I have been working with clients suffering from PTSD for almost five years, and recently came across an incredibly effective treatment option for reducing PTSD related symptoms that often prevent folks from seeking trauma treatment. This treatment option is called a Stellate Ganglion Block (SGB). At first I thought it was too good to be true, but upon further research I have found that it is an invaluable tool to be used in conjunction with trauma focused psychotherapy. I’ve found that information regarding the intersection of therapeutic and medical treatments for PTSD is not widely available to many therapists. This post will serve as an overview of what a Stellate Ganglion Block is, how it can help, and how to find out more about the block for yourself or your clients.
I found out about SGB because a local doctor, Dr. James Lynch, reached out to our practice. Having seen my specialty on our website, Dr. Lynch thought we may be able to collaborate in trauma care for our patients and clients. Having just retired from 31 years in Army medicine, Dr. Lynch settled in Annapolis to partner up with his longtime colleague and fellow SGB pioneer, Dr. Sean Mulvaney. Drs. Lynch and Mulvaney are considered the world’s experts in Stellate Ganglion Block treatment for PTSD, so they teamed up to form The Stellate Institute in Annapolis, which serves as a center of excellence for SGB clinical care, research, education, and advocacy for trauma survivors. More information of their background and The Stellate Institute can be found at: The Stellate Institute
When Dr. Lynch first told me that the block immediately reduces the effects of PTSD with a success rate of 80%,; I honestly thought he was selling me snake oil. The more I found out about this treatment however, the more I realized that it is most definitely not too good to be true. In fact, it is a life-changing tool in the interdisciplinary treatment of trauma. SGB is not a magic bullet, and does not treat all symptoms of PTSD, similar to pharmacological interventions. It does, however, lead to marked improvement in: irritability, anger outbursts, difficulty concentrating, trouble falling or staying asleep, and relief from undesired fight-or-flight reactions (Lynch et al., 2016). These symptoms are often what prevent folks from seeking psychotherapy, as talking about these symptoms can heighten their presence, thus creating a vicious cycle that reduces the client’s motivation to seek help. SGB is not a replacement for trauma based talk therapy, in fact, talk therapy in conjunction with SGB is the recommended treatment and is the course of action Dr. Lynch required of service members who received SGBs from him, and what is advocated for all patients treated at The Stellate Institute.
So what is ‘the block’? As many of us know, PTSD sufferers experience an overactivity in their sympathetic nervous system. To put it simply, their fight/flight/freeze/fawn responses have been turned on repeatedly, or intensely, and trauma survivors now perceive threats with too high a frequency. This dysfunction presents anatomically as hyperarousal of the cervical sympathetic chain, which is a nerve located on either side of the neck, that connects to the amygdala (aka the brain’s ‘smoke alarm’). This nerve is a two-way conduit that carries signals between the brain and body that cause racing heart, shortness of breath, sweaty palms, anger, irritability, sleep disturbances, etc.
A Stellate Ganglion Block is simply an injection of local anesthetic in the neck to temporarily block the cervical sympathetic chain, which controls the body’s fight-or-flight response. This outpatient procedure, performed under ultrasound or fluoroscopic guidance, takes less than thirty minutes, is virtually painless, extremely safe, and is immediately effective (Lynch, 2020). Blocking the nerve allows it to go to sleep and wake up, in about eight hours, in a less excited state, within which it can function more appropriately.
Sounds too good to be true, right? SGB is not new! Stellate Ganglion Blocks have been used for over one hundred years to successfully treat a variety of sympathetically modulated pathologies ranging from chronic pain to postherpetic neuralgia (Imani, Hemati, Rahimzadeh, Kazemi, & Hejazian, 2016; Moore, 1954; Moore & Bridenbaugh, 1956; Summers & Nevin, 2017). But it was only over the past decade or so that innovative clinicians, like Drs. Lynch and Mulvaney, began applying SGB to PTSD and researching the effects. This may explain in part why many are not aware of SGB, despite Level 1B evidence in the literature, including a multicenter randomized clinical trial published in JAMA Psych in 2020.
So what I am telling you here is that you, or your clients, can receive a simple, safe, outpatient procedure that is quite similar to the numbing procedure one experiences prior to having dental work done, and it will help you/them to feel more safe, relaxed and present in the world. What a gift modern medicine and interdisciplinary work has given us in the field of PTSD treatment.
So how does one know if an SGB is right for them/how to assess client’s on your current caseload? If you are thinking this procedure may be right for you and have questions, please reach out to myself or Dr. Lynch’s office directly. What I began to do after consulting with Dr. Lynch, is administer a PCL-5, which is a standardized scale of PTSD symptoms, to all of my clients who have suffered trauma. Scores above 33 are clinically significant. I then educated my clients on the procedure, and attended the procedure with the first few clients I referred to get a better understanding of the procedure myself. The results were quite surprising, and my client’s PCL-5 scores dropped by 50% or more. Clients describe the effects of the block as a “good weird” sensation; clients often experience an emotional release or a state of euphoria post block, and note that they have a sense of calm that reminds them of what life was like prior to their traumatic experiences.
This reduction in symptoms is not permanent if not properly fostered, however. If the client enters into a traumatic or stressful situation shortly after receiving an SGB, this may result in a subsequent return to pre-block scores. If clients do not continue with therapy post block, this also shortens the time they experience symptom relief. Some clients require more than one block in order to feel relief as well; this varies widely person to person. However, when combined with therapy, these positive effects can have a profound impact on one’s quality of life, and increases comfort level with continuing trauma therapy.
One client describes the effects of an SGB as follows:
“When Caroline first told me about the Stellate Ganglion Block procedure, I was nervous, but willing to try anything to help me cope with my stress and anxiety. I was blown away with how quick and simple the procedure is, and how comfortable both Caroline and Dr. Lynch made me feel. Dr. Lynch took time to thoroughly explain what I could expect and continues to follow up to see how I am feeling post procedure. Within minutes of receiving the block I felt a sense of calm that I had not felt for years. It has truly made a difference in my symptoms and I am hopeful others suffering from trauma have the opportunity to take advantage of this amazing procedure.”
About the Author:
Caroline Fowler is a Maryland Board approved Licensed Certified Social Worker – Clinical (LCSW-C) therapist at Cedar Counseling & Wellness. Caroline specializes in providing compassionate care to individuals who have experienced direct trauma, secondary trauma, and/or chronic stress.
