conventional therapy alone. Methods Two reviewers independently searched PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant Randomized Controlled Trials (RCTs) examining CBT for PPPD which were conducted and published in English from January 2002 to November 2022. RCTs reporting any indicators for assessing corresponding symptoms of PPPD were included, such as Dizziness Handicap Inventory (DHI), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Two independent reviewers conducted extraction of relevant information and evaluation of risk of bias. The Cochrane Collaboration risk of bias tool version 1.0 was used to evaluate risks and assess the quality of the included studies, and Cochrane Review Manager 5.3 software (RevMan 5.3) was used to perform meta-analyses. Results The results of six RCTs indicated that combining additional CBT with conventional therapy significantly improved outcomes for PPPD patients compared with conventional therapy alone, especially in DHI-Total scores (Mean Difference [MD = −8.17], 95% Confidence Interval [95% CI: −10.26, −6.09], p< 0.00001), HAMA scores (MD = −2.76, 95% CI: [−3.57, −1.94], p< 0.00001), GAD-7 scores (MD = −2.50, 95% CI [−3.29, −1.70], p< 0.00001), and PHQ-9 scores (MD = −2.29, 95% CI [−3.04, −1.55], p< 0.00001). Subgroup analysis revealed a significant benefit of additional CBT compared with conventional therapies alone, including Vestibular Rehabilitation Therapy (VRT) (MD = −8.70, 95% CI: [−12.17, −5.22], p< 0.00001), Selective Serotonin Reuptake Inhibitor (SSRI) (with controlled SSRI: MD = −10.70, 95% CI: [−14.97, −6.43], p< 0.00001), and VRT combined with SSRI (MD = −6.08, 95% CI [−9.49, −2.67], p= 0.0005) in DHI-Total scores. Conclusion Additional CBT combined with conventional therapy may provide additional improvement for patients with PPPD compared with conventional therapy alone. However, more RCTs are needed to support and guide the application of CBT in treating PPPD. Level of evidence: I; Systematic review of RCTs. (CBT PosturalPerceptual Postural Perceptual (PPPD alone PubMed Embase Science Library ClinicalTrialsgov ClinicalTrials gov (RCTs 200 2022 DHI, DHI , (DHI) HAMA, (HAMA) HAMD, HAMD (HAMD) HADS, HADS (HADS) Questionnaire9 Questionnaire 9 Questionnaire- PHQ9. PHQ9 PHQ . (PHQ-9) 10 1 0 1. studies 53 5 3 5. RevMan metaanalyses. metaanalyses meta analyses. analyses meta-analyses DHITotal Total Mean −8.17, 817 −8.17 8 17 −8.17] 95 [95 1026 26 −10.26 −6.09, 609 −6.09 6 09 −6.09] p 0.00001, 000001 0.00001 00001 0.00001) 276 2 76 −2.76 −3.57, 357 57 [−3.57 −1.94, 194 −1.94 94 −1.94] GAD7 GAD 7 GAD- 250 50 −2.50 −3.29, 329 29 [−3.29 −1.70, 170 −1.70 70 −1.70] PHQ- 229 −2.29 −3.04, 304 04 [−3.04 −1.55, 155 −1.55 55 −1.55] 0.00001. (VRT 870 −8.70 −12.17, 1217 12 [−12.17 −5.22, 522 −5.22 22 −5.22] (SSRI 1070 −10.70 −14.97, 1497 14 97 [−14.97 −6.43, 643 −6.43 43 −6.43] 608 08 −6.08 −9.49, 949 49 [−9.49 −2.67, 267 −2.67 67 −2.67] 0.0005 00005 0005 However evidence I 20 202 (DHI (HAMA (HAMD (HADS (PHQ-9 81 −8.1 [9 102 −10.2 60 −6.0 00000 0.0000 0000 27 −2.7 −3.57 35 [−3.5 19 −1.9 25 −2.5 −3.29 32 [−3.2 −1.7 −2.2 −3.04 30 [−3.0 15 −1.5 87 −8.7 −12.17 121 [−12.1 52 −5.2 107 −10.7 −14.97 149 [−14.9 64 −6.4 4 −9.49 [−9.4 −2.6 0.000 000 (PHQ- −8. [ −10. −6. −2. −3.5 [−3. −1. −3.2 −3.0 −12.1 [−12. −5. −14.9 [−14. −9.4 [−9. 0.00 00 (PHQ −8 −10 −6 −2 −3. [−3 −1 −12. [−12 −5 −14. [−14 −9. [−9 0.0 − −3 [− −12 [−1 −14 −9 0.