Symptom discrimination and habituation: a case study of behavioral treatment for postural orthostatic tachycardia syndrome (POTS)
Abstract
Postural orthostatic tachycardia syndrome (POTS) is a multifaceted disorder of the autonomic nervous system that profoundly impacts physical functioning. In addition to physical consequences, many patients develop situational anxiety that causes reduced activity level, which may impede functional recovery from POTS. Despite links with anxiety, to date there have been no reports of psychological intervention for POTS. Here we report a case study of POTS in a 40-year-old female serving on active duty in the US military. Because there are no established guidelines for the psychological treatment of POTS, intervention techniques were adapted for use with the patient. Elements of cognitive behavioral therapy, including in-vivo exposure and symptom discrimination, were used to target avoidance of feared situations. Over the course of treatment, the patient learned to discriminate her POTS symptoms from anxiety and displayed a significant decrease in POTS-related functional impairment. Implications for future care are discussed.
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Specific data supporting psychological therapy in POTS are lacking, but there is a 2016 case report demonstrating significant decrease in POTS-related functional impairment in a woman treated with cognitive behavioral therapy.
“Specific data supporting psychological therapy in POTS are lacking, but there is a 2016 case report demonstrating significant decrease in POTS-related functional impairment in a woman treated with cognitive behavioral therapy (116).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [116]
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Postural tachycardia syndrome (POTS)
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Postural Orthostatic Tachycardia Syndrome
Bryarly, M., Phillips, L. T., Fu, Q., Vernino, S., & Levine, B. D. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.059 · Cited by 245 · see citing works
Psychological and Psychiatric Support; When, Why and What to Do
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- Authors
- Ralston, T. E., & Kanzler, K. E.
- Affiliations
- United States Air Force (US)
- Malcolm Grow Medical Clinic (US)
- Corresponding author
- Ralston, Timothy E.
- ORCID
- Kanzler, Kathryn E.
- Venue
- Behavioral Medicine
- Publisher
- Informa UK Limited
- Published
- 2015-01-29
- Volume
- 42
- Issue
- 1
- Pages
- 57-62
- ISSN
- 0896-4289 (ISSN-L)
- 1940-4026
- OpenAlex
- W2074147116
- Cited by
- 6
- References
- 6
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2020: 1 · 2019: 1 · 2018: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- postural orthostatic tachycardia syndrome, habituation, cognitive behavioral therapy, in vivo exposure, anxiety, autonomic dysfunction, avoidance, functional disability, military personnel, psychological intervention
- MeSH terms
- Adult, Anxiety, Behavior Therapy, Blood Pressure, Female, Heart Rate, Humans, Cognitive Behavioral Therapy, Postural Orthostatic Tachycardia Syndrome
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