Hundreds of people in the Lac-Megantic region have sought psychological help for anxiety, flashbacks and a "terrible fear" of the area's train tracks following last year's rail catastrophe, says the local health authority.
And the patient list continues to grow as the first anniversary of the fatal derailment approaches, with about five new clients knocking on the Quebec agency's door each week.
The clinical co-ordinator for psychosocial assistance said her team treated 423 people in the Lac-Megantic area during the last 10 months in interventions that included 188 group and 2,035 individual therapy sessions. The town itself is home to fewer than 6,000 people.
"Many, many of them have been left with after-effects of the disaster," said Mychelle Beaule, adding that a handful of locals developed a "terrible fear" of the tracks that zigzag their way across the railroad town.
She described in an interview how therapy included gradually accompanying some people to the tracks and reassuring them that nothing would happen if they stepped over the rails.
Beaule painted a picture of a community still struggling to cope, even as it prepares to the mark the one-year anniversary this weekend of the July 6 crash.
A year ago Sunday, a runaway tanker train carrying volatile crude oil careened off the tracks in Lac-Megantic, setting off huge explosions that destroyed part of the downtown area and killed 47 people.
Beaule said her team has had success in treating many of the patients, the vast majority of whom were suffering from symptoms of post-traumatic stress disorder, including flashbacks and physical distress upon hearing certain sounds.
But she expects the suffering for some to resurface during this weekend's commemorative activities. A number of locals have already said they will steer clear of the events, which will attract a lot of media attention.
"We have many people who are doing OK and who know that the July 6 commemoration will be another painful step," Beaule said.
"Many of them are in a hurry to get to July 7."
Beaule said the health authority currently follows about 120 people with individual therapy and around 40 in group sessions.
She said the locals who have sought help for the first time in recent months are those who thought they could manage their symptoms without professional assistance.
"They arrive more fragile, more worn out because they tried to sort things out on their own and maybe it took more of their energy than they thought," she said.
Patients seen during the last year have included children affected by the disaster, several whom lost one or both parents.
Other kids, Beaule said, developed problems after witnessing the explosions or even by hearing adults discuss the destruction.
Last winter, the grief was so prevalent in town that group sessions were organized to help massage therapists, estheticians and hairdressers learn how to talk to clients suffering in the disaster's aftermath. The discussions were also aimed at helping them protect themselves from developing symptoms of their own as a result.
Beaule said similar group sessions will be held this month for local restaurant servers, bar staffers and taxi drivers to help them learn how to field probing questions by curious tourists.
"It's going better for many, (but) there's still more road to cover," Beaule said of Lac-Megantic's recovery.
"It will be a big weekend (of commemorative events), but I think that afterwards maybe we will finally get to start the summer that we didn't have last year."
Follow @AndyBlatchford on Twitter