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.
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.