Have you ever had overwhelming anxiety or a triggered stress response from PTSD, with a racing heart, shallow breath, and a feeling of being “stuck” in fight-or-flight? That’s sympathetic nervous system overload. And, while therapy helps, cognitive approaches for trauma and anxiety are limited because many feelings are often stored in the body.
Dual Sympathetic Reset (DSR) is an emerging, simple somatic (body) technique with the ability to quickly discharge sympathetic nervous system overload.
DSR is an advanced version of the FDA-approved Stellate Ganglion Block (SGB) that aims to “reset” an overactive sympathetic nervous system and can provide rapid relief for many patients with trauma‑ and anxiety‑related symptoms.
It is promising but still considered an off‑label, emerging intervention that should be integrated with, but not substituted for, good trauma‑focused psychotherapy and broader care.
In this article, I explore what DSR is, the proposed science behind it, how to practice it safely, and its potential role in a broader healing approach.
What is the Dual Sympathetic Reset (DSR)?
DSR is a protocol where two injections of local anesthetic (typically Bupivacaine or Ropivacaine) are injected around the stellate ganglion and adjacent cervical sympathetic chain levels, usually at two levels on the same side of the neck (e.g., C4/C6 or similar) [1].
The sympathetic chain connects the brain’s fight-or-flight response to the rest of the body. It dampens sympathetic output and helps recalibrate fight‑or‑flight circuitry [2].
A Refinement of SGB
DSR is a refinement of standard SGB, which uses a single injection. DSR adds a second level or more comprehensive “dual‑level” block, with the goal of stronger and longer‑lasting symptom reduction in PTSD and anxiety compared with a single‑level block.
By calming the sympathetic nervous system, the DSR is thought to reduce the physical symptoms of chronic stress and trauma, such as rapid heartbeat, high blood pressure, and difficulty concentrating.
While the medication itself is FDA-approved for pain, its use for PTSD and anxiety is considered “off-label.” However, it is a legal and increasingly common practice supported by a growing body of clinical evidence. The anesthetics used have been well proven for decades.
Rapid Benefits, But Not a Standalone Cure
Many patients report feeling immediate relief, experiencing a deep sense of calm within 30 minutes of the procedure.
DSR is not considered a standalone cure. Instead, it is often used in combination with trauma-informed talk therapy (e.g., CBT, EMDR) to enhance the effectiveness of these psychological approaches.
How DSR Works
By temporarily blocking sympathetic fibers, DSR/SGB appears to reduce norepinephrine signaling and sympathetic hyperarousal. This is believed to allow limbic and autonomic circuits to “reset” toward baseline rather than chronic hypervigilance [2].
Clinically, such reduction often translates into rapid changes in somatic and affective symptoms (startle, panic, insomnia, irritability), which can in turn make trauma processing and emotion regulation work more accessible.
5 Benefits of DSR
A number of benefits of SGB/DSR have emerged, some in comparison to conventional therapies (SSRI antidepressants and Prolonged Exposure Therapy, as follows [3]:
- Decreased barriers to care: Conventional trauma-focused treatments do not work for all patients, and many may refuse them.
- Onset of relief: An SGB procedure often brings immediate relief of many of the acute symptoms of trauma, with consistent efficacy rates higher than 70% across multiple studies.
- Decreased dropout from care: Exposure-based talk therapies like Prolonged Exposure and Cognitive Processing Therapy have long been touted as “evidence-based” and “gold standard” treatments for military servicemembers and veterans. However, the very high dropout rates hinder both treatments.
- Trauma-informed care: One of the most important advantages of SGB is its ability to deliver relief in a more compassionate way when paired with trauma-informed talk therapy.
- Cost savings: Another advantage of SGB is the relatively low cost associated with deploying it as an alternative to conventional treatments.
Evidence for Trauma and Anxiety Relief
Overall Treatment Success Rates
Multiple peer‑reviewed studies on SGB (not all specifically DSR) show meaningful reductions in PTSD symptom scores (e.g., PCL) and chronic anxiety. Many patients experience clinically significant changes, and some data suggest effects can persist for months.
Across the full range of existing case reports and studies, the efficacy of SGB for symptoms of trauma ranges from 70% to 83% of treated patients experiencing clinically significant positive outcomes. There are between 10% and 20% of patients for whom SGB does not seem to be effective [3].
PTSD Treatment
A retrospective analysis of over 300 patients who received the DSR treatment reported an average decrease in PTSD symptoms (measured by the PCL score) that was almost three times higher than the “clinically significant” threshold defined by the National Center for PTSD.
Case series and clinic outcome data for dual‑level/DSR protocols report high proportions of patients with substantial symptom relief (often in the range of majority responders), including improved sleep, reduced hyperarousal and panic, and better day‑to‑day functioning; however, most data are uncontrolled and from specialty centers, so findings need replication in larger randomized trials.
Major institutions, including the Department of Veterans Affairs and NYU Langone Health, are conducting ongoing randomized controlled trials to further investigate the effects of SGB and DSR on PTSD symptoms.
Anxiety Treatment
Another study involving 258 patients with Generalized Anxiety Disorder received DSR treatment, leading to a drop in GAD-7 scores that was more than double the smallest important change needed to show improvement in anxiety. This effect was sustained for at least 1 month following the SGB injection [4].
Risks, Limitations, and Safety
When performed by experienced physicians using image guidance, SGB/DSR is generally brief (10-15 minutes) and typically done as an outpatient procedure. It still carries medical risks such as transient Horner’s syndrome, hoarseness, vascular puncture, and rare but serious complications.
Key limitations for a clinician to weigh include:
- Its off‑label status for psychiatric indications
- Lack of large controlled research studies compared with gold‑standard psychotherapies
- Variable duration of benefit (some need repeat or bilateral procedures)
- Cost/access issues
- The need to manage expectations so that patients do not view it as a stand‑alone cure.
Considerations
- Not a Cure: DSR temporarily alleviates symptoms and does not erase memories of the trauma.
- Individual Results Vary: The duration of relief varies among individuals, lasting months or years, and some may require additional treatments.
- Side Effects: Potential temporary side effects include a droopy eyelid, hoarseness, and a feeling of warmth in the face and arm, which typically resolve within 24 hours.
- Cost and Insurance: DSR treatment is not currently covered by most insurance plans, as insurance typically only covers SGB for pain management.
Clinical Integration for Trauma/Anxiety
For appropriate candidates—often with persistent hyperarousal despite evidence‑based care—DSR can be conceptualized as a neuromodulatory complement to:
- Enhance engagement in trauma‑focused psychotherapy (e.g., EMDR, CPT, PE) by reducing physiological overwhelm.
- Support a reduction in avoidance
- Promote behavioral activation and social reconnection.
In practice, a cautious pathway would include:
- Careful diagnostic assessment and medical screening.
- Psychoeducation that DSR targets physiology and works best within a broader biopsychosocial plan.
- Coordinated follow‑up with psychotherapy, skills work (grounding, body awareness, emotion regulation), and ongoing outcome monitoring using standardized measures (PCL‑5, GAD‑7, PHQ‑9, etc.).
Finding Support for Healing at Corner Canyon
Treatment for mental health conditions and trauma is available in Utah. Are you or a loved one looking for a compassionate space to heal from OCD, anxiety, trauma, PTSD, CPTSD, other mental health conditions, or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.
Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.
Sources
[1] Lipov, E. nd. Dual Sympathetic Reset (DSR). dreugenelipov.com
[2] Wood, R. 2025. What’s A Dual Sympathetic Reset Stellate Ganglion Block? NW Regen.com
[3] Springer, S., et al. (2024). Optimizing clinical outcomes with stellate ganglion block and trauma-informed care: A review article. NeuroRehabilitation, 55(3), 385–396.
[4] Lynch, J., et al. (2023). Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. Journal of personalized medicine, 13(6), 958.