Pseudobulbar affect (PBA) causes uncontrollable emotional outbursts—like hysterical laughing or crying—that often don’t fit the situation. PBA may embarrass and confuse those who live with the condition, leading many to retreat from public events. Fortunately, several coping strategies can help minimize the affect PBA episodes have on daily life.

“You Don’t Have to Miss Out on Everything:” Delanie’s Story

After she suffered a stroke in 2012, Delanie Stephenson developed PBA (also known as emotional lability, emotional incontinence, labile affect, or forced crying and laughing). Over the past 6 years, Stephenson has learned how to cope with her condition. But in the early days, she struggled with how to limit its interference in her life.

PBA’s emotional episodes may be triggered by specific situations. For Stephenson, her PBA was provoked by crowds. This turned church—once a place of solace—into a trigger.

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“I avoided going to church, and I hated that,” Stephenson said. “But the swarm of people coming and going would set me off. I’d have crying episodes in the lobby because there were too many people.”

One of Stephenson’s top PBA coping tips is to avoid situations that trigger PBA. But as the weight of total avoidance from church began to wear on her, Stephenson found a workaround: Attend services at a Sunday school instead of the main church.

“If it’s really important to you, find alternative routes,” she said. “You don’t have to miss out on everything.”

Coping Strategies When Emotions Erupt

When you feel a PBA episode coming on, in-the-moment coping skills may minimize the emotional response. Below are effective strategies, some of which Stephenson employs in her everyday life:

  1. Switch your body position. If you’re sitting at the onset of a PBA episode, stand up. If you’re standing, sit down. “Doing the opposite of what you’re doing distracts your body and preoccupies your mind,” Stephenson said.
  2. Distract yourself. Distracting yourself diverts your mind away from the emotional outburst. Change the subject, walk away, focus on an interesting piece of art on the wall—anything to divert your mind away from the emotion that you’re feeling.
  3. Remove yourself from situation. It sounds simple enough, but that’s not always the case. PBA episodes vary from person to person. In Stephenson’s case, her episodes take over her “whole physical being,” so it can be hard to move once one hits.

“If I’m standing, it feels like I’m going to fall to the floor because I cry so hard that I forget to stand and breathe,” she said. “It’s sometimes hard to do this, but removing yourself from the situation helps.” Stephenson recalled a PBA episode she had in church. She started laughing during the preacher’s sermon, drawing eyes from fellow worshippers.

“I got up and walked to the lobby,” she said. “By the time I got to the lobby, I didn’t even know why I was laughing. I felt silly, but that bit of separation was enough to collect my thoughts and stop the episode.”

  1. Breathe the episode out. Stephenson said deep breathing helps calm her down during a PBA episode. Take slow, deep breaths until the episode subsides. Breathing will also help you relax your body and release tension, which has also been shown to minimize the severity and duration of outbursts.

Strategies to Minimize Pseudobulbar Affect Between Episodes

Between emotional episodes, patients have several ways to reduce PBA’s grip on daily life.

Many patients like Stephenson rely on a combination of medication and conservative therapy (like exercise) to manage PBA. Stephenson takes Neudexta, which is the only drug approved by the US Food and Drug Administration (FDA) to treat PBA. While Neudexta isn’t a cure for PBA, it may reduce the number of episodes.

In addition to using Neudexta, Stephenson focuses on reducing unnecessary stress by keeping her schedule simple. Even as a mother of two busy preteens with after-school activities and her own regular doctor’s appointments, Stephenson puts boundaries on her to-do list.

“When I get tired, overwhelmed, and stressed, that’s when I can feel the PBA emotions coming on,” she said. “If I see too many dots on my iPhone calendar, that can get me overwhelmed.”

Stephenson’s minimalistic approach to her schedule means she limits herself to one or two activities a day.

“Remember that you don’t have to get everything done in a day,” she urged fellow people with PBA. “If I don’t mark anything off my to-do list, it’s not a sign of failure. It’s just the way life is.”

Another way to stave off PBA episodes to keep yourself restored throughout the day. For Stephenson, she takes a daily nap to stay rested.

“If I don’t get a nap in, it can cause me to have PBA episodes, especially crying ones, in the evening,” she said.

Relaxation exercises, such as yoga and meditation, are also effective at promoting a calm mental state throughout the day. Many patients, Stephenson included, also enjoy other activities (like walking or biking) to help relieve tension, promote their overall health, and reduce the number and severity of their PBA episodes.

The Essential PseudoBulbar Affect Coping Strategy: Talking About It

Many people with PBA are afraid to leave their home because they worry what other people will think of them—even loved ones.

Talking to your family, friends, and co-workers about PBA is a liberating act. By talking about PBA, you’ll help others understand your condition and may not feel the need to explain or apologize if an episode occurs.

It’s also beneficial for those around you. They can better respond to you during an episode. They’ll understand that your emotional responses are not in your control, and that this is a real condition that you’re actively managing. And they can be a better source of support for you.

Every person with pseudobulbar affect (PBA) has their own unique experiences with the condition. While these coping strategies may help one person with the disorder, they might not help all. If you’re struggling to manage your forced crying and laughing, talk to your doctor about ways you can better cope. PBA may change your life, but it doesn’t have to control it.

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Last Updated: Nov 25, 2018