Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.
J Trauma Stress. 2022 Dec;35(6):1801-1809. doi: 10.1002/jts.22873. Epub 2022 Sep 1.
Prolonged exposure therapy (PE) is an efficacious treatment for active duty service members and veterans with posttraumatic stress disorder (PTSD). However, PE is sometimes associated with high dropout rates, limited tolerability, and temporary symptom exacerbation during treatment. Stellate ganglion blocks (SGBs) are an emerging treatment that has the potential to enhance outcomes for PTSD when combined with trauma-focused psychotherapy. To date, no study of which we are aware has examined the potential additive benefits of SGB injections when administered in conjunction with trauma-focused behavioral treatment for PTSD. Thus, we conducted a nonrandomized clinical trial to evaluate the use of an SGB combined with massed PE therapy for combat-related PTSD. Participants (N = 12) were treated with 10 daily 90-min PE sessions delivered over 2 weeks and received a single SGB injection between Sessions 1 and 2. PE sessions lasted 90 min each. Participants reported a mean posttreatment PTSD symptom reduction of 32 points on the PTSD Checklist for DSM-5 (PCL-5), Hedges' gs = 1.28-2.80. Most participants (90.9%) demonstrated clinically significant change on the PCL-5 (i.e., ≥10 points) by the final treatment session and 50.0% no longer met the diagnostic criteria for PTSD per the Clinician-Administered PTSD Scale for DSM-5 at 1-month follow-up. Adverse events for the combined treatment were consistent with those previously reported for standalone SGB and PE. This combined treatment approach provides promising results for improving the tolerability of trauma-focused therapies, reducing symptom severity, and increasing PTSD remission rates.
延长暴露疗法（PE）是一种有效的治疗方法，适用于患有创伤后应激障碍（PTSD）的现役军人和退伍军人。然而，PE 有时与高退出率、有限的耐受性以及治疗期间症状暂时恶化有关。星状神经节阻滞（SGB）是一种新兴的治疗方法，当与创伤聚焦心理治疗结合使用时，有可能改善 PTSD 的治疗效果。迄今为止，我们所知道的没有研究探讨过在 PTSD 创伤聚焦行为治疗中联合使用 SGB 注射的潜在附加益处。因此，我们进行了一项非随机临床试验，以评估 SGB 注射联合密集型 PE 治疗与战斗相关 PTSD 的疗效。参与者（N=12）接受了 10 次每天 90 分钟的 PE 治疗，为期 2 周，在第 1 次和第 2 次治疗之间接受了单次 SGB 注射。PE 治疗每次持续 90 分钟。参与者报告 PTSD 检查表 DSM-5（PCL-5）的 PTSD 症状在治疗后平均减少了 32 分，Hedges' gs=1.28-2.80。大多数参与者（90.9%）在最后一次治疗结束时表现出明显的临床变化（即≥10 分），50.0%在 1 个月随访时根据 DSM-5 临床医生管理 PTSD 量表不再符合 PTSD 的诊断标准。联合治疗的不良事件与单独使用 SGB 和 PE 报道的不良事件一致。这种联合治疗方法为改善创伤聚焦治疗的耐受性、减轻症状严重程度和提高 PTSD 缓解率提供了有希望的结果。
