As a fellow professional dedicated to healing trauma, I write to share compelling evidence about a breakthrough intervention that could revolutionise outcomes for your PTSD clients: the Stellate Ganglion Block (SGB).

The SSRI Dilemma

Many of our clients have trialed multiple SSRIs without success, experiencing only unwanted side effects. This frustrating reality reflects the sobering statistics about pharmaceutical interventions for PTSD:

• Only 60% of PTSD patients respond to SSRI treatment, with just 20-30% achieving complete remission
• Approved medications such as paroxetine and sertraline rarely produce response rates exceeding 60%
• PTSD is relatively hard to treat pharmacologically, and SSRIs are not very effective for this disorder
• Common side effects include upset stomach, sweating, headaches, dizziness, and sexual dysfunction

This means 40-70% of trauma clients either don't respond to medication or can't tolerate the side effects—leaving them with limited neurobiological support for their recovery journey.

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A Neurobiological Solution

The Stellate Ganglion Block directly addresses the neurobiological foundation of trauma by temporarily blocking sympathetic nerve activity in the cervical sympathetic chain. This simple outpatient procedure involves injecting local anaesthetic around the stellate ganglion—a cluster of nerve cells that regulate the body's fight-or-flight response and connects to brain regions including the amygdala, which becomes hyperactive in PTSD.

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The Evidence is Compelling

Recent peer-reviewed research demonstrates remarkable outcomes:

Efficacy Rates: Studies consistently show 70-83% of patients experience clinically significant improvement in PTSD symptoms following SGB treatment. A 2024 study of 113 individuals treated at military hospitals demonstrated significant reductions in PTSD symptom severity using validated CAPS-5 assessments.

Rapid Symptom Relief: Unlike traditional therapies that require weeks or months to show effect, SGB can provide meaningful symptom reduction within days to weeks of treatment, creating an optimal neurobiological environment for psychological intervention.

Enhanced Therapy Outcomes: A groundbreaking 2024 pilot study found that combining SGB with Prolonged Exposure therapy was both feasible and highly acceptable to veterans, showing promise for accelerated symptom reduction compared to therapy alone.

Sustained Benefits: Research published in Translational Psychiatry (2024) revealed that SGB produces differential improvements across PTSD symptom clusters, with particularly strong effects on hyperarousal symptoms that often interfere with therapeutic engagement.

Anxiety Reduction: A case series of 285 patients demonstrated that SGB reduced anxiety symptoms by over half, with effects sustained for at least one month post-treatment—creating a window of reduced reactivity ideal for trauma processing.

The Neurobiological Rationale

SGB works by temporarily "resetting" the overactivated sympathetic nervous system, allowing the parasympathetic nervous system to restore balance. This creates what researchers term a "therapeutic window"—a period of reduced hypervigilance and emotional reactivity during which trauma-focused therapy can be more effective and better tolerated.

For clients whose nervous systems are chronically dysregulated, SGB essentially provides a neurobiological "reset button," calming the very physiological systems that maintain trauma symptoms and often interfere with therapeutic progress.

Cost-Benefit Analysis

While SGB requires initial medical consultation and procedure costs (typically $2500 AUD per treatment), the economic benefits are substantial:

• Reduced therapy duration: Clients may achieve therapeutic goals 30-50% faster when SGB precedes or accompanies psychological treatment
• Lower dropout rates: Reduced symptom intensity improves therapy tolerance and completion rates
• Decreased healthcare utilisation: Rapid symptom improvement reduces emergency presentations, GP visits, and psychiatric hospitalisations
• Improved functional outcomes: Faster return to work capacity and reduced disability claims
• Enhanced quality of life: Earlier symptom resolution means reduced suffering and improved family/social functioning

For healthcare systems, every client who achieves faster recovery through SGB-enhanced therapy represents significant cost savings in ongoing treatment, crisis interventions, and disability support.

Integration with Your Practice

SGB works synergistically with established trauma therapies:

• Pre-EMDR: Calms nervous system arousal, enabling deeper trauma processing with reduced risk of overwhelm
• Pre-Somatic Experiencing: Creates optimal conditions for tracking sensation and building resilience
• Ongoing therapy support: Can be repeated if hyperarousal symptoms return, maintaining therapeutic gains

The procedure doesn't replace psychological intervention—it optimises the neurobiological conditions for therapy to succeed.

Taking Action

I encourage you to:

1. Educate yourself about SGB through the research cited below
2. Identify appropriate candidates among your trauma clients, particularly those with chronic hyperarousal
3. Develop referral relationships with qualified anaesthetists or pain specialists who perform SGB
4. Consider timing SGB strategically within your treatment planning

The Future of Trauma Treatment

We stand at the threshold of a paradigm shift in trauma treatment—one where we address both the psychological and neurobiological dimensions of PTSD simultaneously. SGB represents evidence-based medicine at its finest: a targeted intervention that enhances rather than replaces our therapeutic expertise.

Your clients deserve every evidence-based tool available for their recovery. SGB may be the key that unlocks faster, more complete healing for those who have suffered long enough.

I welcome further discussion about implementing this innovative approach in trauma treatment.

In service of healing,

Nora Fatayerji

General Manager - Stella centre AUS

Key References

1. Optimizing clinical outcomes with stellate ganglion block and trauma-informed care: A review article. PMC, 2024. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC11613001/
2. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry, 2020.
3. Differential posttraumatic stress disorder symptom cluster response to stellate ganglion block. Translational Psychiatry, 2024.
4. A pilot study of stellate ganglion block paired with exposure therapy: Feasibility and acceptability in combat veterans. PubMed, 2024.
5. Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. PMC, 2023.
6. Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of PTSD. NCBI Bookshelf, 2024.

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