Posttraumatic Stress Disorder (PTSD)
Most of us have had frightening experiences. Often we think about
them long after the event. For some people, these distressing
thoughts or images persist, as well as other symptoms such as a
strong sense of threat, feeling emotionally numb, and irritability. If
these reactions occur frequently, last at least a month, and interfere
with daily functioning, the person may be suffering from PTSD.
PTSD Symptoms (American Psychiatric Association (1994). Diagnostic and
Statistical Manual of Mental Disorders: Fourth Edition. Wash, D.C.
At least 1 of:
 Intrusive thoughts or images about the event
 Dreams or nightmares about the event or similar events
 Flashbacks or illusions about the event
 Distress when reminded of the event
 Physical arousal (becoming physically upset) when reminded
At least 3 of:
 Avoidance of thoughts or talk about the event
 Avoidance of activities/people that are reminders of the event
 Inability to recall important aspects of event
 Emotional detachment from others
 Restricted emotions
 Sense of foreshortened future (fear of future or death in future)
At least 2 of:
 Insomnia
 Irritability or anger
 Difficulty concentrating
 Hypervigilance (always on guard)
 Exaggerated startle response (too easily startled or scared)
What do we know about PTSD?
Research shows us that the majority of people exposed to a
traumatic event experience some symptoms of PTSD within the
first weeks and most people’s symptoms start to go away within
one month. Twenty to forty percent suffer from PTSD for at least a
month, one-half to two-thirds of those initially distressed people
recover within the first year, and the rest remain disabled for more
than one year. Research with transportation and assault victims, for
example, suggests that between 10 and 20 percent are disabled for
several years.
Some people are more vulnerable than others, especially those with
a history of depression, anxiety, or other traumas, an angry
disposition, or a style of coping with stress that includes not
thinking about or talking about the event (an avoidant style).
Women are about twice as likely to develop PTSD as men. People’s
subsequent attitudes and beliefs about their personal safety can
influence recovery. That is, negative beliefs about one’s own coping
ability or the safety of the world, as well as repeated angry or
resentful thinking about the reasons for the trauma all make it
harder to recover.
PTSD can result in significant personal suffering. Avoidance of
important activities (e.g., driving a car, socializing with others)
decreased sleep and related fatigue, and interference with one’s
relationships are some of the more typical consequences. These
problems can have significant financial costs to the individual and
society. PTSD is associated with subsequent worse physical health
(e.g., headaches), resulting in increased medical care and
absenteeism from work or school. PTSD sufferers are more likely
to be unemployed and have lower incomes than similar persons
without PTSD.
Effective assessment and treatment of PTSD
Two important issues interfere with the accurate assessment of
PTSD. First, many cases of PTSD are missed because health
professionals fail to ask patients if they have experienced traumatic
events (e.g., sexual assault). It is important for health practitioners
to ask patients and it is vital that patients tell health practitioners
about traumas in their lives. On the other hand, many health
professionals over-diagnose PTSD in cases where they focus solely
on "classic" symptoms (e.g., nightmares) rather than conducting a
systematic diagnostic interview. Effective assessment of PTSD
requires detailed screening for traumatic stressors and a systematic
diagnostic interview. Specialized psychological tests such as the
Stressful Life Events Screening Questionnaire (SLESQ),
Posttraumatic Diagnostic Scale (PDS), PTSD Checklist (PCL),
Posttraumatic Cognitions Inventory (PTCI), and Accident Fear
Questionnaire are frequently helpful both for diagnosis and for
treatment planning.
Over the past decade psychologists have evaluated treatments for
PTSD. Some have proven to be quite effective, while others have
PTSD is not limited to combat and disaster experiences. It also
not. The popular one-session procedure referred to as Critical
occurs following sexual or physical assault, transportation or
Incident Debriefing now appears to be of little benefit in reducing
industrial accidents, life-threatening illnesses such as cancer, war
psychological distress. However, brief cognitive-behavioural
zone experiences, and repeated exposure to others’ physical trauma therapy (5-6 sessions) provided to very distressed people shortly
(e.g., emergency room nurses and ambulance attendants). Roughly after a traumatic event appears helpful in reducing PTSD
speaking, sexual and physical assault results in the highest rates of symptoms. Short-term (8-30 hours) behavioural and cognitive
PTSD, exposure to life-threatening illness (e.g., breast cancer)
therapies have been shown to alleviate PTSD symptoms in chronic
result in the lowest rates, and transportation and industrial
sufferers. Common therapeutic components of successful
accidents are in between. It was initially assumed that the more
treatments include giving people the opportunity to repeatedly
severe the initial stress, the more likely an individual would
describe the traumatic event and their emotional responses to it,
develop PTSD. However, that assumption has not been supported
writing assignments about how they feel about the event and what
by research. The severity of a trauma (e.g., damage to car, physical it means to them and repeated opportunities to discuss the trauma
injuries during assault) is less important in predicting PTSD than is and what it means. Helpful stress-coping skills include helping
the survivor’s initial emotional response. PTSD is more likely to
patients to examine beliefs about personal safety the gradual reoccur to people whose initial responses include extreme fear, panic establishment of more realistic boundaries of, and relaxation
attacks, or dissociation.
training.
Source: Canadian Psychological Association www.cpa.ca
Eating Disorders
What are eating disorders?
Eating Disorders are serious illnesses that affect life quality
and can have lethal consequences. They include bulimia
nervosa, anorexia nervosa, binge eating disorder, and related
conditions. Bulimia nervosa occurs in 1% to 8% and
anorexia nervosa in 0.4% to 1% of Canadians.
Bulimia nervosa typically occurs in people of normal weight,
and involves a cyclical pattern of bingeing and use of
compensatory strategies. Bingeing means eating a large
amount of food with feelings of a loss of control.
Compensatory behaviours are strategies to get rid of
unwanted calories, and may involve self-induced vomiting,
abuse of laxatives, diuretics, or enemas, excessive exercise,
and/or fasting. The self-esteem of individuals with bulimia
nervosa is strongly influenced by their body shape and
weight.
Symptoms of anorexia nervosa include extreme weight loss
due to restriction of food intake, an extreme fear of gaining
weight/becoming fat, and a strong influence of body shape
and weight on self-esteem. Weight loss is severe enough to
involve absence of menstruation in females. Some
individuals with anorexia nervosa also experience episodes
of bingeing and/or use of compensatory behaviours.
Eating Disorders Not Otherwise Specified (EDNOS) is a
final category of eating disorder that allows for the diagnosis
of people not fitting the strict criteria for anorexia or bulimia
nervosa, yet still exhibiting serious symptoms. Binge eating
disorder is an example of an EDNOS, and involves similar
criteria to bulimia nervosa, but does not include the use of
compensatory behaviours.
What psychological approaches are used to treat
the eating disorders?
In cognitive behavioural therapy (CBT), individuals
learn to challenge thoughts, feelings, and behaviours
that maintain eating disorder symptoms.
Interpersonal therapy (IPT) focuses on understanding
links between eating disorder episodes and
relationship issues. For instance, therapy might focus
on difficulties in forming or maintaining relationships,
unresolved grief, and disputes with friends or relatives.
Psychoeducation is typically delivered in group
format, and provides factual information about the
causes of eating disorders as well as strategies for
overcoming an eating disorder.
Family therapy focuses on assisting the family to work
together in overcoming the eating disorder.
Motivational enhancement therapy (MET) focuses on
helping individuals work through their ambivalence
about giving up their symptoms, and making life
choices that are congruent with their higher goals.
How effective are psychological methods of treating
eating disorders?
Research has shown that psychoeducation is a useful
first intervention for individuals with mild to moderate
bulimia nervosa. For individuals with more severe
bulimia symptoms, interpersonal therapy and cognitive
behaviour therapy have been shown to be highly
effective, and identified as the treatments of choice.
Although research is still investigating the best
treatments for anorexia nervosa, a comprehensive
approach that addresses motivational issues, weight
restoration, and underlying psychological issues is
recommended. Family therapy has been shown to be a
critical treatment component for younger clients.
Source: Canadian Psychological Association www.cpa.ca
Couple Distress
Conflict is a normal part of being a couple. However, all of
us need to feel loved, understood, and respected by the
people we are close to, and conflict in these relationships
can undermine our emotional security. What makes a
difference is how conflict is handled. Couples who resolve
conflicts constructively strengthen their relationships over
time by improving intimacy and trust. Constructive
strategies include stating opinions and needs clearly and
calmly, and listening to and attempting to understand the
partner’s point of view.
Conflict becomes destructive when needs are not
expressed to partners or when they are expressed in ways
that criticize, blame, or belittle the partner. For instance, a
woman who is hurt that her husband plays golf every
weekend instead of spending time with her may accuse
him of "selfishness" instead of expressing how lonely and
hurt she feels. When a couple is distressed, typically one
partner takes the position of not saying how they feel while
the other partner takes the position of blaming and
criticizing. This pattern, which is very common in
distressed relationships, tends to get worse over time.
These couples often feel trapped in fights that are never
resolved.
Couples who experience ongoing conflict can become
aggressive with one another, and may push, slap, or hit
each other during arguments. Other couples handle conflict
by avoiding it. Avoiding conflict also damages
relationships because partners become increasingly distant
from one another. Although researchers do not know why
some couples become distressed and others don’t, most
agree that the ways couples resolve conflicts and provide
emotional support to one another are critical.
The impact of conflict on individuals and families is
enormous. Couples who repeatedly have conflicts are at
risk for a variety of emotional problems, notably alcohol
abuse and depression. Distressed couples do not cope well
with life’s inevitable stress, such as unemployment or
illness, and they run into difficulty when they go through
normal changes like the birth of a child. Children who
witness repeated conflict between their parents also are at
risk for emotional and behavioural problems. One of the
most serious impacts of relationship conflict is divorce.
The most common reason given for divorcing is feeling
unloved.
Source: Canadian Psychological Association www.cpa.ca
How can psychology help?
Three kinds of psychological treatments have been
shown to help distressed couples.
Behavioural Couple Therapy (BCT) involves coaching
couples to fight in ways that resolve conflicts. Couples
are encouraged to show more positive behaviour toward
one another, and to solve problems through constructive
communication. Research shows most couples are more
satisfied with their relationships by the end of
treatment, and 35% are no longer distressed. However,
many couples deteriorate again over the following
months. Researchers are now working to improve this
therapy so that more couples keep the gains that they
made during treatment.
Cognitive-Behavioural Couple Therapy (CBCT) helps
couples change the negative ways they think about their
partners. While this treatment does not seem to be quite
as effective as BCT at the end of treatment, couples
continue to improve after treatment.
Emotionally-Focused Couple Therapy (EFT) tackles
the frustrated emotional needs underlying relationship
distress. Instead of trying to solve problems, the health
professional helps the partners to talk about their needs
to feel loved and important in ways that promote
compassion and new ways of behaving toward one
another. At the end of treatment, the majority of these
couples have improved, and 70% are no longer
distressed. One study also showed that couples who had
worked with emotionally-focused therapy remained
satisfied with their marriages two years later.
Unfortunately, few couples seek psychological
treatment before divorce, at which time it is often too
late. As a result, programs for relationship enrichment
and prevention of conflict have been developed. These
programs focus on improving communication and
teaching conflict resolution skills to couples before they
are in trouble. Often they are offered to groups over a
weekend or series of weeks. While these programs are
effective in the short-term, research shows that couples
often have difficulty maintaining these new skills once
the program ends.
Parenting
Parents play the most important role in children’s development. Caregivers, teachers, friends, and the media are
important in children’s lives. However, psychological
research shows that parents are the most important influence
on their children. Being a parent is demanding. It requires
skills, flexibility and openness to learn. Whether parenting
with a partner, in one or two homes, or as a single parent,
parents need support from family, friends, and their
community.
Two basic ingredients - love and structure and structure. A
loving relationship is essential for children to develop
confidence and self-esteem. Parents show love in different
ways according to their personal style and cultural
background. Love is shown by smiles, hugs, compliments,
interest in the child, and by being available to spend time
with them. The investment of a few minutes of quality time
each day devoted entirely to the child (without distraction
from phones, TV, or the computer!) is the foundation of a
good relationship. It also helps children turn to their parents
when they are upset. Children who do not experience a
warm and loving relationship with their parents are at risk
for low self-esteem and lack of confidence. They may try to
find other, more negative ways to get attention and to feel
good such as, acting-out, trying to impress their peers, or
using drugs and alcohol.
A loving relationship is necessary, but is not enough to
ensure healthy development. Children also need structure
and monitoring. From an early age, children benefit from
routines that help them know what to expect each day.
Parents show children the limits of acceptable behaviour by
setting clear rules and expectations. Parents help children to
learn that their actions have consequences. By noticing and
commenting on good behaviour, parents strengthen good
habits.
Physical punishment, yelling and humiliation can hurt
children. The appropriate use of a brief time-out or a brief
withdrawal of privileges are effective alternatives to
physical punishment and yelling. Without structure, children
may have difficulty learning self-control and may
experience conflict with authority figures if they fail to learn
to follow rules. Parents provide an important model for their
child’s behaviour. Children learn from watching their
parents’ appropriate (e.g., problem solving, tolerance,
communication) and inappropriate (e.g., yelling and physical
aggression) behaviour.
Children of all ages need love and structure. As children get
older, parents need to change the ways they show love and
provide guidance. A baby thrives on rocking, broad smiles,
Source: Canadian Psychological Association www.cpa.ca
and singing. A teenager is likely to feel cared for by a
parent who is a good listener while driving to an activity.
In helping a toddler to learn that it is not acceptable to pull
the cat’s tail, the parent may say "No" firmly. Because
teenagers need to develop responsibility and the ability to
make healthy independent decisions, parents should
negotiate with them about issues such as curfews.
Adults can be especially challenged in their roles as
parents when they are stressed at work, when they are
dealing with separation or divorce, or when a child or
adult in the family suffers from a mental or physical
illness. Children present a variety of challenges depending
on their temperament, developmental level, learning style
and cognitive abilities. Parents of children with, for
example, mood, anxiety, acting-out or learning disorders
are likely to benefit from evidence-based psychological
services.
How can psychology help?
Research psychologists have studied families to learn about
parenting that works. Based on that knowledge, psychologists
offer many different services to families.
Parent Education provides information about normal child
and adolescent development as well as problem
behaviours. Parent education presents positive approaches
to parenting that have been shown to be effective.
Behavioural Parent Training is offered in either a group,
couple or individual format to help parents learn and
practice strategies that research has shown to be effective
in managing misbehaviour. Parents learn how to spend
quality time with their children, how to notice and reward
desirable behaviour, and how to effectively deal with
undesirable behaviour by using time-out and the
withdrawal of privileges. Behavioural parent training is
most effective when parents have opportunities to observe
and practice the techniques they are learning. Following
behavioural parent training, two-thirds of children show
significant improvements in their behaviour and they have
fewer problems in adolescence.
Cognitive-Behavioural Therapy: Parents who are, for
example, depressed, anxious or in an unhappy relationship,
usually require help with their own problems before they can
benefit from behavioural parent training. CognitiveBehavioural Therapy is effective in helping parents deal with
their own problems such as depression, anxiety, chronic pain,
or marital distress. Cognitive-behavioural therapy is effective
in improving communication, anger management, and
problem solving in the family.
Depression
What is Depression?
Almost everyone feels sad or "depressed" at certain times.
Clinical depression (also called Major Depressive Disorder)
is confirmed by the presence of a number of symptoms for
at least a two week period. These symptoms include
sadness, loss of interest in usual activities, changes in
appetite, changes in sleep, changes in sexual desire,
difficulties in concentration, a decrease in activities or
social withdrawal, increased self criticism or reproach, and
thoughts of, or actual plans related to suicide. Clinical
depression may vary in its severity, and in its extreme
forms, can be life threatening and may require
hospitalization.
Clinical depression, or Major Depressive Disorder, is
distinguished from manic-depression or Bipolar Disorder,
in that the individual only experiences periods of
depression, potentially returning to normal functioning in
between times. In Bipolar Disorder, however, the
individual will cycle between depression and periods of
hypomania or full manic problems (euphoria, high energy,
lots of activity).
Approximately 1% of Canadian men and 2% of Canadian
women are clinically depressed at any one point in time,
and about 5% of men and 10% of women experience
clinical depression at some point in their life. Women are at
twice the risk of men to experience depression, but
regardless of gender, once a person has had one experience
of clinical depression, they are at high risk for repeated
experiences.
Although the causes of clinical depression are complex and
vary from individual to individual, it is now clear that a
variety of factors increase the risk of a person experiencing
clinical depression. These factors include having a parent
who has been clinically depressed, physical illness, the
death or separation of parents, major negative life events
(in particular, events related to interpersonal loss or
failure), pervasive negative thinking, physical or emotional
deprivation, or having previously experienced depression.
Further, some individuals experience depression in a
regular seasonal pattern, or in the case of women, after
childbirth.
Source: Canadian Psychological Association www.cpa.ca
What Psychological Approaches are Used to Treat
Depression?
Behaviour therapy is offered in individual or group
therapy and works about 65% of the time. Behaviour
therapy helps patients increase pleasant activities and
become more aware of pleasant events when they occur
and teaches new strategies to cope with personal problems
and new behaviour patterns and activities.
Cognitive therapy involves the recognition of negative
thinking patterns in depression, and correcting these
patterns though various "cognitive restructuring"
exercises. Cognitive therapy also uses behaviour therapy
strategies. Cognitive therapy has been shown to
successfully treat approximately 67% of individuals with
clinical depression, and some evidence also suggests that
cognitive therapy reduces the risk of having a subsequent
episode of depression.
Interpersonal therapy is a short-term treatment of
depression, based on the idea that interpersonal stresses
and strains are the major problems experienced in
depression. Interpersonal therapy teaches the individual to
become aware of interpersonal patterns, and to improve
these through a series of interventions. Interpersonal
therapy has a success rate that is comparable to behaviour
therapy and cognitive therapy.
In addition to the above treatments, several other
psychological treatments have promise in treating
depression. Reminiscence therapy is a treatment that has
been developed for older adults. It involves teaching
people to remember times when the individual was
younger and functioned at a higher level than as a
depressed older adult. Self Control therapy is a treatment
which combines some elements of cognitive and
behaviour therapy for depression and teaches better selfcontrol in negative situations. These treatments have some
evidence to support their use, although they are not as
well-established as the first three treatments.
An important note about psychological treatments for
depression is that they are roughly as successful as
pharmacotherapy for depression. In fact, psychological
treatments often have significantly lower drop-out rates
than pharmacotherapy (approximately 10% in
psychological therapies, versus 25-30% in drug therapy),
and there is some evidence that cognitive therapy in
particular reduces the risk of relapse relative to those
individuals who are treated with drug therapy.
Psychological treatments are effective and safe
alternatives to drug therapy for depression.
Obsessive Compulsive Disorder
What is Obsessive Compulsive Disorder?
Have you ever had a strange or unusual thought just pop
into your mind that is entirely out of character for you?
Maybe you’ve had the thought of suddenly blurting out an
embarrassing or rude comment, or of causing harm or
injury to another person, or of doubting whether you acted
correctly in a particular situation. Have you had an
irresistible urge to do something that you know is entirely
senseless, like checking the door even though you know it
is locked, or washing your hands even though they are
clean? Most people experience unwanted, even somewhat
bizarre or disgusting thoughts, images and impulses from
time to time. We don’t feel upset by these thoughts and
urges, even though they seem pretty unusual for our
personality and our experience.
Some individuals, however, suffer with a special type of
unwanted thought intrusion called obsessions. Obsessions
are recurrent and persistent intrusive thoughts, images or
impulses that are unwanted, personally unacceptable and
cause significant distress. Even though a person tries very
hard to suppress the obsession or cancel out its negative
effects, it continues to reoccur in an uncontrollable
fashion. Obsessions usually involve upsetting themes that
are not simply excessive worries about real-life problems
but instead are irrational concerns that the person often
recognizes as highly unlikely, even nonsensical. The most
common obsessional content involve (a) contamination by
dirt or germs, (b) losing control and harming oneself or
other people, (c) doubts about one’s verbal or behavioral
responses, (d) repugnant thoughts of sex or blasphemy, (e)
deviations from orderliness or symmetry, (f) the
possibility of sudden sickness (e.g., fear of vomiting), or
(g) the need to save even the most useless objects.
Compulsions are repetitive, somewhat stereotypic
behaviours or mental acts that the person performs in
order to prevent or reduce the distress or negative
consequences represented by the obsession. Individuals
may feel driven to perform the compulsive ritual even
though they try to resist it. Typical compulsions include
repetitive and prolonged washing in response to fears of
contamination, repeated checking to ensure a correct
response, counting to a certain number or repeating a
certain phrase in order to cancel out the disturbing effects
of the obsession. Over 90% of people with clinical OCD
have both obsessions and compulsions, with 25% to 50%
reporting multiple obsessions.
Approximately 1% to 2% of the Canadian population will
have an episode of OCD, with the possibility that slightly
more women experience the disorder than men. The
majority of individuals report onset in late adolescence or
early adulthood, with very few individuals experiencing a
first onset after 40 years of age. OCD is also seen in
childhood and adolescence where it has a similar symptom
pattern to that seen in adults. OCD tends to be a chronic
condition with symptoms waxing and waning in response
to life stresses and other critical experiences. It is
Source: Canadian Psychological Association www.cpa.ca
uncommon for individuals to spontaneously recover from
OCD without some form of treatment.
Depending on the severity of the symptoms, OCD can
have a profound negative impact on functioning. In severe
cases, obsessive thoughts and repetitive, compulsive
rituals can consume one’s entire day. Like other chronic
anxiety disorders, OCD often interferes with jobs and
schooling. Social functioning may be impaired and
relationships can be strained as family and close friends
get drawn into the individual’s OCD concerns.
The actual cause of this disorder is not well known.
Genetic factors may play a role but to date there is little
evidence of a specific inheritance of OCD. Studies have
suggested there may be some abnormalities in specific
regions or pathways of the brain. Other research indicates
that critical experiences or personality predispositions
might be related to increased susceptibility for OCD.
However, there is no known single cause to OCD. Instead,
most of the genetic, biological and psychological causes
probably increase susceptibility to anxiety in general
rather than to OCD in particular.
What Psychological Approaches are used to treat
OCD?
Since the early 1970s research has shown that behaviour
therapy is the most effective treatment for most types of
OCD. It involves experiencing the fearful situations that
trigger the obsession (exposure) and taking steps to
prevent the compulsive behaviours or rituals (response
prevention). These studies have shown that 76% of
individuals who complete treatment (13-20 sessions) will
show significant and lasting reductions in their obsessive
and compulsive symptoms. When measured against other
treatment approaches such as medication, behaviour
therapy most often produces stronger and more lasting
improvement. In fact, there may be little advantage to
combining behaviour therapy and medication given the
strong effects of the psychological treatment.
However, up to 30% of people with OCD will refuse
behaviour therapy or drop out of treatment prematurely.
One of the main reasons for this is a reluctance to endure
some discomfort that is involved in exposure to fearful
situations. As well, certain types of OCD such as hoarding
or rumination without overt compulsion may not respond
as well to behaviour therapy.
More recently, psychologists have been adding cognitive
interventions to the behaviour therapy treatments
involving exposure and response prevention. Referred to
as cognitive behaviour therapy, this approach helps people
change their thoughts and beliefs that may be reinforcing
obsessive and compulsive symptoms. Together with
exposure and response prevention, this new approach has
been shown to be effective in offering hope to individuals
suffering from OCD.
Psychologists
What Is A Psychologist?
A psychologist studies how we think, feel and
behave from a scientific viewpoint and applies this
knowledge to help people understand, explain and
change their behaviour.
Where Do Psychologists Work?
Some psychologists work primarily as researchers
and faculty at universities and at governmental and
non-governmental organizations. Others work
primarily as practitioners in hospitals, schools,
clinics, correctional facilities, employee assistance
programs and private offices. Many psychologists are
active in both research and practice.
What is the Nova Scotia Board of Examiners in
Psychology (NSBEP)?
All psychologists must be registered with NSBEP to
practice psychology in Nova Scotia. Psychology is a
self-regulated profession under the Nova Scotia
Psychologists Act (2000). To be registered,
psychologists must meet the standards of the
profession, which include a graduate degree in
Psychology and extensive education, training and
supervised work experience in Psychology.
NSBEP maintains the list of Registered Psychologists
and the Register of Candidates. Psychologists
(Candidate Register) have met the education and training
requirements for registration, but have not completed the
supervised work experience and the required
examinations. For more information please visit
www.nsbep.org
What is the Association of Psychologists of Nova
Scotia?
APNS is a voluntary professional organization
established in 1965 to represent the needs of psychology
professionals in the province. APNS promotes
psychology as a profession, as a science, and as a means
of promoting human welfare. www.apns.ca
How many psychologists are there in Nova Scotia?
The combined number of Registered Psychologists
and Candidates Register in Nova Scotia is over 400.
What Do Psychologists Do?
Psychologists engage in research, practice and
teaching across a wide range of topics having to do
Source: Canadian Psychological Association www.cpa.ca
with how people think, feel and behave. Their work
can involve individuals, groups, families and as well
as larger organizations in government and industry.
Some psychologists focus their research on animals
rather than people. Here are some of the kinds of
topics towards which psychologists focus their
research and practice:
 mental health problems such as depression,
anxiety, phobias, etc.,
 neurological, genetic, psychological and social
determinants of behaviour,
 brain injury, degenerative brain diseases,
 the perception and management of pain,
 psychological factors and problems associated
with physical conditions and disease (e.g.
diabetes, heart disease, stroke),
 psychological factors and management of
terminal illnesses such as cancer,
 cognitive functions such as learning, memory,
problem solving, intellectual ability and
performance,
 developmental and behavioural abilities and
problems across the lifespan,
 criminal behaviour, crime prevention, services
for victims and perpetrators of criminal
activity,
 addictions and substance use and abuse (e.g.
smoking, alcohol, drugs),
 stress, anger and other aspects of lifestyle
management,
 court consultations addressing the impact and
role of psychological and cognitive factors in
accidents and injury, parental capacity, and
competence to manage one’s personal affairs,
 the application of psychological factors and
issues to work such as motivation, leadership,
productivity, marketing, healthy workplaces,
ergonomics,
 marital and family relationships and problems,
 psychological factors necessary to maintaining
wellness and preventing disease,
 social and cultural behaviour and attitudes, the
relationship between the individual and the
many groups of which he or she is part (e.g.
work, family, society),
 the role and impact of psychological factors
on performance at work, recreation and sport.
Gambling
What are Gambling and Gambling Problems?
Most Canadians play games of chance for money or
other prizes. Popular gambling activities include
lottery and raffle tickets, scratch tickets, casino
games, slot machines, vlts, bingo, sports betting and
informal card games. In Canada and around the
world, people have had more and more opportunities
to gamble over the past 20 years.
Although most Canadians are recreational gamblers,
about 5% of the adult population develops gamblingrelated problems. These problems can range from the
person who over spends on one occasion to the
person who has a longer-term problem controlling
his or her gambling activity. At the extreme end of
the scale is pathological gambling, which is
continued and extreme gambling that is maladaptive
because of its negative effects on family, personal
and work life (APA, 1994). About 1% of adults
experience this severe form of the disorder.
Indicators1 may include: repeated unsuccessful
attempts to control, cutback or stop gambling,
restlessness or irritability when making these
attempts, needing to gamble with increasing amounts
of money to achieve the desired excitement,
preoccupation with gambling, gambling to escape
from problems or emotions such as depression or
anxiety, lying to family members or others about the
extent of gambling, committing illegal acts such as
forgery, fraud or theft to finance gambling,
jeopardizing relationships, jobs or career
opportunities because of gambling, and relying on
others to provide money to relieve the financial
consequences of gambling. Chasing losses (returning
to gamble on another day to win back lost money) is
considered a key feature.
There is no one cause of gambling problems and it is
clear that biological, psychological and social factors
all play a role. Gambling problems tend to run in
families and people who have or have had problems
with other addictions such as alcohol are at an
increased risk of developing a gambling problem.
Gambling problems can also be related to clinical
depression, but we do not yet fully understand
whether gambling problems lead to depression,
whether depression contributes to gambling problems
or both. People who are impulsive (for example,
people who make decisions without thinking about
Source: Canadian Psychological Association www.cpa.ca
consequences) are also more likely to have gambling
problems. Most gambling also occurs in a social
context. People gamble because their friends and
family are gambling.
What can Psychologists do to Help People who have
Gambling Problems?
Researchers are only starting to look at how
successful we are at treating people with gambling
problems. In most areas of the country, programs and
counselors use treatment approaches that are similar
to those used for drug and alcohol problems. These
approaches can be provided individually or in groups
and for inpatients and outpatients. Most cities have
chapters of Gamblers Anonymous, which offer
mutual support groups that operate on a twelve-step,
spiritual model.
Research supports psychologists’ use of cognitive
and behavioural treatments with problems gamblers.
Cognitive treatments help people understand and
change thinking that maintains maladaptive
gambling. For example, problem gamblers try to
predict the outcome of their next bet by considering
the outcomes of earlier bets. This kind of thinking is
false and risky. A certain outcome is not more likely
because it has or has not occurred on earlier bets - the
chance of a certain outcome remains the same for
each bet. With behavioural treatments, people change
their behaviours and environment in order to make it
harder for them to gamble. For example, people will
often limit their access to cash.
Research also highlights the importance of
motivation in overcoming gambling problems.
Motivational enhancement techniques help people to
understand how gambling effects their lives and the
mixed feelings they might have about stopping
gambling.
To date, there are no medications which have been
proven to be effective in treating problem gambling.
The website for the Responsible Gambling Council,
www.responsiblegambling.org has a
comprehensive list of links to Canadian treatment
programs, Gamblers Anonymous and provincial help
lines.
Postpartum Depression
What is Postpartum Depression?
The birth of a child creates many changes in a
woman’s life. If the child is her first, her relationship
with her husband will change from being a romantic
bond to include a working partnership focused on
housework and childcare. If she already has children,
her relationships with them will change as the family
includes the new member. A new mother may give up
paid work or she may no longer have time for her own
activities about which she can feel sad and isolated.
Some women are unprepared for these losses and for
the amount and type of work involved in caring for an
infant. They may feel resentful of the baby and
ashamed that they are not living up to the image of the
perfect mother - feelings which can sometimes spiral
into postpartum depression (PPD). Ten to 15% of new
mothers experience clinically significant Post Partum
Depression.
Symptoms of Postpartum Depression
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Sadness and/or anger
Cannot think clearly
Lack of interest or pleasure in activities
Guilt, especially about the baby
Increased or decreased appetite
Feels inadequate, especially as a mother
Increased or decreased sleep
Suicidal thoughts
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Extreme fatigue
What causes Postpartum Depression?
The term “postpartum depression” is misleading
because it implies two things that are not true. First, it
implies that the depression is caused by childbirth.
Although some professionals blame PPD on
hormones, there is little scientific evidence to support
this view. A minority of women develop PPD because
of thyroid problems. Further, PPD does not necessarily
reflect a mother’s negative feelings about her baby.
Having a baby may reveal problems in her life, such as
marital difficulties, that were not obvious before the
birth. Finally, PPD may not even begin after
childbirth; for 40% of women, it starts during
pregnancy. Second, the term implies that there is
something different about PPD that distinguishes it
from depression that occurs at other times in a
person’s life. However, research shows that the
symptoms of PPD are common to both postpartum and
non-postpartum depression. In addition, women who
are at risk for PPD are at risk for depression at other
times in their lives. The vast majority of women with
PPD become depressed because of psychological and
social risk factors as listed in the following table.
Source: Canadian Psychological Association www.cpa.ca
Men also can experience PPD. Research shows that
when a woman has PPD, often her husband is
depressed and anxious as well.
Risk Factors for Postpartum Depression
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Depressed or anxious during pregnancy
Previous history of depression or emotional problems
Difficulties with infant’s care or health
Baby is “difficult”
Life stress during pregnancy
Not married to baby’s father
Lack of support from husband and/or family
Financial problems or low levels of education
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Unhappily married
What is the impact of Postpartum Depression?
PPD can have a dramatic impact on the parents and the
baby. Husbands often feel burdened by their wives’
depression and unable to help, which can have a
negative effect on the marriage for years afterward.
The babies of mothers with PPD are more irritable and
difficult to soothe, and they tend not to develop as
well. Women with PPD can be impatient, distant or
insensitive with their babies, which may affect the
mother-child bond and have consequences for their
future relationship. When older, these children can be
at risk for emotional and behavioural problems.
How can Psychologists help?
Most women experiencing PPD are too ashamed of
their feelings to seek help. When they do seek help
from a health care professional, they may be told that
their feelings are normal or that they will get better on
their own. Like any other depression, however, PPD
can be treated psychologically.
Research clearly shows that Interpersonal therapy
(IPT) is effective. IPT helps women to make changes
within important relationships so that they get the
emotional support, help, and understanding they need.
Cognitive-behavioural therapy (CBT) helps women to
identify and change those beliefs and expectations that
make them feel depressed. For instance, many women
with PPD have overly high expectations of themselves
as mothers. Although CBT is a proven treatment for
depression, more research is needed to prove its
effectiveness specifically for women with PPD.
Some women may find postpartum support groups to
be helpful. Although the evidence for the effectiveness
of these groups is mixed, groups may help women to
overcome feelings of guilt and isolation.
Caregivers and Caring for Persons in Need
Caregiving is helping a person accomplish the activities of
daily living. The person is unable to accomplish these activities
independently and the help provided enables him or her to
maintain dignity and well-being. Caregiving can range from
straightforward tasks such as providing a meal or doing
someone’s laundry, to 24 hour care and supervision that can
include assuming full responsibility for an person’s personal,
medical and financial matters. The tasks or roles the caregiver
takes on depend on the needs and abilities of the person
receiving care. These include:
 Physical, emotional and cognitive (thinking, judgment,
memory) status
 Ability to get around independently
 Mobility level
 Specific needs for help with activities of daily living
 Supervision to ensure safety and security needs (e.g. need
for help down stairs, need for help in taking medication)
Who needs caregiving?
Many types of people at different stages of life might need a
caregiver. Some examples are:
 a child with a developmental delay in the school system
whose assistant accompanies her through the school day
 a widowed and retired 65-year-old man whose teenage
granddaughter visits him every noon hour through the week to
“have lunch with him, to keep him company and make sure he
eats his noon meal”
 a 78-year-old woman following recovery from a stroke
visited in hospital every day by her daughter and husband who
are helping her to make plans for her return home
 an 86-year-old man whose wife has just learned he has a
“dementia”, confirming her impression that his memory and
judgement were “getting worse”.
Who are caregivers?
An “informal” or “family” caregiver is one who is an unpaid
family member. When there are several family members who
directly provide care, a primary caregiver is usually identified.
The primary caregiver is the one who provides the majority of
the help and often has the closest relationship with the person
needing care. The primary caregiver is often also the person
with the enduring Power of Attorney and who has legal
authority to make decisions on behalf of the person if he or she
is not competent to do so. A single caregiver might provide
care to several different older relatives as well as to their own
dependent children.
There are natural caregivers, obliged caregivers, and there are
reluctant caregivers; sometimes a single caregiver can think he
is both on any given day. The natural caregivers tend to be
female and are “always ready with a helping hand.” Obliged
caregivers are those who are asked to help because of their
Source: Canadian Psychological Association www.cpa.ca
relationship to the person needing care or because the relative
has no one else to help.
The reluctant caregiver may or may not feel obliged to
provide help, but there are limits to the tasks she wants or is
able to take on.
The risks and rewards of caregiving
The rewards of caregiving can be felt even by the most
reluctant caregiver over time. Caregiving builds self-esteem
(for a job well done) and one’s sense of self-worth (knowing
one has made a positive difference in someone’s life); it
increases confidence and is empowering.
There are risks to caregiving, however, that can affect the
physical and emotional health of the caregiver. Some
caregivers, particularly the “naturals”, can easily overdo it.
People feel useful and good about themselves when providing
care and they can receive a lot of respect and positive regard
from others for their caregiving role. The formal caregiver’s
job satisfaction depends on these two factors.
Both formal and informal caregivers, however, can burn out,
from demands that are too great or difficult, last too long,
and/or might be more than the caregiver can cope with. Signs
of burnout include physical and emotional exhaustion,
decreased satisfaction in the “job”, and a sense of detachment
from the person to whom care is being provided. Caregivers
who always put themselves in the caregiver role are
particularly at risk for burnout. Beliefs such as “I should be
able to help everyone”;“I would be selfish if I thought myself
first”, “I am inadequate if I have to ask for help.” or “Only I
can provide the right care because I know my
mother/husband best” might signal a need for the caregiver to
think about whether she is at risk.
How well a caregiver thinks she is coping, how well she is
actually coping, and the change in what she has to cope with,
affect how burdened she feels by her role and her risk for
burnout. For example, a wife who feels able to cope with her
husband and his early-stage dementia and is in fact coping
well, might not feel or cope so well as his dementia worsens,
she develops her own age-related health problems, and their
only adult child, who had been some help and support, left
town for a new job in another city.
The stress of caring for a person with a dementia puts the
caregiver at higher risk for health and emotional problems
than she might be otherwise. She may be feeling impatient
and angry with his constant and repetitive questioning and his
“stubborn” unreasonableness – feelings about which she then
feels guilty. She may not be sleeping well because of her own
health problems and be feeling frustrated that constant
supervision of her husband leaves her with little time to
attend to her own mental or physical health and enjoyment. If
she feels unable to cope, she will also feel anxious and selfcritical which in turn can contribute to problems in eating,
sleeping and general self-care.
non-caregivers. In adult children caregivers, the rate is twice
as high as it is in non-caregivers.
How psychologists can help…
Why the caregiving needs to care for him or herself
About one-third of the population over 18 is involved in
caregiving at some level.
At least 40 % of caregivers are male.
Caregiving lasts for an average of 8 years and can “last” for up
to 18 years. Some of these years overlap with child-rearing
responsibilities for adults in the “sandwich” generation.
In the US, the “free” caregiving services are estimated to be
worth twice the amount spent on paid home care and nursing
home services.
There is a 63% higher mortality rate among older caregivers of
spouses, who have a chronic illness themselves and who
experience caregiving-related stress.
A family caregiver’s immune system is negatively affected for
up to 3 years after caregiving ends, increasing chances of their
developing a chronic illness.
Spouses, who provide more than 36 hours of caregiving, have
rates of depression and anxiety that are 6 times higher than in
Psychologists are trained to assess how a person is coping
with stress and whether the stressor or problems in coping
have led to mental health problems or disorders (e.g.
depression, anxiety). Psychologists can also help caregivers
by:
 providing psychoeducation about chronic or debilitating
illness and its effects on physical and mental well-being
 training caregivers to cope better and to better manage
challenging behaviours of their care receivers
 providing individual supportive therapy and/or
psychotherapy for the caregiver who might have developed a
mental health problem
 facilitating support groups or consulting to peer-led
groups
Source: Canadian Psychological Association www.cpa.ca
Chronic Pain
Chronic Pain is pain that does not go away. When pain
lasts over a period of six months, or beyond the usual time
for recovery, it is said to be chronic. There are different
types of chronic pain, many of which are not clearly
understood. Chronic pain may be associated with an
illness or disability, such as cancer, arthritis or phantom
limb pain. Some types of chronic pain start after an
accident. Others may start as acute episodes but then the
pain becomes constant over time, such as low back pain.
With some types of chronic pain, like migraine headaches,
the pain is recurrent, rather than constant. There are many
other kinds of chronic pain, such as chronic postsurgical
pain, fibromyalgia, temporomandibular disorders, etc.
While in some cases the cause of pain is known, in many
other cases it is not clear why pain persists.
Pain medication is helpful in managing chronic pain, but
the suitability of long-term use of medication needs to be
considered in regard to the individual and the type of pain.
Scientists are continuing to search for medications that
take the pain away but also allow people to continue to
function in their daily lives without side effects.
About one in ten Canadians has chronic pain. Chronic pain
affects both sexes and while it is most common in middle
age, it can occur at any age - from infancy to the elderly.
Chronic pain can make simple movements hurt, disrupt
sleep, and reduce energy. It can impair work, social,
recreational, and household activities. People who have
been injured in accidents may develop anxiety symptoms
as well as pain. Chronic pain can have a negative impact
on financial security, and can provoke alcohol or drug
abuse. It can disrupt marital and family relationships.
As no one can see pain, people who experience chronic
pain often feel alone in their suffering. Some people find
that the legitimacy of their pain is questioned. Given the
impact pain can have on quality of life, it is no surprise
that more than a quarter of all people who develop chronic
pain also experience significant depression or anxiety.
How can a psychologist help a person with chronic
pain?
Psychologists use several different techniques to help
people with chronic pain to recover their strength and
sense of self, and improve the quality of their lives, in
spite of the pain. Specific techniques to help people with
chronic pain include support, education and skill building
in areas such as relaxation, biofeedback, stress
management, problem solving, goal setting, sleep hygiene,
and assertiveness.
Source: Canadian Psychological Association www.cpa.ca
Cognitive approaches foster thoughts, emotions and
actions that are adaptive for managing a life with pain.
Behavioural approaches help people plan their activities in
ways that give them more control without increasing the
pain. Vocational assessment examines a person's interests,
aptitudes and abilities and is useful for individuals who
may need to change the way in which they work, or the
kind of work they do, because of pain. Psychological
therapy for anxiety and depression is helpful in managing
the emotional consequences of chronic pain. When
indicated, therapy for drug or alcohol abuse helps people
deal with addiction. For people who find that chronic pain
has affected their personal relationships, marital or family
therapy is often recommended.
Are psychological approaches effective?
Psychological techniques and approaches have been
proven to help people with chronic pain improve the
quality of their lives. People report that they are more
active, less depressed and anxious, and feel more in
control. Even though they continue to have pain, it is more
manageable.
While individual therapy may be offered, often people
with chronic pain are treated in groups where they are able
to share their experiences with others who live with pain.
As chronic pain is complex, psychologists often work on
teams with other health care professionals, such as
physiotherapists, occupational therapists, physicians,
nurses, social workers and pharmacists to help people with
disabling chronic pain develop satisfying and healthy
lifestyles.
They can put a man on the moon, and replace a heart, why
can't they get rid of my pain? Or: Is there research being
done to help people with chronic pain?
In addition to working directly with people who have
chronic pain, psychologists have advanced our
understanding of pain through different kinds of research.
Clinical research is done by psychologists in collaboration
with organizations and workers in an attempt to reduce the
incidence of some types of chronic pain, either through
injury prevention or early intervention programs. In
addition, research involving people with chronic pain has
helped develop effective management approaches.
Consultation with or referral to a registered psychologist
can help guide you as to the use of these therapies. For a
list of psychologists in your area, please press here.
Depression in Later Life
Is depression in later adulthood different?
The fact sheet on depression
(http://www.cpa.ca/factsheets/depression.htm) lists the
symptoms of depression, many of which are also
experienced by depressed older adults. Those symptoms of
depression most common in older adults are loss of energy,
decreased interest and pleasure in activity, pain and bodily
complaints, and complaints of memory problems.
Who is affected?
Although depression is not necessarily associated with
aging and older age, a significant number of seniors do
experience depression. About 15-20 % of older persons,
living independently in the community, experience clinical
levels of depression. There is a higher rate of depression
among patients with serious medical problems (25%).
Approximately 25% of older persons with Alzheimer’s
disease will struggle with depression in the early phase of
the disease. Further, among older adults living in nursing
homes and residential settings, the rate of depression is
even higher (between 30% and 50%). In addition, between
25% and 50% of older adults who care for a family
member with dementia will experience depression.
What are the other problems associated with
depression?
Depression worsens an older person’s experience of
medical problems and makes it harder for them to recover
from problems such as hip fracture and stroke. People are
less active and independent when depressed which, for the
older adult, can lead to declines in physical condition and
more disability. Depression increases the risk of death in
older adults by 2 to 3 times. Depression is the most
important factor associated with suicide in old age.
Why is depression often missed and/or under-treated
among seniors?
Depression can be hard to detect in older adults because
older adults are often reluctant to admit to psychological
symptoms or difficulties and are more likely to report
physical symptoms. Also, the myth that it is normal for
older adults to feel some amount of depression, may result
in true cases of clinical depression being overlooked.
What are the causes of depression in later life?
Some depressed older adults will have experienced
depression before and others will face depression for the
first time in their later years. The factors that put people at
risk for depression in later life are the same as those for
adults in general
http://www.cpa.ca/factsheets/depression.htm The factors
Source: Canadian Psychological Association www.cpa.ca
that seem to particularly trigger depression in older adults
are loss of control and independence as the result of
illness and/or disability, social isolation and lack of social
support.
What psychological approaches are useful to treat
depression among seniors?
Psychological treatments used with younger adults have
been found effective with older adults as well
(http://www.cpa.ca/factsheets/depression.htm). In
particular, cognitive behaviour therapy, interpersonal
therapy, problem-solving therapy and reminiscence
therapy are effective treatments.
Cognitive-behaviour therapy helps clients understand the
interactions among thoughts, feelings and behaviour and
how negative ways of thinking affect behaviour and
mood – thereby causing or maintaining depression.
Interpersonal therapy helps clients work through
depression by focusing on current stresses and challenges
in interpersonal relationships – these can include
conflicts with other people, grief following a loss,
changes in roles and activity, and a lack of social support.
Problem-solving therapy helps the depressed person cope
with current difficulties, such as managing a health
condition or adjusting to living in a nursing home, by
developing effective problem-solving skills.
Reminiscence therapy helps clients work through
depression by revisiting past and pleasant times,
rediscovering coping skills, and finding meaning by reevaluating good and bad aspects of their lives.
These psychological treatments are safe and effective
alternatives to drug therapy for mild to moderate
depression. Combined drug and psychological treatment
is usually recommended for severe depression. However,
research does not conclusively show that the combination
of treatments works better than either drug treatment or
psychological treatment alone. Psychological treatments
are of particular importance for people who are unable to,
or uninterested in, taking medications.
More information on depression in older adults,
including more detailed descriptions of psychological
treatments and other supports, can be found at this web
site: www.therapyadvisor.com.
Consultation with a registered psychologist can help in
the assessment and treatment of depression. For a list of
psychologists in your area, consult http://www.crhspp.ca/