Targeting Brain-Body Processes in Postural Tachycardia Syndrome: A Pilot Trial of POts Reprocessing Therapy

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.