ART THERAPY CURRICULUM FOR POTS

Art Therapy Curriculum for Postural Orthostatic Tachycardia Syndrome

Caroline Harper
Department of Graduate Studies, Pennsylvania Western University
COUN 7550: Intro to Art Therapy Research
Dr. Penny Orr
December 4, 2024

ART THERAPY CURRICULUM FOR POTS

Abstract
Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic condition that impacts
physical and emotional well-being, often leaving individuals struggling with symptoms such as
fatigue, dizziness, and cognitive impairment. These challenges can lead to emotional distress,
feelings of isolation, and difficulties managing life transitions, especially in young adulthood.
Art is a powerful tool for emotional expression, offering a way to process these experiences nonverbally. This research explored how integrating art therapy and evidence-based approaches can
address the equally important mental health needs that this disease creates. An art therapy
curriculum was developed to provide a holistic framework to support emotional resilience,
coping skills, and self-compassion for young adults with POTS.

Keywords: art therapy, Postural Orthostatic Tachycardia Syndrome, chronic illness, cognitive
behavioral therapy, mindfulness, positive psychology interventions

ART THERAPY CURRICULUM FOR POTS

Art Therapy Curriculum for Postural Orthostatic Tachycardia Syndrome
Section I: Introduction
This research paper explores the development of an art therapy curriculum specifically
designed for young adults with Postural Orthostatic Tachycardia Syndrome (POTS). POTS is a
condition characterized by significant cardiovascular and autonomic dysfunction with symptoms
such as dizziness, fainting, brain fog, heart palpitations, fatigue, shortness of breath, chest pain,
and nausea (Raj et al., 2022). Art therapy provides a non-verbal outlet for expressing complex
emotions, fostering a sense of community, and promoting psychological resilience (Gussak &
Rosal, 2016). The art therapy setting can enhance the therapeutic process for chronically ill
individuals by facilitating shared experiences, mutual support, and empowerment (Fenner et al.,
2024). This project reviews the literature to create a specialized art therapy curriculum designed
to improve the overall well-being of individuals living with POTS.
Problem to be Investigated
Individuals with POTS often experience psychological effects such as depression and
anxiety, which can worsen their physical symptoms (Swathi et al., 2023). Additionally, the
burden of physical POTS symptoms such as fatigue, brain fog, fainting, and heart palpitations
can lead to social isolation, a diminished quality of life, and mental health challenges (Raj et al.,
2018). Traditional medical treatments for POTS may fail to address the psychological challenges
associated with this disease. This project addresses the need for holistic interventions that target
both the physical and psychological aspects of POTS through a curriculum that integrates artbased therapeutic interventions to target all needs of this population.

ART THERAPY CURRICULUM FOR POTS

Purpose Statement
The purpose of this project is to develop an art therapy curriculum designed for
individuals with POTS. The curriculum aims to improve the quality of life of this population by
using art therapy to promote emotional resilience, develop coping skills, explore the mind-body
connection, explore identity, and foster self-compassion.
Justification
This project addressed the comorbid psychological challenges, such as anxiety and
depression, which may not adequately be addressed by traditional medical treatments for POTS.
Statistics indicate that POTS affects about 1-3 million people in the United States (Harris, 2022),
of which 68.7% experience stress, 51.1% experience anxiety, and 58.8% experience depression
(Swathi et al., 2023).
There remains a lack of support and research focused on holistic interventions that
address both the physical and psychological aspects of POTS. This project fills that gap by
creating a specialized art therapy curriculum to improve the mental and physical well-being of
individuals with POTS.
Terms Related to the Study
Postural Orthostatic Tachycardia Syndrome (POTS)
A chronic condition characterized by an excessive increase in heart rate of 30 beats per
minute or more (40 bpm in adolescents) within 10 minutes of standing, accompanied by
symptoms such as dizziness, fainting, brain fog, heart palpitations, fatigue, shortness of breath,
chest pain, and nausea, persisting for over six months (John Hopkins Medicine, 2019).

ART THERAPY CURRICULUM FOR POTS

Art Therapy
Art Therapy is an integrative mental health profession that uses active artmaking, creative
processes, and applied psychological theory within a therapeutic relationship to support personal
and relational treatment goals and community concerns (American Art Therapy Association,
2022).
Quality of life
Refers to how individuals perceive their place in life, considering the culture, value
systems, goals, expectations, standards, and concerns that shape their experiences (World Health
Organization, 2012).
Conclusion
The creation of an art therapy curriculum specifically tailored for individuals with POTS
represents a step toward addressing both the physical and psychological challenges faced by this
population. Given the significant prevalence of anxiety, depression, and social isolation among
POTS patients, traditional medical treatments may fall short of providing comprehensive care.
By offering a non-verbal means to express complex emotions, this art therapy curriculum aims to
improve psychological resilience and quality of life. The creation of this curriculum may
contribute to the development of holistic therapeutic interventions, bridging the gap between
physical symptoms and emotional health, thereby improving the quality of life for individuals
living with POTS.

ART THERAPY CURRICULUM FOR POTS

Section II: Literature Review
This literature review explores the various aspects of POTS, including its physical and
psychological impacts, current medical treatments, and existing interventions for chronic
illnesses. By examining the symptoms and the efficacy of different therapeutic approaches, this
review aims to provide a comprehensive understanding of how POTS affects patients, potential
strategies to manage this condition, and improve quality of life for this population.
Postural Orthostatic Tachycardia Syndrome
Symptoms and Diagnosis
POTS stands for Postural Orthostatic Tachycardia Syndrome, where postural refers to the
position of the body, orthostatic relates to standing upright, tachycardia indicates an increased
heart rate, and syndrome denotes a group of symptoms (Johns Hopkins Medicine, 2019). The
diagnosis process involves several key criteria. POTS is defined as the presence of symptoms of
orthostatic intolerance associated with a heart rate increase of at least 30 beats per minute (bpm)
within the first 10 minutes of standing or upright tilt (Grubb, 2008; Raj, 2013; Anderson et al.,
2014; Abed et al., 2012; Harris, 2022). This heart rate increase can exceed 120 bpm; therefore, it
is important to rule out other causes of tachycardia and symptoms that overlap with POTS (Abed
et al., 2012). A thorough physical examination, including heart rate and blood pressure
measurements in different positions, is crucial for diagnosis (Grubb, 2008; Abed et al., 2012;
Raj, 2013). The diagnostic criteria also require that no other chronic conditions are causing
significant disability and no medications that could weaken vascular function (blood vessels) or
autonomic function (the body's automatic control of heart rate, blood pressure, and digestion).
(Grubb, 2008; Abed et al., 2012; Raj, 2013; Harris, 2022).

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Treatment
The treatment of POTS varies depending on the symptoms and individual needs of the
patient (Knoop & Dunwoody, 2023; Grubb, 2008; Raj, 2013; Harris, 2022; Abed et al., 2012).
The first step in treatment is to discontinue any medications that may be contributing to the
symptoms (Grubb, 2008). Diet and lifestyle modifications also play a significant role in
managing POTS (Knoop & Dunwoody, 2023; Anderson et al., 2014; Harris, 2022; Abed et al.,
2012; Raj, 2013). Increasing fluid and electrolyte intake, as well as salt consumption, can help
alleviate symptoms (Harris, 2022; Abed et al., 2012; Raj, 2013). Gradual physical
reconditioning, including aerobic activity, is recommended (Grubb, 2008; Raj, 2013; Harris,
2022). Medications such as beta blockers to reduce heart rate and vasoconstrictors to reduce
blood pooling in the lower extremities are used to stabilize the condition and facilitate
reconditioning (Johns Hopkins Medicine, 2019; Grubb, 2008). Additionally, psychological
support is crucial because POTS patients may experience mental health impacts, such as anxiety
and depression. (Anderson et al., 2014; Raj, 2013; Grubb, 2008; Knoop & Dunwoody, 2023;
Harris, 2022).
Physical Impacts
POTS is a complex condition that manifests primarily through a variety of physical
symptoms, affecting multiple bodily systems. Patients with POTS frequently experience a
diverse array of symptoms, such as heart palpitations, fatigue, lightheadedness, and exercise
intolerance. These symptoms, along with nausea, difficulty concentrating, tremors, and episodes
of syncope or presyncope (fainting or the feeling of fainting without losing consciousness), can
severely limit day-to-day functioning (Abed et al., 2012; Anderson et al., 2014; Grubb, 2008;
Harris, 2022; Raj, 2013). The impact on physical capabilities and quality of life can be profound,

ART THERAPY CURRICULUM FOR POTS

often leading to significant lifestyle changes as individuals attempt to manage their condition
(Pankowski et al., 2022). Beyond these primary symptoms, many POTS patients also experience
reduced blood volume, which contributes to their circulatory difficulties. To counteract this,
interventions such as elastic compression stockings can be beneficial by promoting venous return
and stabilizing blood pressure (Abed et al., 2012; Anderson et al., 2014; Grubb, 2008; Harris,
2022; Raj, 2013).
In addition to the primary symptoms of POTS, patients often contend with a range of
comorbid conditions, including migraine headaches, irritable bowel syndrome, and various
autoimmune diseases. These overlapping conditions can complicate both diagnosis and
treatment, often requiring a multidisciplinary approach to care. Despite these challenges, there is
growing evidence that exercise rehabilitation protocols, tailored specifically to the needs of
POTS patients, can offer significant improvement in symptoms. In some cases, regular physical
activity, under medical supervision, may even lead to remission, providing hope for those
affected by this debilitating disorder (Abed et al., 2012; Harris, 2022; Raj, 2013). The wide range
of physical symptoms associated with POTS highlights the importance of comprehensive
treatment approaches that address both the disorder’s primary effects and its comorbidities.
Psychological Impacts
In addition to the physical symptoms, POTS also has significant psychological impacts
that can complicate the overall experience of the disorder. POTS patients often face
psychological challenges, including anxiety, depression, and attention deficits, which may arise
from both the condition itself and the stress of managing chronic illness (Abed et al., 2012;
Anderson et al., 2014; Grubb, 2008; Knoop & Dunwoody, 2023; Raj, 2013). Misdiagnosis is
common, with patients sometimes being incorrectly diagnosed with severe anxiety or panic

ART THERAPY CURRICULUM FOR POTS

disorder due to overlapping symptoms (Grubb, 2008; Raj, 2013). Additionally, sleep
disturbances frequently contribute to their psychological distress, further diminishing the overall
quality of life (Abed et al., 2012; Anderson et al., 2014; Raj, 2013).
Addressing these psychological challenges requires more than just physical treatment.
Psychological support, including therapy, is crucial for helping patients manage the mental
health aspects of the condition. Access to therapists who understand the psychosocial impact of
living with a chronic physical illness is essential for effective management and coping (Anderson
et al., 2014; Grubb, 2008; Harris, 2022; Knoop & Dunwoody, 2023). This holistic approach to
care, recognizing the importance of both mental and physical health, is vital for improving the
quality of life for POTS patients and ensuring comprehensive treatment.
Treatment Approaches
Pharmacological Approaches
According to Raj (2013), several medications are commonly used to manage the
symptoms and underlying causes of POTS. Fludrocortisone, a cortisone-like medicine, helps
expand blood volume but can cause side effects like hypokalemia (low potassium) and fluid
retention. Propranolol, a beta-blocker, is effective at lowering standing heart rate and improving
symptoms but may cause excessive fatigue. Midodrine, a medication that treats low blood
pressure, can reduce orthostatic tachycardia but may cause side effects like goosebumps and
scalp tingling. Pyridostigmine, which increases activity in the parasympathetic nervous system,
can improve symptoms but may lead to gastrointestinal issues. Desmopressin (DDAVP) is used
for short-term volume expansion but carries a risk of hyponatremia, or low sodium levels. While
these medications can be effective, they are used off-label which means they are being

ART THERAPY CURRICULUM FOR POTS

prescribed for a purpose other than what the FDA has approved. They may not be suitable for
long-term use due to potential side effects.
Non-Pharmacological Approaches
Non-pharmacological treatments for POTS include lifestyle modifications such as
increasing water and sodium intake, wearing compression stockings, and engaging in a
structured exercise program. These measures aim to improve blood volume and venous return,
which can help alleviate symptoms. For instance, patients are advised to consume 8-10 cups of
water daily and increase their sodium intake to 8-10 grams per day (Fu & Levine, 2018).
Compression stockings can help minimize blood pooling but may be uncomfortable for some
patients.
Exercise, particularly aerobic and leg-based resistance exercises, has been shown to
reduce orthostatic tachycardia and improve quality of life (Fu & Levine, 2018). However,
patients often report feeling debilitated for days after exertion, which can limit compliance to a
routine. Some patients benefit from occupational and physical therapy for reconditioning and
managing symptoms. Occupational therapy focuses on improving daily functioning and quality
of life using tailored interventions such as energy conservation, adaptive equipment, and pacing
strategies (Dochod & Grapczynski, 2019). Personalized care- like the case of Gemma, a 34-yearold with POTS who used adaptive tools like a shower chair and wheeled office chair- can restore
normalcy and enhance emotional well-being. Similarly, physical therapy targets cardiovascular
deconditioning, a key contributor to POTS, by promoting early interventions with horizontal
exercises like rowing or recumbent biking, gradually increasing intensity as tolerance improves
(Fu & Levine, 2018). These exercise programs aim to reverse deconditioning and improve
cardiovascular health. Additional strategies such as muscle tensing, leg crossing, skin cooling,

ART THERAPY CURRICULUM FOR POTS

and negative pressure breathing help alleviate symptoms by reducing venous pooling and
restoring blood flow (Fu & Levine, 2018). Combining these physical approaches can enhance
patients’ quality of life and functional abilities.
However, while non-pharmacological treatments offer considerable benefits, they may
not fully treat POTS. The effectiveness of interventions like compression garments and physical
countermeasures often varies between individuals, and some methods, such as skin cooling or
negative pressure breathing, require further research to confirm their long-term efficacy (Fu &
Levine, 2018). Additionally, these treatments can be time-consuming and financially
burdensome for patients, particularly if they require consistent, long-term therapy. The complex
nature of POTS demands a comprehensive and individualized approach, and while physical
interventions can alleviate symptoms, they may not fully address the root causes or long-term
needs of all patients.
Therapeutic Approaches
Cognitive Behavioral Therapy
Cognitive Behavioral therapy (CBT) can help reduce emotional distress by changing how
a person thinks about their illness. For example, Edelman, Mahoney, and Cremer (2012)
conducted a study demonstrating that CBT interventions including psychoeducation about the
illness, attentional refocusing, and exposure exercises to feared situations can significantly
reduce dizziness-related symptoms, disability, and functional impairment. However, the study
found no significant change in psychological outcomes such as depression, anxiety, and stress,
indicating that while CBT may alleviate physical symptoms, it might not fully address the
underlying psychological distress in all patients. These findings suggest that CBT may offer a

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cost-effective method to improve outcomes in chronic illness by addressing both physical
symptoms and psychological factors. Additionally, the effectiveness of CBT can vary, with
approximately 25% of patients not showing clinically significant improvements (Edelman et al.,
2012). This variability suggests that CBT may need to be tailored or combined with other
treatments to be effective for all patients. Further research is needed to identify factors that
influence treatment response and to validate the measures used in such studies.
Positive Psychology
The effectiveness of positive psychology interventions (PPIs) on emotional well-being in
individuals with chronic illness has been widely studied. Boselie, Vancleef, and Peters (2018)
conducted a study examining the effects of an eight-week online self-help PPI on emotional
well-being and executive task performance in chronic pain patients. The results showed that the
PPI led to increased positive emotions, optimism, and self-compassion, as well as decreased
pain, catastrophizing, depression, and anxiety. However, there was no significant improvement
in executive task performance. These findings suggest that while PPIs can effectively improve
emotional well-being in individuals with chronic illness, their impact on executive functioning
may be limited. Further research is needed to explore other psychological factors that may
enhance executive functioning in this population.
Family/Couples Therapy
Interventions for chronic illness often involve family members, which can significantly
impact patient outcomes. Martire et al. (2004) conducted a meta-analysis of 70 studies and found
that including a family member in psychosocial interventions, especially spouses, can reduce
depression in patients and sometimes even improve mortality rates. These interventions also

ART THERAPY CURRICULUM FOR POTS

benefit family members by alleviating the caregiving burden and reducing their own depression
and anxiety. Martire and Helgeson (2017) highlighted the importance of close relationships in
managing chronic illness, collaborative behaviors, and shared illness management as key to
effective intervention. They advocate for technology-supported approaches like web-based
programs to broaden access and effectiveness. Although there are many benefits, the wide
variability in illness parameters, family populations, and methods used to deliver interventions
can lead to inconsistent outcomes, making it difficult to generalize findings across different
contexts (Martire et al., 2004).
Mindfulness and Self-Compassion
Mindfulness and self-compassion techniques have become promising approaches for
managing chronic illnesses, particularly chronic pain (CP). Mindfulness is particularly effective
in promoting pain acceptance—acknowledging pain without attempting to control it while
continuing to engage in meaningful activities—and has been shown to lower the risk of
depression relapse and alleviate depressive symptoms, especially in individuals with chronic
illnesses (Carvalho et al., 2018).
Self-compassion, defined as treating oneself with kindness and understanding during
moments of pain or failure, is closely linked to improved mental health outcomes (Neff, 2003).
Research shows that self-compassion fosters adaptive behaviors, builds resilience to stress, and is
associated with lower levels of depression and anxiety symptoms (MacBeth & Gumley, 2012).
In the context of chronic pain (CP), self-compassion has been found to reduce emotional
distress and depressive symptoms (Pinto-Gouveia et al., 2013). While both mindfulness and selfcompassion can help reduce feelings of depression, self-compassion is especially helpful because

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it encourages individuals to continue meaningful activities even when they are in pain. This
ability to stay active despite the pain helps reduce depressive feelings. (Carvalho et al., 2018).
These findings suggest that self-compassion, with its focus on actionable change, plays a
pivotal role in enhancing the quality of life for individuals with chronic illnesses by encouraging
meaningful activity engagement despite discomfort. Further research is needed to clarify the
distinct and shared pathways through which mindfulness and self-compassion support chronic
illness management.
Art Therapy
Art therapy interventions for individuals with chronic illnesses facilitate improvements in
emotional well-being and overall quality of life. Research indicates that art therapy improves
cognitive functioning, coping skills, and interpersonal relationships, as well as a creative outlet
for pain expression (Hass-Cohen et al., 2022). It offers a non-verbal, symbolic means for patients
to communicate their experiences and emotions, using various artistic mediums to explore their
conditions (Lintott, 2022). The CB-ART protocol, combining a cognitive-behavioral approach
with art making, is particularly effective in reducing distress and improving well-being among
those with chronic pain, anxiety, and depression (Czamanski-Cohen et al., 2014). Furthermore,
medical art therapy (MAT) has shown benefits such as decreasing isolation, enhancing selfconfidence, and supporting resilience in medically ill patients (Anand, 2016).
Conclusion
In conclusion, this literature review highlights the complex physical and psychological
challenges faced by individuals with POTS. While advancements have been made in
understanding its symptoms, diagnosis, and treatment, managing POTS effectively requires a

ART THERAPY CURRICULUM FOR POTS

personalized and multidisciplinary approach. Interventions such as medication, lifestyle changes,
and therapeutic approaches offer varying levels of success, emphasizing the need for tailored and
multidisciplinary care to meet the needs of patients. Additionally, approaches like mindfulness,
positive psychology, and art therapy show promise in addressing emotional well-being and
enhancing overall quality of life. Continued research is critical to improving these interventions,
increasing accessibility, and providing comprehensive support for individuals living with POTS
and other chronic illnesses.
Section III: Methodology
The curriculum was designed for young adults with POTS and includes approaches such
as CBT, family and couples therapy, PPIs, mindfulness, and art therapy. These approaches were
chosen for their specific benefits in addressing the mental health needs of those with chronic
illnesses and they informed the development of the art therapy interventions included in the
curriculum. These approaches collectively support a holistic framework, helping participants
build practical skills for managing both the physical and emotional aspects of POTS.
Target Audience
This curriculum is tailored for use with young adults between the ages of 18 and 30 who
have been diagnosed with POTS. This age group represents those most affected by the condition,
which are primarily females of childbearing age (Johns Hopkins Medicine, 2019). The selected
range highlights a time in life when many are pursuing independence and navigating the
transition into adulthood, a challenge made even more difficult by living with a chronic illness.
The curriculum was developed as a comprehensive resource for therapists and other
professionals who work with young adults with POTS.

ART THERAPY CURRICULUM FOR POTS

Curricular Structure
The curriculum consists of four sections each containing art therapy interventions that
explore the different stages of living with a chronic illness including onset and diagnosis,
symptom management, maintenance, and adjustment. This structure ensures that the materials
are easy to follow and can be adapted for specific clients or settings. Each intervention details a
specific art therapy activity designed to address the individual experience with POTS with the
aim of enhancing well-being. Also included will be the goals the intervention is designed to
meet, potentially aligning with existing treatment goals of clients. An introduction will provide
an overview and purpose of the intervention, followed by a materials list, specifying the supplies
needed to complete the activity. The instructions section offers step-by-step instructions on how
to facilitate the intervention with a client. Finally, reflection prompts are included to encourage
reflection and deeper understanding of the therapeutic process. This structured approach ensures
each intervention is comprehensive and accessible for both therapists and clients.
Conclusion
In conclusion, this art therapy curriculum provides a comprehensive and structured
approach to supporting young adults with POTS in navigating the emotional and physical
challenges of their condition. Drawing from evidence-based practices such as CBT, family and
couples therapy, PPIs, mindfulness, and art therapy the curriculum fosters resilience, emotional
stability, and practical coping skills. Tailored specifically for individuals aged 18 to 30, it
addresses key aspects of the chronic illness journey, including onset and diagnosis, symptom
management, maintenance, and adjustment. The workbook format ensures accessibility for
therapists and adaptability for diverse therapeutic settings, offering detailed instructions, goals,

ART THERAPY CURRICULUM FOR POTS

and reflective prompts to maximize the therapeutic experience. By addressing the unique needs
of individuals with POTS, this curriculum aims to enhance overall well-being and quality of life.
Section IV: Curriculum
Art offers a unique and powerful means of emotional expression, allowing individuals to
process their experiences in a non-verbal way. Through the creative process, art connects the
mind and body, fostering a sense of healing and self-awareness. This curriculum is designed as a
resource of art therapy interventions specifically for individuals navigating the complexities of
POTS, where emotional and psychological struggles often accompany the physical ones. The
curriculum serves as a tool for professionals, therapists, clinicians, and healthcare providers
interested in incorporating art-based interventions into their work with these clients. The goal of
these creative interventions is to facilitate emotional processing, resiliency, and nurture selfcompassion while helping clients navigate their journey toward living a full, meaningful life.
Structured around the four key stages of living with chronic illness—Onset and
Diagnosis, Symptom Management, Maintenance, and Adjustment—this workbook offers
tailored interventions for each stage. Recognizing that emotional needs and experiences evolve
over time, the activities within this curriculum are adaptable, allowing flexibility to meet clients
where they are in their journey. Whether clients are confronting the uncertainty of a new
diagnosis, learning to manage symptoms, or navigating the long-term process of adjustment, this
resource provides interventions that support their emotional growth. No prior artistic experience
is required to use this workbook; it is not about creating "good" art but about creating meaningful
art that enables clients to connect with their inner selves. I encourage both clients and
professionals to explore all four stages, taking the time to work through the entire journey, even
when it feels uncomfortable or painful. Ultimately, this workbook aims to inspire self-

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compassion, fostering an empowered approach to life with chronic illness, one creative step at a
time.
Section V: Discussion
This section will discuss the findings and implications of this research, summarize its key
elements, address its limitations, and propose directions for future study. By reflecting on the
insights gained and acknowledging areas for improvement, this discussion highlights the
significance of this art therapy curriculum for young adults with POTS and identifies
opportunities for further development.
Summary of the Research
The development of this curriculum was informed by research into the physical,
psychological, and emotional impacts as well as various treatment approaches for young adults
with POTS. Studies highlight the prevalence of anxiety, depression, and reduced quality of life
among individuals with POTS, emphasizing the need for targeted therapeutic interventions to
address these challenges (Abed et al., 2012; Anderson et al., 2014; Grubb, 2008; Knoop &
Dunwoody, 2023; Raj, 2013). Research on Cognitive Behavioral Therapy (CBT) shows that
helping individuals develop adaptive coping mechanisms can reduce physical symptoms such as
dizziness (Edelman et al., 2012). Research on mindfulness demonstrated its ability to enhance
emotional regulation and promote acceptance, making it a valuable approach for managing
depressive symptoms of chronic illness (Carvalho et al., 2018). Additionally, self-compassion is
linked to improved mental health outcomes and is associated with lower levels of depression and
anxiety symptoms (Neff, 2003; MacBeth & Gumley, 2012)

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The inclusion of family and couples therapy principles were informed by evidence that
strong, supportive relationships contribute significantly to better health outcomes in chronic
illness management (Martire et al., 2004). Positive psychology interventions (PPIs) show the
capacity to increase positive emotions, optimism, and self-compassion, as well as decreased pain,
catastrophizing, depression, and anxiety (Boselie et al., 2018) Finally, art therapy literature
demonstrates how interventions can improve emotional well-being, cognitive functioning,
coping skills, and interpersonal relationships, while providing a creative outlet for pain
expression. Approaches like the CB-ART protocol and medical art therapy have proven effective
in reducing distress, enhancing self-confidence, and fostering resilience in patients with chronic
conditions (Hass-Cohen et al., 2022; Lintott, 2022; Czamanski-Cohen et al., 2014; Anand, 2016).
The integration of these evidence-based approaches into an art therapy curriculum highlights
their combined potential to improve the mental and emotional well-being of young adults with
POTS.
Discussion
The research emphasizes the critical need for tailored therapeutic resources for young
adults with POTS, a demographic navigating the dual challenges of chronic illness and life
transitions. The inclusion of CBT and mindfulness offers practical tools for emotional regulation
and adaptive thinking, while family and couples therapy elements underscore the importance of
support systems in managing a condition as multifaceted as POTS. Additionally, the
incorporation of PPIs fosters resilience and highlights strengths, helping participants reframe
their experience of chronic illness more positively. This comprehensive approach provides
therapists with a versatile framework for addressing the psychological and emotional impact of
POTS.

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This work also reinforces the broader potential of art therapy in chronic illness
management, demonstrating how creative expression can serve as a bridge between physical
symptoms and emotional well-being. By connecting art-making with these therapeutic
approaches, this curriculum offers a valuable tool for mental health professionals seeking to
enhance the quality of life for individuals with chronic illnesses.
Limitations
While this curriculum was designed with therapists in mind, its current format may not be
appropriate for clients to use independently, as it relies on guided facilitation. Additionally, the
curriculum was limited in scope due to time constraints, excluding some elements that could
further enhance its depth and applicability. For example, more interventions focused on cultural
or spiritual dimensions of chronic illness could broaden its relevance. Similarly, it would be
beneficial to explore the use of technology or digital platforms to adapt the curriculum for virtual
or hybrid therapy sessions.
Suggestions for Future Research
Future research could expand on this foundation by developing a version of the
curriculum specifically designed for clients to use independently, offering greater accessibility
for those without consistent access to therapy. Further exploration could also focus on adapting
the curriculum to diverse cultural contexts or including community-based interventions.
Investigating the use of somatic-focused approaches with art therapy interventions could also
deepen the therapeutic value for individuals managing POTS symptoms and fostering a better
mind-body connection.

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Additionally, subsequent studies could examine the long-term effects of this curriculum
on emotional regulation, self-efficacy, and overall quality of life among participants. Students or
practitioners inspired by this research could explore its application to other chronic illnesses,
creating parallel resources for conditions such as fibromyalgia or chronic fatigue syndrome.
Conclusion
This paper has explored the development of an art therapy curriculum designed to
support young adults with POTS, a chronic condition that significantly impacts physical and
mental health. Drawing from research on the psychological effects of chronic illness, the
curriculum incorporates evidence-based approaches such as CBT, family and couples therapy,
PPIs, and mindfulness to address the emotional and relational challenges associated with POTS.
By structuring the curriculum around four key stages: onset and diagnosis, symptom
management, maintenance, and adjustment. Covering the four stages provides a holistic
framework for therapeutic interventions.
The curriculum’s design as a workbook allows for accessibility and flexibility, offering
therapists a valuable resource for guiding clients through structured art therapy interventions.
Research on chronic illness, resilience, and art therapy informed the curriculum, highlighting the
importance of fostering self-compassion, strengthening support systems, and promoting adaptive
coping strategies for improved well-being. While limitations exist, such as its current focus on
therapist use and the omission of cultural adaptations, these challenges provide opportunities for
further development.
Future research could expand the curriculum to include adaptations for diverse cultural
contexts, ensuring it is relevant and inclusive for a broader range of individuals. Additionally,
creating a version tailored for independent use by clients could increase its accessibility and

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impact. This work contributes to the growing body of knowledge on art therapy and chronic
illness, offering a foundation for continued exploration and innovation in this field. By
addressing the mental health needs of individuals with POTS, this curriculum aims to foster
emotional resilience, enhance quality of life, and empower clients to navigate their journey with
greater confidence and hope.

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