Occupational Therapy Helps People with Pseudobulbar Affect

Pseudobulbar Affect:  Laughing When Crying

People with neurological condition such as Brain Injury, Stroke, ALS, Parkinson’s, and MS sometimes have a condition called Pseudobulbar Affect.  It is a frustrating and embarrassing condition because pseudobulbar affect results in episodes of uncontrolled laughing or crying.  The laughing or crying doesn’t match your inner feelings and is more intense and often inappropriate.  And it can have a substantial impact on your life and the lives of your family members and caregivers.  It can cause anxiety that leads to withdrawal and social isolation.

What Causes Pseudobulbar Affect?

Pseudobulbar affect goes by many names – emotional lability, pathological laughing and crying, involuntary emotional expression disorder, compulsive laughing or weeping, or emotional incontinence. It is believed to be caused by a disconnect between the frontal lobe and the cerebellum and brainstem. And, sadly, it is often misdiagnosed as depression, bipolar disorder or other psychological conditions.

When assessing if pseudobulbar affect is an issue for you, it’s important to know the difference between mood and affect.  Mood is your inner feelings and emotions such as sadness, anger or happiness. Affect is the visible display of emotion that others can see, such as smiling, laughing or crying.  Pseudobulbar affect is a display of laughing or crying that doesn’t match your feelings or the intensity of your feelings.  Involuntary outbursts of anger or frustration may also occur.  The laughing, crying and/or anger can:

• Be unpredictable, sudden and involuntary.
• Be out of proportion to the trigger.
• Happen for no apparent reason.

How to Function in Your Daily Tasks with Pseudobulbar Affect

So how do you cope with something like pseudobulbar affect?  Although there’s no cure, there are medications and management strategies you can use to help cope with it.  

Pharmaceutical options include Nuedexta®, a medicine developed specifically to treat pseudobulbar affect and Antidepressants tohelp manage the symptoms of PBA (the doses are typically lower than the doses required to treat depression).

Occupational therapy can also play an important role in helping patients manage pseudobulbar affect.  Your occupational therapist can help you:

• Understand what is happening:  It is helpful to get reassurance that this is a fairly common occurrence with neurological disorders; that you are not alone and you are not going crazy.
• Effectively explain what is happening to your family, friends, and coworkers:  Your occupational therapist can help you develop different explanations with different levels of complexity to let others know what’s happening to you.
• Distraction Strategies:  Some people can feel pseudobulbar affect coming on and can use distraction strategies to divert or reduce the intensity.  Distraction strategies include distraction of thoughts, changing position or activity you’re involved in, and therapeutic breathing.
• Relaxation Techniques:  Because pseudobulbar affect can lead to anxiety and withdraw, your occupational therapist can help you develop relaxation techniques to manage anxiety and allow you to function in your daily tasks.

Because sadness, depression, anger, and joy are all real emotions people with neurological conditions experience, it is important to determine if displays of these emotions are caused by matching underlying feelings.  If so, addressing depression or anger management is a priority.  If the underlying feelings do not match these displays, then pseudobulbar affect may be the issue.  In that case, the goal of treatment is to reduce the frequency and severity of episodes so you can function better in your daily tasks.