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Pseudobulbar Affect (PBA) After a Stroke: When Emotions Go on a Rollercoaster Ride

Updated: Nov 10, 2023

Imagine this: you've had a stroke, and you're trying to recover, but suddenly, you find yourself laughing or crying at unexpected moments. It's like your emotions are on a rollercoaster. This is a real thing, and it's called Pseudobulbar Affect (PBA).

man with pseudobulbar affect having a belly laugh
inappropriate laughter can be hurtful to others if they don't understand there's a medical cause.

What is Pseudobulbar Affect?

PBA is when your emotions act a little wild and don't match what's happening. For example, you might burst into laughter during a serious conversation, or tears might flow even when you're not sad.

It's more common after a stroke or other brain injuries. And more people experience tears than do laughter.

Why Does PBA Happen After a Stroke?

When a stroke happens, it can damage the brain's emotional control center. This can make emotions harder to manage. PBA occurs in 1 of 5 stroke survivors according to one study.

Recognizing PBA Symptoms

If you've had a stroke and wonder if you have PBA, here are some signs:

1. Inappropriate Laughter or Crying: You laugh or cry when it doesn't fit the situation.

2. No Connection to Feelings: Your emotions don't match how you really feel.

3. Happens Often: These emotions pop up more often than before.


Dealing with PBA After a Stroke

The good news is there are ways to manage PBA. You don't have to ride that emotional rollercoaster forever. Here's what you can do:

1. Talk to a Doctor. Your healthcare team can help. There is a medicine prescribed for PBA, but it doesn’t help everyone. It’s a discussion to have with your doctor. But you might also request a referral to speech therapy to get help in developing strategies to address PBA.

2. Share your condition with family and friends. It is important that your family and friends understand that this is part of a medical condition. Relationships can be harmed by inappropriate laughter or excessive tears. But when people understand PBA, they can be more supportive and less judgmental during emotional episodes. If there is an ill-timed crying or laughing episode it can seem insensitive and may be hurtful to others.

3. Talk to others who have PBA. This will provide understanding and support from others who have endured a similar experience.

Strategies for PBA

For most people who experience PBA, the heightened emotional episodes do lessen with time. There are some strategies you can try to help mitigate the sudden urge to cry or laugh in an inopportune moment.

1. Distract yourself. If the urge is to cry, think of something lighthearted. If the urge is to laugh, picture something more serious. Or concentrate on something that has a lot of detail or simply requires some mental effort, like counting backwards by 4’s. Each person will find what works best for them. And it can vary based on the situation and communication partner.

2. Focus on your breath. Take slow long deep breaths and put all your energy into controlling your breath until the urge passes.

3. Change your position. If you are standing, shift your weight or take a seat. Distract yourself with a physical action that is acceptable to the situation.

4. Keeping a diary can help you track your emotions and identify triggers for PBA episodes. This self-awareness can be a powerful tool for managing your condition.

PBA can be tough, but remember, you're not alone. Many people who've had strokes deal with PBA and find ways to manage it. With the right help, you can regain control of your emotions and continue your journey toward recovery.

Find an adult speech therapist specializing in stroke rehabilitation with Amplify Speech Therapy, based in Eugene - providing speech therapy to all of Oregon.

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