Trauma & PTSD · Kitchener, Waterloo & Cambridge
A traumatic experience is one that involves actual or threatened serious harm to you or to someone else. Post-traumatic stress disorder (PTSD) is diagnosed when the after-effects, such as reliving the event, avoiding reminders and staying on guard, last longer than a month. It is treatable: the UK guideline says to offer individual trauma-focused cognitive behavioural therapy, and Canada’s guideline lists that and EMDR among the effective approaches. At CARESPACE you start with a counsellor, a Registered Psychotherapist or Registered Social Worker; ask when you book for one trained in trauma-focused therapy.
What trauma and PTSD are
Trauma is common. More than 76 in 100 Canadians report having been exposed to a significantly traumatic event, and not everyone who goes through one develops PTSD. About 9 in 100 Canadians have PTSD at some point in their lives, women about twice as often as men. It usually appears within three months of the event, though sometimes not for years.
PTSD used to be grouped with the anxiety disorders and is now classed separately, as a trauma- and stressor-related disorder. Complex PTSD has largely the same symptoms, together with persistent beliefs about oneself as diminished, defeated or worthless. It is linked to experiences such as abuse or neglect in childhood, ongoing domestic violence, or repeatedly witnessing violence.
An estimated 75% of people with PTSD have another mental health condition as well, such as depression. Unwanted memories are one kind of intrusive thought, and feeling detached or unreal is covered on our dissociation page.
Symptoms of PTSD
- Re-experiencing: unwanted memories, nightmares, or feeling as if the event is happening again
- Avoiding the activities, places or people that are reminders
- Being on guard all the time, easily angered or irritable
- Trouble sleeping and concentrating
- Negative changes in mood and thinking, including losing interest in things you used to enjoy
- Emotional numbness
- Dissociation
- Difficulty managing emotions
- Problems in relationships
- Feeling diminished, defeated or worthless
What causes PTSD
The NHS in the UK lists the kinds of events that can lead to it:
- A serious or life-threatening accident
- Physical or sexual assault
- Abuse, including childhood or domestic abuse
- Certain jobs, such as police officer, paramedic or healthcare worker
- Serious health problems, such as time in intensive care
- A difficult birth, or the death of a baby
- War
In Canada the traumas that most often result in PTSD include the unexpected death of someone close, sexual assault, serious illness or injury to someone close, having a child with a serious illness, and being beaten by a partner or caregiver. In Waterloo Region that list takes in collisions on the 401 and work in the region’s hospitals and emergency services.
Whether PTSD follows depends on more than the event. It is more likely after earlier trauma, with a history of mental health or substance use problems, with little support afterwards, and when further stress follows, such as a bereavement, an injury or losing a job or home. Support from other people is protective.
How PTSD is diagnosed
The diagnosis needs symptoms from four groups, re-experiencing, avoidance, negative changes in mood and thinking, and heightened arousal, lasting longer than one month. In the first month, for symptoms that fall short of PTSD, the UK guideline’s approach is to consider active monitoring, also called watchful waiting, with a follow-up contact within a month. Diagnosing PTSD is the work of a physician, nurse practitioner, psychiatrist or psychologist. Registered Psychotherapists and Registered Social Workers treat it with therapy and do not diagnose or prescribe.
When it is urgent
If you are in danger from another person right now, call 911.
PTSD raises the risk of suicide attempts two- to three-fold.
If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.
If you are in crisis or thinking about suicide, help is available right now.
- Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
- Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
- Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.
The emergency departments in Waterloo Region are:
- WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
- WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
- Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge
If you cannot get there safely, call 911.
Two local organizations work with people living with violence. Women’s Crisis Services of Waterloo Region supports women and children, including transgender and gender-diverse people, to move beyond domestic violence, and its 24-hour support lines are 519-742-5894 in Kitchener-Waterloo and 519-653-2422 in Cambridge. The Sexual Assault Support Centre Waterloo Region, in Kitchener, has a 24-hour support line at 519-741-8633.
What the evidence says about treating PTSD
- The sources. The UK’s PTSD guideline (NICE, 2018), Canada’s 2014 guideline for anxiety and related disorders, and the 2023 guideline of the US Departments of Veterans Affairs and Defense, written for veterans and service members. “Offer” and “recommend” are firm positions; “consider” and “suggest” are weaker, and say as much about how sure the panel was as about the trials.
- Trauma-focused CBT comes first. In the UK it is offered, one to one, to adults with PTSD or clinically important symptoms more than a month after the event. The named forms are cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy and prolonged exposure, typically over 8 to 12 sessions.
- EMDR. For trauma that was not combat-related, the UK guideline says to offer eye movement desensitization and reprocessing when someone presents more than three months after the event, and to consider it between one and three months if the person prefers it. On combat trauma the guidelines differ: the UK one judged that the evidence did not support EMDR for military combat-related trauma, while the US guideline for veterans and service members recommends EMDR alongside cognitive processing therapy and prolonged exposure. In pooled comparisons, individual trauma-focused CBT and EMDR appeared about equally effective.
- Debriefing is not recommended. Do not offer psychologically-focused debriefing to prevent or treat PTSD, is the UK wording. Debriefing everyone after a trauma may have an adverse effect on some people; identifying and treating those who need it is preferred.
- Medication is second in line. Venlafaxine or an SSRI such as sertraline is to be considered for adults who prefer drug treatment (UK); Canada’s first-line medicines are fluoxetine, paroxetine, sertraline and venlafaxine XR. Whether adding medication to therapy helps is unsettled: two trials found no advantage, a more recent one did, and the question needs further study.
- What is advised against. Benzodiazepines, on both counts. They should not be offered to prevent PTSD, since early use after trauma was not beneficial and may increase the risk, and the US guideline recommends against them as a treatment. It also recommends against cannabis or cannabis derivatives.
- When other problems are present. With depression, the PTSD is usually treated first, because the depression often improves with it; the depression is treated first if it is severe enough to make therapy for PTSD difficult, or if there is a risk of the person harming themselves or others. Drug or alcohol problems alone are not a reason to refuse someone treatment. With complex PTSD, extra time is built in to develop trust.
What a doctor may offer
The medicines above are prescribed by a physician, nurse practitioner or psychiatrist. For nightmares, prazosin has reduced trauma nightmares and improved sleep in trials; the US guideline suggests it for nightmares while suggesting against it for PTSD as a whole. CARESPACE counsellors do not prescribe, but it helps to know where medication fits.
How CARESPACE helps with trauma and PTSD
Counselling & Psychotherapy
Trauma-focused CBT includes education about reactions to trauma, strategies for managing arousal and flashbacks, safety planning, working through the trauma memories, and rebuilding the parts of life that have narrowed. EMDR is delivered in phases: self-calming techniques and ways of managing flashbacks are taught, and the memory is then processed using repeated bilateral stimulation, normally eye movements.
CARESPACE counsellors offer cognitive behavioural therapy (CBT). Trauma-focused CBT and EMDR are specific methods that follow validated manuals, so when you book, ask for a counsellor trained in the one you want. If none is available, ask a physician or nurse practitioner about a referral.
More about cognitive behavioural therapy (CBT) →
Other services people ask about
Massage therapy and occupational therapy. Neither is mentioned for PTSD in any of the three guidelines, so there is no evidence to report.
Acupuncture. The Canadian guideline cites one randomized trial in which acupuncture did better than a waiting list and as well as group CBT, and says of alternative therapies in general that more data are needed. The US guideline finds insufficient evidence to recommend for or against acupuncture, yoga or exercise for PTSD, and the UK one does not mention them.
Where most people start
Start with a counsellor. The treatments with the firmest support are talking therapies. See a physician or nurse practitioner as well if you want an assessment or want to discuss medication.
How your team works together
PTSD care is mainly one service, counselling. Medication, where it is used, comes from a prescriber, so let each know what the other has recommended.
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Weekend availability
Cliann Dsouza, BA, MA, RP (Qualifying)
Psychotherapist
You may be feeling overwhelmed, emotionally drained, or caught in worries that are difficult to switch off.
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Evening availability
Zoey Hu, BA, MA, RP
Psychotherapist
If you’re searching for counselling in Waterloo, you’re probably not looking for a generic therapist.
Browse by service: counselling.
What to expect at your first visit
The first visit, with a counsellor, is for understanding your concern and coming up with a plan. It may touch on:
- What is happening now. Memories, nightmares, sleep, being on edge, what you avoid.
- How long it has been going on. And whether it is getting better, worse or staying the same.
- The event, in outline. How much detail a first visit needs is something to raise with the counsellor at the start.
- What else is in the picture. Low mood, alcohol or drug use, medicines, earlier treatment, and whether you are safe now.
Bring notes if saying it aloud is hard. You leave the first visit with a plan.
What you can do at home
The sources say little about self-help for PTSD, and what they do say is about people. Support from friends and family is protective, and so is taking part in a support group. Look for a peer support group facilitated by people with mental health training.
Outlook
People can recover from PTSD. Some recover within six months and others take much longer. The gains from therapy have held for one to ten years in follow-up studies, although about a third to a half of people still have substantial symptoms after a course of CBT.
Trauma and PTSD treatment in Kitchener, Waterloo and Cambridge
Kitchener. Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.
Waterloo. Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.
Cambridge. Counselling in Cambridge. Location: Hespeler Road.
The city pages linked above show the locations and practitioners for each service, with their next availability.
Common questions
Do I have to talk about what happened?
The therapies with the firmest evidence do involve working with the memory. For people who cannot or do not want to do that, an option to consider is CBT aimed at particular symptoms such as sleep or anger. Tell the counsellor at the start what you are ready for.
What is EMDR?
Eye movement desensitization and reprocessing: a phased therapy in which a trauma memory is processed while you follow repeated side-to-side stimulation, normally eye movements. It typically runs 8 to 12 sessions. Ask when you book for a counsellor trained in it.
Is it PTSD if the event was only a few weeks ago?
Not yet. PTSD is diagnosed only when symptoms have lasted longer than a month. In the first month, trauma-focused CBT can be offered to people with acute stress disorder or clinically important symptoms, and watchful waiting is considered for milder ones.
Can massage or acupuncture treat PTSD?
Massage is not mentioned in the guidelines. For acupuncture there is one trial, and the evidence is rated insufficient either way. Neither replaces trauma-focused therapy.
Is there trauma counselling in Cambridge?
Yes. CARESPACE offers counselling in Cambridge as well as in Kitchener and Waterloo. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.
Do I need a referral?
No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →
Sources
- National Institute for Health and Care Excellence (UK). Post-traumatic stress disorder (NG116), 2018.
- Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 2014.
- US Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Provider Summary, version 4.0, 2023.
- Centre for Addiction and Mental Health (CAMH). Posttraumatic Stress Disorder.
- NHS (UK). Post-traumatic stress disorder (PTSD), reviewed April 2026.
- Women’s Crisis Services of Waterloo Region. wcswr.org, viewed November 2026.
- Sexual Assault Support Centre Waterloo Region. 24 Hour Support Line, viewed November 2026.
- College of Nurses of Ontario. NP Practice Resources (what Nurse Practitioners are authorized to do), viewed November 2026.
- College of Psychologists and Behaviour Analysts of Ontario. The Controlled Act of Communicating a Diagnosis (registration guidelines, section H), viewed November 2026.
- 9-8-8: Suicide Crisis Helpline. 988.ca.
- Here 24/7 (addictions, mental health and crisis services, Waterloo Wellington). here247.ca.
Related conditions
Ready to book?
Book online with a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.