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 ( 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 (ηp 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.