Combining a stellate ganglion block with prolonged exposure therapy for posttraumatic stress disorder: A nonrandomized clinical trial

Abstract

Prolonged exposure therapy (PE) is an efficacious treatment for active duty service members and veterans with posttraumatic stress disorder (PTSD). However, PE is sometimes associated with high dropout rates, limited tolerability, and temporary symptom exacerbation during treatment. Stellate ganglion blocks (SGBs) are an emerging treatment that has the potential to enhance outcomes for PTSD when combined with trauma‐focused psychotherapy. To date, no study of which we are aware has examined the potential additive benefits of SGB injections when administered in conjunction with trauma‐focused behavioral treatment for PTSD. Thus, we conducted a nonrandomized clinical trial to evaluate the use of an SGB combined with massed PE therapy for combat‐related PTSD. Participants (N = 12) were treated with 10 daily 90‐min PE sessions delivered over 2 weeks and received a single SGB injection between Sessions 1 and 2. PE sessions lasted 90 min each. Participants reported a mean posttreatment PTSD symptom reduction of 32 points on the PTSD Checklist for DSM‐5 (PCL‐5), Hedges’ gs = 1.28–2.80. Most participants (90.9%) demonstrated clinically significant change on the PCL‐5 (i.e., ≥10 points) by the final treatment session and 50.0% no longer met the diagnostic criteria for PTSD per the Clinician‐Administered PTSD Scale for DSM‐5 at 1‐month follow‐up. Adverse events for the combined treatment were consistent with those previously reported for standalone SGB and PE. This combined treatment approach provides promising results for improving the tolerability of trauma‐focused therapies, reducing symptom severity, and increasing PTSD remission rates.

A pilot study of stellate ganglion block paired with exposure therapy: Feasibility and acceptability in combat veterans with posttraumatic stress disorder.

“…In keeping with our hypotheses and the study by Peterson and colleagues (Peterson et al, 2022), we did observe a statistically significant reduction in PTSD symptoms as measured by the CAPS-5 in mixed models (though not in paired t tests). There was a main effect of time, and after adjusting for multiple comparisons, there was a statistically significant decrease overall from baseline to 1 month, indicating that symptoms improved over the course of the study.…”

“…It is also quite possible that delivering the full PE protocol (as in the Peterson et al study;Peterson et al, 2022) in combination with SGB is necessary to achieve greater symptom relief and functional PILOT STUDY OF STELLATE GANGLION BLOCK improvements. Indeed, several participants commented that they would have liked additional therapy sessions.…”

“…While SGB is unlikely to be a standalone treatment for PTSD, to date, only one recently published study has examined SGB in combination with psychotherapy. Peterson and colleagues (Peterson et al, 2022) conducted an open-label pilot study of SGB in conjunction with massed prolonged exposure (PE; Foa et al, 2018; Peterson et al, 2018), delivered over the course of 2 weeks in a small sample ( N = 12) of active-duty service members. They found significant reductions in PTSD symptoms, with most participants demonstrating clinically meaningful change posttreatment and about half the sample no longer meeting PTSD diagnostic criteria at the 1-month follow-up.…”

Differential posttraumatic stress disorder symptom cluster response to stellate ganglion block: secondary analysis of a randomized controlled trial

“…Indeed, prior studies of civilians and veterans with PTSD showed that hyperarousal symptoms were associated with weaker neural habituation to aversive stimuli [ 59 ] and poorer response to Cognitive Processing Therapy [ 60 ]. As one pilot study combining SGB with Prolonged Exposure to treat combat-related PTSD ( N = 12) reported clinically significant change without evidence of more adverse events compared to standalone SGB and PE trials [ 61 ], additional studies comparing the effects of SGB delivered alone or delivered alongside TFTs are warranted. Indeed, two clinical trials pairing SGB and TFT are ongoing and will hopefully inform how to best combine or sequence these approaches in the future.…”

Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients

“…Over the past 12 years, stellate ganglion block has been used successfully to treat thousands of patients with significant symptoms of posttraumatic stress disorder. There have been over 18 original studies published in the peer-reviewed literature which support the use of SGB for this indication [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”