An alternative “Port”? Rationale and development process for POts Reprocessing Therapy (PORT), a brain–body therapy for [POTS] 2026 Crouch et al

[Andy]

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.

Open access

 

[Peter T]

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.

How many times is this ‘novel therapeutic treatment’ to be rolled out in pilot studies?

 

[Hutan]

"PORT" - that's hilarious given Wessely's metaphor of a research trial "ship" sailing securely to its planned destination. The end point is never in doubt. Nothing, not a difficulty recruiting people, not the dropouts who need to be ignored, not the protestations of some of the participants that the approach doesn't work and causes emotional harm, prevents these ships from safely reaching port.

This study introduces a novel therapeutic treatment for POTS

Yes, to quote another Wessely-ism I think - old wine in new bottles. It's all a variation on 'you inferior people are afraid of stuff - let me help you see the world and be in your body better'.

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.

So, what exactly is this paper then? It looks to be more like a news item or an advertisement than a scientific paper with results. As in 'Here is something we made up. It might work, it might not. But we are sure that it will. It might be acceptable, it might not. But we are sure that it will be. Look out for more exciting updates.'

 

[Liie]

With this in mind, recent efforts to reclassify complex, centralized, multi-system conditions under the umbrella of functional disorders offer a compelling framework for understanding POTS. As Burton et al. (2020) propose, functional somatic disorders (FSDs) are characterized by persistent bodily symptoms maintained by dysregulated CNS processes and not fully explained by structural pathology [17].

The word “functional” has been historically controversial because such syndromes have often been forced into a false dichotomy—categorized as either “mind” or “body”; “medical” or “psychological”—which obscures the complex ways in which top-down processes can impact neurobiology and physiology.

Aha, they are functionalists! Should have guessed they would come for POTS also.

 

[Liie]

A randomized clinical trial demonstrated that participants with chronic back pain randomized to PRT had large reductions in pain intensity and disability compared to an open-label placebo injection and usual care, with many patients experiencing complete or near-complete pain relief sustained at 1-year follow-up [31].

Reference 31 is this one. PORT is apparently a variant of PRT, adapted for POTS.

J

Thread 'Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain an RCT, 2021, Asher, Gordon et al'

Sep 30, 2021

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694

Key Points

Question Can a psychological treatment based on the reappraisal of primary chronic back pain as due to nondangerous central nervous system processes provide substantial and durable pain relief?

Findings In this randomized clinical trial, 33 of 50 participants (66%) randomized to 4 weeks of pain reprocessing therapy were pain-free or nearly pain-free at posttreatment, compared with 10 of 51 participants (20%) randomized to placebo and 5 of 50 participants (10%) randomized to...

• JohnTheJack
• alan gordon chronic pain pain psychosomatic medicine
• Replies: 118
• Forum: Other psychosomatic news and research

• 

 

[Hoopoe]

They are so out of touch one is tempted to burst out into laughter.

 

[Utsikt]

I found this:

The new PORT needs the same old evidence-based standards - Clinical Autonomic Research

link.springer.com

Does anyone have access?

The data from the pilot is here, also paywalled:

https://www.jpain.org/article/S1526-5900(25)01039-9/abstract

 

[rvallee]

Always novel. Always the same thing. Always (not) backed by "the neuroscience". Always years of clinical experience delivering it. We could hook up the corpse of George Orwell onto this and have a neat perpetual source of energy.

Clueless people explaining what they did about a problem they don't understand and have no effective solution to because all they do is copy-paste the same failed nonsense that others have done, calling it new because clearly no one in this industry cares about outcomes anyway.

 

[Nightsong]

I found this:

The new PORT needs the same old evidence-based standards - Clinical Autonomic Research

link.springer.com

A mixture of reasonable and sensible arguments, e.g. -

Crouch et al. describe feedback from five patients who had undergone the brain–body reprocessing therapy that the authors call "new" [1]. The methods are not entirely clear and incomplete to understand whether this is indeed a new type of therapy or rebranding of cognitive behavioral therapy (CBT).

For example, there is no data-driven evidence to date regarding CBT, brain–body therapy, or other forms of psychotherapy being effective for treatment of POTS compared with standard care without these interventions.

Since the bar to prove that pharmacologic therapies are effective, safe, or promising is high, it should be equally high for nonmedication therapies, including all forms of psychotherapy. Both subjective patient reports and objective measurements that include supine and standing heart rate and 24 h heart rate monitoring should be utilized to determine the benefits of a therapeutic intervention.

and some less convincing ones, e.g. -

Numerous studies have identified the interplay between the autonomic and the immune systems, highlighting blood–brain barrier disruption, cerebral hypoperfusion, neuroinflammation, autoimmunity, and other important mechanistic factors, both in patients with long COVID and in non-infectious dysautonomia

some patients utilize ports temporarily or long term to treat hypovolemia: No alternative PORT would serve as a substitute for the vital hydration received via intravenous port in these patients.

On the second link:

The data from the pilot is here, also paywalled:

https://www.jpain.org/article/S1526-5900(25)01039-9/abstract

There's no data there; that's a poster presentation from "The 2026 USASP Annual Scientific Meeting" (link). The abstract is all there is.

 

[Utsikt]

Thank you @Nightsong

 

[Liie]

EDIT: I read sloppily and though the comment below by Nightsong was about the original article, but they pointed out that the comment is about the one Utsikt linked to.

A mixture of reasonable and sensible arguments ... and some less convincing ones

My impression was also that it seemed to be weirdly mixed... Some biomedical stuff which sounded reasonable (and which I don't have the knowledge to evaluate).

But then it all leads to the typical functionalist conclusion that I quoted above...?

functional disorders offer a compelling framework for understanding POTS.

 

[Hoopoe]

I find it rather strange that there are frequent references to functional disorders as a sort of valid theoretical framework, when there does not seem to exist any reliable evidence of the validity of the theoretical framework. It seems like an idea from the 19th century that was incorporated into modern medicine ("grandfathered") out of tradition, where it continues to function as a convenient pseudoexplanation for everything unexplained.

Whenever the current name for it has accumulated too much disrepute, they come up with new name, instead of getting the hint that maybe bad ideas fall into disrepute for good reasons.

 

[Nightsong]

My impression was also that it seemed to be weirdly mixed... Some biomedical stuff which sounded reasonable (and which I don't have the knowledge to evaluate).

But then it all leads to the typical functionalist conclusion that I quoted above...?

My comments were about the Blitshteyn letter that Utsikt linked, which was a critical response to the 'psychobehavioural PORT' programme, not the thread's title paper. The Blitshteyn letter explicitly criticises the FNDising -

Additionally, we previously asserted that POTS and other autonomic disorders are not functional neurologic disorders given a distinguishing set of diagnostic criteria, pathophysiology, and treatments [6].

[6] is:

6. Blitshteyn S, Treisman GJ, Ruhoy IS et al (2024) Postural orthostatic tachycardia syndrome and other common autonomic disorders are not functional neurologic disorders. Front Neurol 15:1490744

 

[Grigor]

Letter criticizing PORT:

The new PORT needs the same old evidence-based standards