Post-traumatic stress disorder (PTSD) remains a pervasive challenge for military service members and veterans, affecting psychological well-being and overall quality of life. Traditional therapies such as cognitive processing therapy (CPT), a form of cognitive-behavioral treatment emphasizing restructuring maladaptive trauma-related thoughts, are established frontline interventions for this condition. However, CPT’s efficacy can be limited, with a significant subset of patients continuing to endure debilitating symptoms despite receiving daily sessions. Addressing this therapeutic gap, a novel randomized clinical trial led by researchers at The Ohio State University Wexner Medical Center and College of Medicine explores the potent combination of CPT with stellate ganglion block (SGB), an innovative adjunctive treatment leveraging neuroanatomical pathways to modulate autonomic nervous system responses.
Stellate ganglion block is an injection-based intervention delivering a long-acting anesthetic to the cervical sympathetic chain, specifically targeting the stellate ganglion. This cluster of nerves plays a pivotal role in regulating sympathetic nervous system arousal, which modulates the fight-or-flight responses often hyperactivated in PTSD. By “resetting” this pathway, SGB has shown preliminary promise in reducing hyperarousal symptoms, potentially improving psychological states related to trauma exposure. The integration of SGB prior to or after CPT presents a paradigm shift in trauma therapy—moving from purely cognitive interventions toward a biobehavioral model combining neurophysiological and psychotherapeutic mechanisms.
The study enrolled 86 active military personnel and veterans with clinically diagnosed PTSD symptoms, employing an open-label randomized wait-list design. Participants received either SGB before initiating daily CPT or SGB following the completion of CPT in cases of residual symptomatology. The primary measure employed was the PTSD Checklist for DSM-5 (PCL-5), a validated tool quantifying symptom severity across intrusion, avoidance, negative alterations in cognition and mood, and hyperarousal domains. Notably, the intervention yielded a rapid and substantial decline in mean PCL-5 scores from an initial 50 to approximately 20 within a remarkably short two-week interval. This scale of improvement surpasses normative therapeutic outcomes associated with CPT alone and demonstrates durability extending over a 12-month follow-up period.
Mechanistically, this research illuminates how the sympathetic nervous system’s recalibration through SGB can potentiate cognitive-behavioral modifications, potentially by dampening hyperactive neurocircuitry implicated in threat processing, fear conditioning, and stress response. The synergy observed with CPT suggests a neurobiological priming effect where reduced autonomic hyperarousal facilitates engagement and cognitive restructuring during psychotherapy sessions. In scenarios where CPT alone fails to produce significant alleviation, post-treatment administration of SGB still confers meaningful symptom reductions, broadening the therapeutic applicability of this combined approach.
Importantly, the efficacy of SGB was not limited to combat-related trauma, a predominant cause of PTSD in military cohorts. A considerable proportion of participants reported non-combat related traumas, including sexual assault, domestic violence, and childhood abuse, suggesting the generalizability of this treatment modality to civilian populations burdened by complex trauma histories. This expands the clinical utility of SGB-enhanced CPT and invites further research into its role within diverse trauma-affected groups.
Beyond clinical benefits, the practical implications of integrating SGB with CPT are substantial. The military’s operational readiness can be severely compromised by PTSD, affecting retention, deployment eligibility, and overall mission effectiveness. Accelerated symptom resolution as demonstrated by this regimen could enable faster reintegration into active duty. Moreover, this approach holds promise in addressing disparities in access to specialized PTSD care, particularly within rural and under-resourced settings where mental health providers are scarce. By offering a targeted intervention that enhances psychotherapy response, health systems could optimize resource allocation while improving patient outcomes.
The funding for this pivotal study was supported by reputable organizations such as The Navy Seal Foundation, The USAA Foundation, and The Bob Woodruff Foundation, alongside charitable contributions from groups including Honor 365, Ride To Zero, and 33 Forever. Investigators assert full responsibility for content, emphasizing that funders did not influence study design, data collection, statistical analysis, results interpretation, or manuscript development. Notably, conflict of interest disclosures delineate that the primary lead author, Dr. Jaryd Hiser, reported no conflicts, while some co-authors declared external associations unrelated to the present work.
The translational potential of this research extends to shaping future PTSD treatment protocols. Combining minimally invasive nerve blocks with evidence-based psychotherapy could revolutionize standards of care, enable personalized treatment plans, and deepen understanding of PTSD pathophysiology. Prospective studies might explore optimization of dosing schedules, comparative effectiveness against pharmacotherapies, and underlying neural mechanisms through neuroimaging and biomarker assessments.
Importantly, this research aligns with a growing recognition that effective PTSD treatment requires nuanced integration of neurobiological and psychological interventions. The stellate ganglion block addresses the physiological substrate of PTSD—sympathetic nervous system dysregulation—while cognitive processing therapy targets maladaptive trauma cognitions and behaviors. Their combination represents a comprehensive assault on the multifactorial nature of PTSD, amplifying the likelihood of symptom remission and functional restoration.
In conclusion, the collaboration between neuromodulation and psychotherapy introduced by the adjunctive use of SGB with CPT heralds a breakthrough in PTSD management for military personnel and veterans. This approach harnesses the power of neurophysiological resetting to synergize with the established psychological framework of CPT, offering hope for improved recovery trajectories and enhanced quality of life for those affected by trauma. As PTSD continues to impose a significant burden on individuals and society, such innovative therapeutic strategies will be essential to advancing mental health care and fostering resilience within vulnerable populations.
Subject of Research: People
Article Title: Effectiveness of Combined Cognitive Processing Therapy with Stellate Ganglion Block: An Open-Label Randomized Wait-List Clinical Trial
News Publication Date: 15-Dec-2025
Web References: http://dx.doi.org/10.1159/000550014
References: Psychotherapy and Psychosomatics journal article
Image Credits: The Ohio State University Wexner Medical Center
Keywords: Anxiety disorders, Panic disorders, Cognitive psychology, Mental health, Cognitive disorders, Behavioral psychology
