Differential posttraumatic stress disorder symptom cluster response to stellate ganglion block: secondary analysis of a randomized controlled trial.
Journal
Translational psychiatry
ISSN: 2158-3188
Titre abrégé: Transl Psychiatry
Pays: United States
ID NLM: 101562664
Informations de publication
Date de publication:
29 May 2024
29 May 2024
Historique:
received:
26
05
2023
accepted:
13
05
2024
revised:
09
05
2024
medline:
30
5
2024
pubmed:
30
5
2024
entrez:
29
5
2024
Statut:
epublish
Résumé
Empirically supported treatments for posttraumatic stress disorder (PTSD) exist, but research suggests these therapies are less effective, acceptable, and feasible to deliver to active duty service members (SMs) compared to civilians. Stellate ganglion block (SGB) procedure, in which a local anesthetic is injected around the cervical sympathetic chain or stellate ganglion to temporarily inhibit sympathetic nervous activity, is gaining popularity as an alternative PTSD treatment in military settings. However, it is unknown whether certain PTSD symptoms are more responsive to SGB than others. The current study involved a secondary analysis of data collected from a previous randomized controlled trial of SGB compared to sham (normal saline) injection (N = 113 SMs). PTSD symptoms were assessed via clinical interview and self-report at baseline and 8 weeks post-SGB or sham. Logistic regression analyses showed that the marked alterations in arousal and reactivity PTSD symptom cluster demonstrated the greatest symptom severity reductions after SGB, relative to sham. The reexperiencing cluster also showed pronounced response to SGB in clinician-rated but not self-reported outcomes. Post-hoc item-level analyses suggested that arousal and reactivity cluster findings were driven by reductions in hypervigilance, concentration difficulties, and sleep disturbance, whereas clinician-rated reexperiencing cluster findings were driven by reductions in physiological reactions to trauma cues, emotional reactions to trauma cues, and intrusions. Our findings align with a burgeoning literature positioning SGB as a potential novel or adjunctive PTSD treatment. Results could guide future hypothesis-driven research on mediators of therapeutic change during SGB for PTSD symptoms in SMs.
Identifiants
pubmed: 38811568
doi: 10.1038/s41398-024-02926-8
pii: 10.1038/s41398-024-02926-8
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
223Subventions
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Organisme : U.S. Department of Defense (United States Department of Defense)
ID : W81XWH2010847
Informations de copyright
© 2024. The Author(s).
Références
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 2013.
Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, et al. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol. 2016; https://doi.org/10.1007/s00127-016-1208-5 .
Institute of Medicine. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. (The National Academies Press, 2014).
Clancy CP, Graybeal A, Tompson WP, Badgett KS, Feldman ME, Calhoun PS, et al. Lifetime trauma exposure in veterans with military-related posttraumatic stress disorder: association with current symptomatology. J Clin Psychiatry 2006; https://doi.org/10.4088/jcp.v67n0904 .
Stretch RH, Knudson KH, Durand D. Effects of premilitary and military trauma on the development of post-traumatic stress disorder symptoms in female and male active duty soldiers. Mil Med. 1998;163:466–70.
doi: 10.1093/milmed/163.7.466
pubmed: 9695612
Hamblen JL, Norman SB, Sonis JH, Phelps AJ, Bisson JI, Nunes VD, et al. A guide to guidelines for the treatment of posttraumatic stress disorder in adults: An update. Psychotherapy (Chic) 2019; https://doi.org/10.1037/pst0000231 .
Foa EB, Hembree E, Rothbaum B. Prolonged Exposure Therapy for PTSD: Therapist Guide. (Oxford University Press, 2007).
Resick PA, Monson CM, Chard KM. Cognitive Processing Therapy for PTSD: A Comprehensive Manual. (Guilford Press, 2016).
Watkins LE, Sprang KR, Rothbaum BO. Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Front Behav Neurosci. 2018; https://doi.org/10.3389/fnbeh.2018.00258 .
Straud CL, Siev J, Messer S, Zalta AK. Examining military population and trauma type as moderators of treatment outcome for first-line psychotherapies for PTSD: A meta-analysis. J Anxiety Disord. 2019; https://doi.org/10.1016/j.janxdis.2019.102133 .
Jacoby VM, Straud CL, Bagley JM, Tyler H, Baker SN, Denejkina A, et al. Evidence-based posttraumatic stress disorder treatment in a community sample: Military-affiliated versus civilian patient outcomes. J Trauma Stress 2022; https://doi.org/10.1002/jts.22812 .
McLean CP, Levy HC, Miller ML, Tolin DF Exposure therapy for PTSD in military populations: A systematic review and meta-analysis of randomized clinical trials. J Anxiety Disord. 2022; https://doi.org/10.1016/j.janxdis.2022.102607 .
U.S. Department of Veterans Affairs & U.S. Department of Defense. VA/DoD Clinical Practice Guidelines, https://www.healthquality.va.gov/guidelines/mh/ptsd/ .
McLean CP, Cook J, Riggs DS, Peterson AL, Young-McCaughan S, Borah EV, et al. Barriers and potential solutions to implementing evidence-based PTSD treatment in military treatment facilities. Mil Med. 2022; https://doi.org/10.1093/milmed/usac240 .
Foa EB, McLean CP, Zang Y, Rosenfield D, Yadin E, Yarvis JS, et al. Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present-centered therapy on PTSD symptom severity in military personnel: A randomized clinical trial. JAMA. 2018;319:354.
doi: 10.1001/jama.2017.21242
pubmed: 29362795
pmcid: 5833566
Resick PA, Wachen JS, Dondanville KA, LoSavio ST, Young-McCaughan S, Yarvis JS, et al. Variable-length cognitive processing therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors. Behav Res Ther. 2021;141:103846.
doi: 10.1016/j.brat.2021.103846
pubmed: 33894644
Rae Olmsted KL, Brown JM, Vandermaas-Peeler JR, Tueller SJ, Johnson RE, Gibbs DA. Mental health and substance abuse treatment stigma among soldiers. Mil Psychol. 2011;23:52–64.
doi: 10.1080/08995605.2011.534414
Quartana PJ, Wilk JE, Thomas JL, Bray RM, Rae Olmsted KL, Brown JM, et al. Trends in mental health services utilization and stigma in US soldiers from 2002 to 2011. Am J Public Health. 2014;104:1671–9.
doi: 10.2105/AJPH.2014.301971
pubmed: 25033143
pmcid: 4151945
Sharp ML, Fear NT, Rona RJ, Wessely S, Greenberg N, Jones N, Goodwin L. Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiol Rev. 2015;37:144–62.
doi: 10.1093/epirev/mxu012
pubmed: 25595168
Zinzow HM, Britt TW, Pury CL, Jennings K, Cheung JH, Raymond MA. Barriers and facilitators of mental health treatment-seeking in U.S. active duty soldiers with sexual assault histories. J Trauma Stress. 2015;28:289–97.
doi: 10.1002/jts.22026
pubmed: 26215254
Naifeh JA, Colpe LJ, Aliaga PA, Sampson NA, Heeringa SG, Stein MB, et al. Barriers to initiating and continuing mental health treatment among soldiers in the army study to assess risk and resilience in servicemembers (Army STARRS). Mil Med. 2016;181:1021–32.
doi: 10.7205/MILMED-D-15-00211
pubmed: 27612348
Meyer JM, Farrell NR, Kemp JJ, Blakey SM, Deacon BJ. Why do clinicians exclude anxious clients from exposure therapy? Behav Res Ther. 2014;54:49–53.
doi: 10.1016/j.brat.2014.01.004
pubmed: 24530499
Michael ST, Blakey SM, Sherrill AM & Aosved, AC Exposure therapy training and supervision: Research-informed strategies for addressing barriers to adoption and dissemination. Train Educ Prof Psychol. 2021; https://doi.org/10.1037/tep0000304 .
Kehle-Forbes SM, Meis LA, Spoont MR, Polusny MA. Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychol Trauma. 2016;8:107–14.
doi: 10.1037/tra0000065
pubmed: 26121175
Lynch JH. Stellate ganglion block treats posttraumatic stress: An example of precision mental health. Brain Behav. 2020;10:01807.
doi: 10.1002/brb3.1807
Peterson, K, Bourne, D, Anderson, J, Mackey, K & Helfand, M Evidence brief: Effectiveness of stellate ganglion block for treatment of posttraumatic stress disorder (PTSD). (Department of Veterans Affairs, 2017).
Mulvaney SW, Lynch JH, Hickey MJ, Rahman-Rawlins T, Schroeder M, Kane S, Lipov E. Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients. Mil Med. 2014;179:1133–40.
doi: 10.7205/MILMED-D-14-00151
pubmed: 25269132
Hanling SR, Hickey A, Lesnik I, Hackworth RJ, Stedje-Larsen E, Drastal CA, McLay RN. Stellate ganglion block for the treatment of posttraumatic stress disorder: A randomized, double-blind, controlled trial. Reg Anesth Pain Med. 2016;41:494–500.
doi: 10.1097/AAP.0000000000000402
pubmed: 27187898
Lipov E. A randomized, double-blind, placebo-controlled trial of stellate ganglion block in the treatment of post-traumatic stress disorder: Scientific poster. J Trauma Treat. 2015; https://doi.org/10.4172/2167-1222.S4-022 .
Rae Olmsted KL, Bartoszek M, Mulvaney S, McLean B, Turabi A, Young R, et al. Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: A randomized clinical trial. JAMA Psychiatry. 2020; https://doi.org/10.1001/jamapsychiatry.2019.3474 .
Goel V, Patwardhan AM, Ibrahim M, Howe CL, Schultz DM, Shankar H. Complications associated with stellate ganglion nerve block: A systematic review. Reg Anesth Pain Med. 2019;44:669–78.
doi: 10.1136/rapm-2018-100127
McLean B. Safety and patient acceptability of stellate ganglion blockade as a treatment adjunct for combat-related post-traumatic stress disorder: A quality assurance initiative. Cureus. 2015;7:320.
Lipov EG, Joshi JR, Sanders S, Slavin KV. A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Med Hypotheses. 2009;72:657–61.
doi: 10.1016/j.mehy.2009.01.009
pubmed: 19237252
Uchida K, Tateda T, Hino H. Novel mechanism of action hypothesized for stellate ganglion block related to melatonin. Med Hypotheses. 2002;59:446–9.
doi: 10.1016/S0306-9877(02)00158-5
pubmed: 12208186
Yeo J, Jeon Y. Effects of stellate ganglion block on sedation as assessed by bispectral index in normal healthy volunteers. Pain Physician. 2015;18:173–8.
pubmed: 25794203
Lynch JH, Mulvaney SW, Kim EH, de Leeuw JB, Schroeder MJ, Kane SF. Effect of stellate ganglion block on specific symptom clusters for treatment of post-traumatic stress disorder. Mil Med. 2016;181:1135–41.
doi: 10.7205/MILMED-D-15-00518
pubmed: 27612365
American Psychiatric Association. DSM-IV-TR. 2000.
Ruggiero KJ, Del Ben K, Scotti JR, Rabalais AE. Psychometric properties of the PTSD checklist-civilian version. J Trauma Stress. 2003; https://doi.org/10.1023/A:1025714729117 .
Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). 2013; www.ptsd.va.gov .
National Center for PTSD. Using the PTSD checklist for DSM-IV (PCL), https://www.ptsd.va.gov/professional/assessment/documents/PCL_handoutDSM4.pdf (n.d.).
DoDI 3216.02, “Protection of human subjects and adherence to ethical standards in DOD-conducted and -supported research,” April 15, 2020, Incorporating Change 1 on June 29, 2022 (whs.mil).
Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane TM. The clinician-administered PTSD scale for DSM-5 (CAPS-5). 2013; https://www.ptsd.va.gov/ .
Weathers FW, Bovin MJ, Lee DJ, Sloan DM, Schnurr PP, Kaloupek DG, et al. The clinician-administered PTSD scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018;30:383–95.
doi: 10.1037/pas0000486
pubmed: 28493729
Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J Trauma Stress. 2015;28:489–98.
doi: 10.1002/jts.22059
pubmed: 26606250
Bovin MJ, Marx BP, Weathers FW, Gallagher MW, Rodriguez P, Schnurr PP, Keane TM. Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychol Assess. 2016;28:1379–91.
doi: 10.1037/pas0000254
pubmed: 26653052
Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci. 2011;13:263–78.
doi: 10.31887/DCNS.2011.13.2/jsherin
pubmed: 22034143
pmcid: 3182008
Lynch JH, Mulvaney SW, Bryan CJ, Hernandez D. Stellate ganglion block reduces anxiety symptoms by half: a case series of 285 patients. J Pers Med. 2023; https://doi.org/10.3390/jpm13060958 .
Arntz A, Rauner M, van den Hout M. “If I feel anxious, there must be danger”: ex-consequentia reasoning in inferring danger in anxiety disorders. Behav Res Ther. 1995;33:917–25.
doi: 10.1016/0005-7967(95)00032-S
pubmed: 7487851
Engelhard IM, Arntz A. The fallacy of ex-consequentia reasoning and the persistence of PTSD. J Behav Ther Exp Psychiatry. 2005;36:35–42.
doi: 10.1016/j.jbtep.2004.11.004
pubmed: 15687008
Engelhard IM, Macklin ML, McNally RJ, van den Hout MA, Arntz A. Emotion- and intrusion-based reasoning in Vietnam veterans with and without chronic posttraumatic stress disorder. Behav Res Ther. 2001;39:1339–48.
doi: 10.1016/S0005-7967(00)00101-7
pubmed: 11686268
Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess. 2007;19:176–88.
doi: 10.1037/1040-3590.19.2.176
pubmed: 17563199
Marshall GN, Miles JN, Stewart SH. Anxiety sensitivity and PTSD symptom severity are reciprocally related: evidence from a longitudinal study of physical trauma survivors. J Abnorm Psychol. 2010;119:143–50.
doi: 10.1037/a0018009
pubmed: 20141251
pmcid: 2820125
Mitchell MA, Capron DW, Raines AM, Schmidt NB. Reduction of cognitive concerns of anxiety sensitivity is uniquely associated with reduction of PTSD and depressive symptoms: a comparison of civilians and veterans. J Psychiatr Res. 2014;48:25–31.
doi: 10.1016/j.jpsychires.2013.10.013
pubmed: 24211025
Wilkins KC, Lang AJ, Norman SB. Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety. 2011;28:596–606.
doi: 10.1002/da.20837
pubmed: 21681864
pmcid: 3128669
Morgan-López AA, Saavedra LM, Hien DA, Killeen TK, Back SE, Ruglass LM, et al. Estimation of equable scale scores and treatment outcomes from patient- and clinician-reported PTSD measures using item response theory calibration. Psychol Assess. 2020;32:321–35.
doi: 10.1037/pas0000789
pubmed: 31804102
Alpert E, Hayes AM, Barnes JB, Sloan DM. Predictors of dropout in cognitive processing therapy for PTSD: An examination of trauma narrative content. Behav Ther. 2020;51:774–88.
doi: 10.1016/j.beth.2019.11.003
pubmed: 32800305
Eftekhari A, Crowley JJ, Mackintosh MA, Rosen CS. Predicting treatment dropout among veterans receiving prolonged exposure therapy. Psychol Trauma. 2020;12:405–12.
doi: 10.1037/tra0000484
pubmed: 31318247
Blakey SM, Abramowitz JS. Interoceptive exposure: An overlooked modality in the cognitive-behavioral treatment of OCD. Cogn Behav Pract. 2018;25:145–55.
doi: 10.1016/j.cbpra.2017.01.002
McCurry KL, Frueh BC, Chiu PH, King-Casas B. Opponent effects of hyperarousal and re-experiencing on affective habituation in posttraumatic stress disorder. Biol Psychiatry Cogn Neurosci Neuroimaging. 2020;5:203–12.
pubmed: 31759868
Stein NR, Dickstein BD, Schuster J, Litz BT, Resick PA. Trajectories of response to treatment for posttraumatic stress disorder. Behav Ther. 2012;43:790–800.
doi: 10.1016/j.beth.2012.04.003
pubmed: 23046781
pmcid: 3499132
Peterson AL, Straud CL, Young‐McCaughan S, McCallin JP, Hoch M, Roux NP 3rd, et al. Combining a stellate ganglion block with prolonged exposure therapy for posttraumatic stress disorder: A nonrandomized clinical trial. J Trauma Stress. 2022;35:1801–9.
doi: 10.1002/jts.22873
pubmed: 36050896
Roberts LN, Nixon RDV. Systematic review and meta-analysis of stepped care psychological prevention and treatment approaches for posttraumatic stress disorder. Behav Ther. 2023;54:476–95.
doi: 10.1016/j.beth.2022.11.005
pubmed: 37088505
Carey TA, Griffiths R, Dixon JE, Hines S. Identifying functional mechanisms in psychotherapy: A scoping systematic review. Front Psychiatry. 2020;11:291.
doi: 10.3389/fpsyt.2020.00291
pubmed: 32362848
pmcid: 7180170
Moffat JG, Vincent F, Lee JA, Eder J, Prunotto M. Opportunities and challenges in phenotypic drug discovery: an industry perspective. Nat Rev Drug Discov. 2017;16:531–43.
doi: 10.1038/nrd.2017.111
pubmed: 28685762