Psychological Aspects and Rehabilitation in Postural Orthostatic Tachycardia Syndrome

Project: Research

Project Details


Psychological Aspects and Rehabilitation in Postural Orthostatic Tachycardia Syndrome

PhD Research project
Karl Firth, MSc

Main supervisor: Artur Fedorowski, MD, PhD, Assoc.Prof.
Supervisor: Dr Daiva Daukantaite, PhD, Assoc. Prof.
Supervisor: Dr Viktor Hamrefors, MD, PhD

Postural orthostatic tachycardia syndrome (PoTS) is a long-term condition (Linzer et al., 1994; Mathias et al., 2012) that may also be classified as a medically unexplained or functional disorder in that no structural, physiological abnormalities are detectable. Patients with PoTS exhibit a number of symptom characteristics such as dizziness, shortness of breath, muscle tremor, digestive issues, exercise intolerance, poor sleep and cognitive dysfunction (brain fog). Clinical diagnosis of POTS is signalled by a raise in heart rate of greater than 30 beats per minute on head up tilt (HUT) testing or during an active stand test.
This research project has four stages: (a) to develop a better understanding of the role of stress and psychological factors in the initiation of PoTS; (b) to understand factors that may inhibit recovery and rehabilitation from PoTS; (c) to develop a rehabilitation program based on our findings coupled with best medical and rehabilitation practice; and (d) to test the rehabilitation program in a cohort of PoTS patients.

1. Stress and the initiation of PoTS
The aetiology of PoTS is not well understood. Various triggers such as a virus, surgery or trauma have been shown to be possible initiating events for the syndrome (Mathias et al., 2012). However, the environment and psychological state of the patient at the time of the triggering event have not been studied. We propose to study this through the use of tested questionnaires such as the perceived stress scale (Cohen, Kamarch, & Mermelstein, 1983), the negative life events scale for students (Buri, Cromett, Post, Landis, & Alliegro, 2015), and the brief resilience scale (Smith et al., 2008). The working hypothesis being that a “perfect storm” of psychological stress coupled with a triggering event may lead to the condition. The quantitative data from the questionnaires will be supported using a qualitative approach where the participant is offered the opportunity to write at length about their experiences of PoTS. These texts will be analysed using thematic analysis techniques.

2. Factors that may inhibit rehabilitation
Rehabilitation has been shown to be effective in the treatment of PoTS. However, there are a number of psychological factors that may play a role in maintaining the condition by inhibiting the rehabilitation process. We intend to study a number of possible psychological maintaining factors through the use of questionnaires to examine the following: interoceptive sensitivity; health beliefs; anxiety; and depression. We plan to support this quantitative data with a qualitative approach using structured interviews analysed using thematic analysis techniques.

3. Develop a rehabilitation program
Two rehabilitation programs developed at centres in the USA have been shown to be effective in treating some PoTS patients. However, their structure is not well described in the literature. We plan to examine these programs in order to better understand how they operate and which factors are critical for success. We also plan to assess best practice in rehabilitation of other conditions to create a multi-disciplinary approach that would include lifestyle change, psycho-education, physiotherapy and medical support.

4. Clinical test of rehabilitation program
Once the rehabilitation program has been developed, we plan to test it in a cohort of patients diagnosed with PoTS and record clinical outcomes.


Buri, J. R., Cromett, C. E., Post, M. C., Landis, A. M., & Alliegro, M. C. (2015). Negative Life Events Scale for Students (NLESS). Online Submission, 123.
Cohen, S., Kamarch, T., & Mermelstein, R. (1983). A Global Measure of Perceived Stress. Journal Of Health And Social Behavior, 24(4), 385-396.
Linzer, M., Gold, G. T., Pontinen, M., Divine, G. W., Felder, A., Brooks, W. B. (1994). Recurrent Syncope as a chronic disease. Journal of General Internal Medicine, 9:4 181-186.
Matthias, C. J., Low, D. A., Iodice, V., Owens, A. P., Kirbis, M., & Grahame, R. (2012). Postural tachycardia syndrome—current experience and concepts. Nature Reviews Neurology 8, 22-34. doi:10.1038/nrneurol.2011.187.
Smith, B., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: assessing the ability to bounce back. International Journal Of Behavioral Medicine, 15(3), 194-200.

Layman's description

This project will look at the role of stress in feinting and also develop a rehabilitation program to help patients improve their quality of life.
Short titlePsychological aspects of syncope
Effective start/end date2018/09/032026/08/28