An alternative “Port”? Rationale and development process for POts Reprocessing Therapy (PORT), a brain–body therapy for postural tachycardic syndrome (POTS)

Q: What is the clinical evidence from this study?

Population: Adult female patients aged 24-53 years with postural tachycardia syndrome (POTS) and chronic orthostatic intolerance symptoms impacting functioning (n=5). Intervention: POts Reprocessing Therapy (PORT). Primary outcome: Improvement in symptoms and functioning as reported qualitatively by patients after PORT treatment.

Q: What does this research mean for the field?

POts Reprocessing Therapy (PORT), a novel brain-body intervention adapted from pain reprocessing therapy, improves symptom understanding, reduces fear, and enhances daily functioning in patients with postural tachycardia syndrome (POTS). Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.ESTABLISHES_NEW_DIRECTION.

Taylor Crouch; Maggie Nguyen; Mary J. Wells; Tammy Redman; Yoni K. Ashar; Howard Schubiner; Grace Westcott; Patricia Kinser; Madison Maxwell; Gisela Chelimsky; Thomas Chelimsky

doi:10.1007/s10286-026-01189-1

February 27, 2026Clinical Autonomic ResearchOpen Access

An alternative “Port”? Rationale and development process for POts Reprocessing Therapy (PORT), a brain–body therapy for postural tachycardic syndrome (POTS)

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Why the study?

POTS is marked by excessive orthostatic tachycardia without clear structural etiology, and autonomic symptoms may be driven by central nervous system-maintained dysregulation.

Does POts Reprocessing Therapy (PORT) improve symptom perception and functioning in patients with postural tachycardia syndrome (POTS)?

Key Points

To describe the theoretical rationale and protocol development process for POts Reprocessing Therapy (PORT), a brain–body intervention targeting central nervous system dysregulation in postural tachycardia syndrome.
PORT was adapted from pain reprocessing therapy (PRT) through multidisciplinary expert consultations to create an intervention comprising one physician evaluation and eight weekly 50–60-minute psychologist sessions.
A focus group was conducted with N=5 female participants diagnosed with POTS (aged 24–53 years; four White, one Black) who underwent an early protocol version, followed by rapid qualitative analysis across 12 themes.
The finalized protocol incorporates psychoeducation on autonomic nervous system networks, somatic inquiry, imagined and real symptom exposure, and vagal regulation techniques.
All five focus group participants reported reduced fear and anxiety related to orthostatic symptoms, describing the reduction as ranging from moderate to immense or significant.
Participants demonstrated improved understanding of their condition as nervous system-driven rather than purely psychological or cardiac, while emphasizing the need for compassionate provider communication.

Structured PICO

Does POts Reprocessing Therapy (PORT) improve symptom perception and functioning in patients with postural tachycardia syndrome (POTS)?

P

Population

5 women with postural tachycardia syndrome (POTS), ages 24-53, who underwent an early version of the intervention.

I

Intervention

POts Reprocessing Therapy (PORT), an 8-week brain-body intervention adapted from pain reprocessing therapy, including psychoeducation, safety learning-based exposure to symptoms, somatic inquiry, and emotional processing.

O

Outcome

Qualitative themes regarding patient perceptions of symptoms management and treatment outcomes.patient reported

PORT is a novel brain-body intervention for POTS that targets centrally mediated processes and demonstrated initial qualitative benefits in reducing symptom-related fear and improving condition understanding.

Limitations

Small sample size of five participants limits generalizability
Lack of control or comparison group
No quantitative efficacy data reported
Results based on qualitative feedback without standardized outcome measures
Early stage intervention development without formal efficacy trial results

Implication

Should not yet change POTS management; leaves open utility of this novel brain-body intervention pending larger controlled trials.

Abstract

Purpose Postural tachycardia syndrome (POTS) is a chronic disorder marked by excessive orthostatic tachycardia, without clear structural/organic (e.g., cardiovascular) etiology. Recent evidence suggests that persistent autonomic symptoms may be driven by threat-induced and central nervous system-maintained dysregulation, similar to centralized chronic pain disorders. This study describes the rationale and development process of a brain–body intervention—POts Reprocessing Therapy (PORT)—aimed at reducing orthostatic symptomatology by taking advantage of the brain’s plasticity. Methods PORT was adapted from pain reprocessing therapy (PRT), an evidence-based mind–body approach for treating centralized chronic pain. The initial protocol was developed through consultations with multidisciplinary experts, including the developers of PRT. To refine the protocol, a focus group was conducted with five women participants with POTS who underwent an early version of PORT. Rapid qualitative analysis was conducted to identify themes and inform intervention improvements. Results The intervention consists of a medical evaluation followed by eight weekly treatment sessions. Intervention components include psychoeducation, safety learning-based exposure to symptoms, somatic inquiry, and emotional processing. Focus group participants identified reduced fear about symptoms, greater understanding of their condition, and improved functioning. Participants provided suggestions around language and content, and some shared emotional challenges of the treatment, underscoring the need for sensitive provider communication and implementation. Conclusion This study introduces a novel therapeutic treatment for POTS that targets centrally mediated processes hypothesized to underlie persistent autonomic dysregulation. Trials are underway to formally assess feasibility, acceptability, and efficacy.

Discussion

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Cite This Study

Crouch et al. (2026) studied Adult female patients aged 24-53 years with postural tachycardia syndrome (POTS) and chronic orthostatic intolerance symptoms impacting functioning (n=5). POts Reprocessing Therapy (PORT) was evaluated on Improvement in symptoms and functioning as reported qualitatively by patients after PORT treatment.

synapsesocial.com/papers/69a288060a974eb0d3c04005 https://doi.org/10.1007/s10286-026-01189-1

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An alternative “Port”? Rationale and development process for POts Reprocessing Therapy (PORT), a brain–body therapy for postural tachycardic syndrome (POTS)

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

An alternative “Port”? Rationale and development process for POts Reprocessing Therapy (PORT), a brain–body therapy for postural tachycardic syndrome (POTS)

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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