Jaryd Hiser, PhD, Psychologist, Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center
COLUMBUS, OH — In military personnel and veterans, adding a stellate ganglion block to cognitive processing therapy significantly reduced post-traumatic stress disorder (PTSD) symptoms and helped these individuals recover more quickly, according to a recent study.
The randomized clinical trial published in Psychotherapy and Psychosomatics evaluated the effectiveness of cognitive processing therapy, a first-line cognitive-behavioral treatment, combined with stellate ganglion block, a long-acting anesthetic injection.1
PTSD, the most common mental health issue among military personnel and veterans, affects up to 23% of this population and is associated with psychological problems and negative outcomes. PTSD often results from combat trauma, but it can also develop from noncombat trauma, such as sexual assault, domestic violence or childhood abuse. The condition causes psychological problems such as intrusive thoughts, avoidance, mood and cognitive shifts and increased arousal, in addition to negative outcomes such as work or relationship dissatisfaction, aggression, substance abuse and suicidal thoughts. In military personnel, these issues impede deployment readiness and affect the overall quality of life.
First-line cognitive-behavioral treatments, such as cognitive processing therapy, are effective in treating PTSD, but many patients, especially military personnel and veterans, continue to struggle with PTSD symptoms after cognitive processing therapy. Stellate ganglion block, a long-acting anesthetic injection that is proposed to reset sympathetic arousal and physical reactivity, is a promising intervention, with prior studies showing reduced PTSD symptoms. The effectiveness of cognitive processing therapy combined with stellate ganglion block has been understudied, the researchers explained.
The study authors are affiliated with The Ohio State University in Columbus, Ohio; VA Finger Lakes Health Care System in Canandaigua, NY; Uniformed Services University in Bethesda, MD; VA Pacific Islands Health Care System in Honolulu; Pine Rest Christian Mental Health in Grand Rapids, MI; and Michigan State University in Grand Rapids, MI.
“The Suicide and Trauma Reduction Initiative (STRIVE) lab at The Ohio State University is a nationally leading research program that focuses on increasing the efficacy of evidence-based treatments for suicide and trauma,” Jaryd Hiser, PhD, senior author of the study and a psychologist in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center, told U.S. Medicine. “Unfortunately, despite recent advances, a significant portion of individuals that have experienced a traumatic event do not reach symptom remission. Our goal is to increase clinicians’ ability to help as many individuals with trauma disorders as possible.”
In this first-ever randomized clinical trial, 86 military personnel and veterans with PTSD were assigned to receive stellate ganglion block before or after massed cognitive processing therapy. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5), a standardized tool for assessing post-traumatic stress after a traumatic event, the study reported.
The investigators determined that stellate ganglion block works best when given before cognitive processing therapy, but it can also be given after therapy to help military personnel and veterans who didn’t feel better with cognitive processing therapy alone.
The study found that military personnel and veterans who didn’t benefit from an initial course of massed cognitive processing therapy have significant reductions in PTSD symptoms when stellate ganglion block was performed after cognitive processing therapy. However, stellate ganglion block before cognitive processing therapy appears especially useful for patients seeking a faster treatment response, according to a press release on the study from The Ohio State University Wexner Medical Center.
This novel approach could help military personnel return to work faster, and it could be especially useful when specialized PTSD care is difficult to find, such as in rural areas, the study authors explained in the press release.
The study’s most important findings are the rapid reduction of symptoms (nearly 30-point reduction in PCL-5 scores in two weeks) and the improved efficacy of receiving stellate ganglion block before cognitive processing therapy, Hiser pointed out.
Over an average period of only two weeks, participants’ PCL scores fell from 50 to 20, which is more than double the standard improvement, and this positive effect lasted for at least one year after treatment, Hiser noted in the press release.
“Despite there being two frontline PTSD treatment options, a significant portion (up to 30%) of individuals do not fully reach remission,” Hiser said. “SGB [stellate ganglion block] appears to be one option to increase the likelihood of treatment working for individuals that may not respond to treatment as usual. SGB should be considered for those with treatment resistant PTSD or for those who are looking to make rapid recovery.”
Stellate ganglion block appears to help patients engage with and benefit from therapy more than at baseline, Hiser suggested.
“SGB has been used for PTSD for over 15 years, but this is the first study that has paired SGB with a frontline psychotherapy. One of the main criticisms of SGB previously was the lack of lasting effect, however the combination of SGB and CPT [cognitive processing therapy] maintained remission up to one-year post-treatment,” Hiser said.
Hiser pointed out that stellate ganglion block is considered safe and is typically well tolerated. The most common side effects are pain, hoarseness and light-headedness. Other side effects are possible (i.e. Horner’s syndrome) but very unlikely. Stellate ganglion block has been around for 100 years, used primarily as a pain intervention.
While the study sample included veterans and servicemembers, many participants had noncombat trauma. The results suggested the therapy could also benefit civilians with difficult trauma cases, Hiser explained in a press release.
Bryan CJ, Lynch J, Bryan AO, Mulvaney S, Effectiveness of Combined Cognitive Processing Therapy with Stellate Ganglion Block: An Open-Label Randomized Wait-List Clinical Trial. Psychother Psychosom. 2025 Dec 15:1-14. doi: 10.1159/000550014. Epub ahead of print. PMID: 41396885.