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

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.