Effectiveness of Combined Cognitive Processing Therapy with Stellate Ganglion Block: An Open-Label Randomized Wait-List Clinical Trial

INTRODUCTION: Posttraumatic stress disorder (PTSD) is common among military personnel and veterans and is associated with numerous psychological problems and negative outcomes. First-line cognitive-behavioral treatments like cognitive processing therapy (CPT) are effective in treating PTSD, especially when delivered in a massed (i.e., daily) format. However, many patients, especially military personnel and veterans, continue to struggle with PTSD symptoms after CPT, which warrants further research to augment CPTs effects. Stellate ganglion block (SGB), which is a long-acting anesthetic injection that is proposed to "reset" sympathetic arousal and physical reactivity, is a promising adjunctive intervention, with previous research demonstrating reduced PTSD symptoms. The effectiveness of CPT combined with SGB remains understudied. METHODS: In this open-label randomized wait-list trial, 86 military personnel and veterans were assigned to receive SGB before or after massed CPT. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). RESULTS: Relative to baseline, PCL-5 scores decreased in both groups (SGB-before-CPT: F(12,724) = 23.4, p < 0.001; SGB-after-CPT: F(12,724) = 21.1, p < 0.001), but reductions in PTSD symptoms were faster in SGB-before-CPT. Among the SGB-after-CPT participants who had not yet reached good end-state functioning by week 8, PCL-5 scores significantly decreased after they received the SGB procedure in week 12. CONCLUSION: Results support SGB increasing CPT's effectiveness when received prior to CPT. Additionally, military personnel and veterans who do not benefit from an initial course of massed CPT have significant reductions in PTSD symptoms when SGB was performed after CPT. SGB before CPT appears especially useful for patients looking for faster treatment response.