Key result
POts Reprocessing Therapy improves POTS symptom severity versus community care with ~83% retention.
Why the study?
Dysregulation within central-autonomic regulatory networks may contribute to persistent symptoms in postural tachycardia syndrome (POTS). The feasibility, acceptability, and preliminary clinical outcomes of POts Reprocessing Therapy (PORT), a neuroplasticity-informed behavioral intervention targeting these processes, had not been evaluated.
Does POts Reprocessing Therapy (PORT) demonstrate feasibility, acceptability, and preliminary improvements in POTS symptom severity and psychological outcomes compared to community care in adults with clinically significant Postural Tachycardia Syndrome?
Does POts Reprocessing Therapy (PORT) demonstrate feasibility, acceptability, and preliminary improvements in POTS symptom severity and psychological outcomes compared to community care in adults with clinically significant Postural Tachycardia Syndrome?
This pilot study provides preliminary evidence that POts Reprocessing Therapy (PORT), a neuroplasticity-informed behavioral intervention, is feasible, acceptable, and potentially effective at reducing symptom severity, anxiety, depression, and catastrophizing in adults with postural tachycardia syndrome.
Purpose Postural tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by orthostatic intolerance and frequently accompanied by a broad constellation of debilitating symptoms. Emerging evidence suggests that dysregulation within central–autonomic regulatory networks may contribute to symptom persistence. We developed POts Reprocessing Therapy (PORT), a neuroplasticity-informed behavioral intervention adapted from Pain Reprocessing Therapy. This pilot study evaluated PORT's feasibility, acceptability, and preliminary clinical outcomes. Methods We conducted a non-randomized, two-arm, open-label pilot feasibility trial. Adults with clinically significant POTS symptoms received eight weekly PORT sessions ( n = 14). A comparison group of adults with POTS receiving community care while awaiting entry to an autonomic clinic served as controls ( n = 15). Self-report measures were collected at baseline and 8-week follow-up, including POTS symptom severity, symptom catastrophizing, anxiety, depression, pain, fatigue, and quality of life. Feasibility and acceptability were assessed via recruitment, retention, and treatment satisfaction. Results PORT demonstrated strong feasibility and acceptability, with 83% retention and strong satisfaction ratings among completers. Participants receiving PORT reported greater symptom improvement compared with community care controls. Mixed ANOVA analyses revealed significant group × time interactions for POTS symptoms (ηp² = 0.283), anxiety (ηp² = 0.363), symptom catastrophizing (ηp² = 0.193), and depression (ηp² = 0.186), reflecting moderate-to-large effects. Conclusion This pilot study suggests that PORT is feasible and acceptable and may be associated with improvements in POTS symptoms and psychological processes. Findings provide preliminary support for targeting central–autonomic processes through neuroplasticity-based interventions and warrant larger randomized controlled trials to evaluate efficacy and mechanisms.
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Crouch et al. (2026) studied Postural tachycardia syndrome (POTS) (n=29). POts Reprocessing Therapy (PORT) vs. Community care (waitlist control awaiting entry to an autonomic clinic) was evaluated on Feasibility (recruitment, retention, session completion, therapist adherence) and acceptability (treatment satisfaction); primary clinical outcome was change in POTS symptom severity (Malmö POTS Symptom Score) (ηp² = 0.283). POts Reprocessing Therapy demonstrated strong feasibility (83% retention) and significantly improved POTS symptom severity compared with community care controls over 8 weeks (ηp² = 0.283).
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