Case Study: Stellate Ganglion Block Combined With Cognitive-Behavioral Therapy for Improved PTSD Symptom Management

Lexie Thomas, VA Northern California Health Care System, Martinez, United States
James Muir, VA Northern California Health Care System, Martinez, United States
Colin Fernandes, VA Northern California Health Care System, Martinez, United States


To evaluate the effectiveness of Stellate Ganglion Block (SGB) as a cointervention intended to boost the effectiveness of cognitive-behavioral psychotherapy (CBT) for post-traumatic stress disorder (PTSD) symptom management.

Participants and Methods:

Participant: The participant was a male US Marine Corps combat Veteran who subsequently worked as an EMT and firefighter for over 15 years. The participant had been off-duty for the past two years due to severe PTSD symptoms and had recently transferred care to the VA for PTSD treatment after previously receiving several years of private-sector care.

Interventions: The participant received approximately six months of individual and group psychotherapies along with SGB (administered midway through the program) from an integrated VA team emphasizing whole health and behavioral health with a collective focus on PTSD symptom management. CBT approaches included acceptance and commitment therapy (ACT), skills training in affective and interpersonal self-regulation (STAIR), communication skills, family/community reintegration, and sleep quality.

Main Outcome Measures: PTSD severity was assessed at baseline before starting psychotherapy, again preoperative SGB, and finally postoperative SGB. Measures of PTSD symptomatology were well-validated with Veterans, including the PTSD Checklist for DSM-5 (PCL-5) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), which is considered the criterion standard for PTSD assessment.


Results showed significant improvement in PTSD severity at both time points. After psychotherapy alone, PCL-5 scores decreased from 66 at baseline (9/22/22) to 45 at preoperative SGB (1/20/23). PCL-5 scores further decreased from 45 to 15 three months at postoperative SGB (4/14/23),. Similarly, the CAPS-5 showed significant improvement in PTSD symptoms from initial baseline (CAPS-5 = 58) to three months postoperative SGB (CAPS-5 = 25).


Demonstrates significant additional benefit following SGB as a cointervention appearing to boost effectiveness of conventional CBT psychotherapy toward improved PTSD symptom management.

Category: Psychiatric Disorders

Keyword 1: adaptive functioning
Keyword 2: post-traumatic stress disorder
Keyword 3: treatment outcome