PORT HAWKESBURY, N.S. -- Lionel Desmond made little progress during a psychological trauma treatment program he underwent less than a year before killing three family members and himself, a fatality inquiry heard Wednesday.

Isabelle Gagnon, a psychologist who in 2016 worked at Ste. Anne's Hospital in Montreal, said the former soldier from Nova Scotia had persistent problems managing severe symptoms of post-traumatic stress disorder, trusting others and regulating his emotions -- especially anger.

"When he came in, his only (coping) skill was avoidance," she said, referring to the Afghanistan war veteran. "That only works to a certain extent .... It has limited applications."

The clinical psychologist told the inquiry about 10 people were involved in his care, which included an initial stabilization phase, followed by a seven-week, residential phase that featured group therapy with other veterans and other treatments.

Gagnon confirmed Desmond often avoided talking about the traumatic events he experienced as a combat soldier in 2007 and instead focused on his troubled relationship with his wife and young daughter.

"He wanted to find something he could fix," she testified, adding that Desmond was also preoccupied with the poor state of his finances and finding a new job.

At one point, Desmond told the psychologist he would sometimes resort to angry outbursts when dealing with his wife, Shanna, but he said he was never violent. The inquiry has heard that Desmond's wife had told others she and her daughter had never been physically harmed by her husband.

Still, Gagnon said Desmond remained volatile and quick to anger towards the end of his treatment, though he had shown some progress on this front. And he continued to view others through a "distrust lens," she said.

As a result, Desmond had lost trust in his treatment team by the time he left the program, she said.

"There was some success, but I would say it was limited," Gagnon told the inquiry. "His skewed perception of others was still there."

Despite the treatment, Desmond still needed help with emotional regulation and managing his PTSD symptoms, she said. "There still remained quite a lot of work to be done."

On another front, Gagnon said she was concerned the former infantryman, who was medically released from the military in 2015, may have been struggling with cognitive issues.

She said he had trouble integrating information, staying focused and initiating actions, and he was impulsive. As well, she reported in her notes that Desmond displayed tangential speech patterns, which meant he found it difficult to answer questions without talking about unrelated topics.

The inquiry has heard Desmond reported suffering three head injuries while serving in the military, though he did not report those accidents until after he was discharged.

The source of Desmond's cognitive issues was unclear, Gagnon said. That's why she recommended he receive a neuropsychological assessment -- a test that was beyond the scope of the Montreal clinic. The assessment never happened.

When asked if his PTSD was the main source of Desmond's distress, Gagnon said: "That would be a very big oversimplification." She said she also saw signs of "borderline personality traits," but she stressed this was not a diagnosis.

On Tuesday, psychiatrist Robert Ouellette testified that Desmond suffered from "mixed personality traits," which mainly involved obsessive compulsive and paranoid behaviour. Ouellette said these traits made Desmond suspicious of other people's motives and unwilling to trust others.

As well, Ouellette said these traits seemed to feed Desmond's mistrust and jealousy towards his wife.

Ouellette said those traits weren't caused by Desmond's PTSD, but the condition may have exacerbated them.

On Wednesday, Gagnon said Desmond's persistent mistrust and avoidance of stressful situations could be a function of personality traits that developed when he was growing up in Guysborough County in eastern Nova Scotia.

"He gave me some clues when he was young and he felt rejection from his peers," she told the inquiry, adding that as an African Nova Scotian, Desmond said he had faced racism and poverty. But there wasn't enough there to draw a firm link to Desmond's personality traits, she said.

Desmond left the clinic on Aug. 15, 2016, and returned home to Upper Big Tracadie, N.S., where he planned to work on his relationship with his family.

For the next four months, he received no therapeutic treatment, though Veterans Affairs was in the process of finding more help for him.

On Jan. 3, 2017, Desmond bought a rifle and killed his 31-year-old wife, their 10-year-old daughter, Aaliyah, and his 52-year-old mother, Brenda, before turning the gun on himself inside the family's home in rural Nova Scotia.

This report by The Canadian Press was first published March 3, 2021.