Pseudobulbar affect (PBA) is uncontrollable laughter, crying, or other intense emotion that comes on without warning and can be hard to stop. PBA affects people who’ve had brain damage from a traumatic injury, stroke, or disease like Alzheimer’s, Parkinson’s, or amyotrophic lateral sclerosis (ALS).
When your loved one’s emotions shift suddenly, unexpectedly, and without provocation, you may feel uncertain of how to respond. Watching someone you care about have such intense emotional outbursts can be upsetting, and make you feel helpless.
Here are a few tips to help you anticipate your loved one’s needs during PBA episodes, and respond effectively.
1. Read up on PBA
Learn all you can about PBA, so that you’ll know what emotional changes to expect and how to react to them positively. For example, you should understand that PBA isn’t a mental illness — it’s a lack of emotional control caused by damage to the brain. Also, you should learn the signs and symptoms of PBA so you can distinguish PBA from depression, which can have overlapping symptoms.
Organizations like the American Stroke Association and Multiple Sclerosis Association of America offer detailed guides on their websites specifically targeted to people who have PBA because of these conditions. You can also read books or pamphlets about this brain disorder, or visit a neurologist with your loved one and ask questions.
2. Share the knowledge
Once you’ve become an expert on PBA, share the informational wealth by educating friends, co-workers, and other select people in your loved one’s life. The more they know about what causes PBA and how these outbursts manifest, the more understanding they’ll have when these episodes occur. Being surrounded by understanding people can lessen the stress, embarrassment, and grief someone living with PBA may feel.
3. Don’t get upset
Watching someone cry or laugh hysterically for no apparent reason, or in an inappropriate situation, can be upsetting. Don’t let your discomfort show. If you don’t act alarmed by PBA episodes, your loved one won’t get as upset by them either.
4. Be patient
Attacks of crying or laughter can be so uncomfortable that they feel as if they’re going on forever. In reality, these bouts only last for a few minutes. Refrain from offering comments in an attempt to speed them up. Just ride them out with your loved one.
Distraction is a useful tool during PBA episodes. Steer the conversation to a topic that’s unlikely to trigger an emotional response — like the color of the shirt you’re thinking about wearing to dinner, or the temperature outside. Also, sometimes trying to provoke the opposite emotional reaction can help stop the current one. For example, if the person is crying, tell a funny joke.
Counting is also a good way to take someone’s mind off their emotions. Count the number of books on the shelf, or letters on the screen. Lead your friend through some deep breathing exercises until they regain control. Animals can be wonderful distractions, as well. If you have a cat or dog, put it on their lap to change their focus.
6. Push for treatment
Antidepressants, and the newer drug dextromethorphan hydrobromide and quinidine sulfate (Nuedexta), reduce the number of PBA episodes and make the ones that do happen less intense.
Make sure your loved one visits a neurologist, neuropsychologist, or another doctor who treats this condition to get started on the right therapy. You might also recommend counseling to help them deal with the stress and embarrassment PBA can cause.
7. Get out of the house
PBA can be so embarrassing that people who have it avoid any social situations rather than risk a public outburst. Staying inside can lead to loneliness and a lower quality of life.
Try to encourage your loved one to get out of the house — even if just for a short time. Get together with friends who are aware of PBA and are empathetic.
Be sure to avoid venues that could prove problematic during an episode — like a quiet movie theater or library. Instead, go to the park, an outdoor festival, or a friend’s house where sudden laughter or tears either won’t be noticed or will be understood.