Understanding emotional lability
Brain injury can change parts of the brain that regulate or control emotional behaviour and feelings
Emotional lability refers to rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying, or heightened irritability or temper) occur. These very strong emotions are sometimes expressed in a way that is not related to the person’s emotional state.
What causes emotional lability?
Emotional lability occurs because of damage to parts of the brain that control:
• Awareness of emotions (ours and others)
• Ability to control how emotions are expressed, so ability to inhibit or stop emotions emerging
When a person is emotionally labile emotions can be out of proportion to the situation or environment the person is in. For example, a person may cry, even when they are not unhappy – they may cry just in response to strong emotions or feelings, or it may happen “out of the blue” without warning.
A person may have little control over the expression of these strong emotions, and they may not be connected to any specific event or person.
Following a brain injury an individual may also lose emotional awareness and sensitivity to their own and others emotions, and therefore their capacity to control their emotional behaviour may also be reduced.
They may overreact to people or events around them – conversations about particular topics, sad or funny movies or stories. Weaker emotional control and lower frustration tolerance, particularly with fatigue and stress can also result in more extreme changes in emotional responses.
The person may express their emotions in situations where previously they would have been able to control (in quiet situations, in church, listening to a concert).
These behaviours can be confusing, embarrassing, and difficult to understand for the person with brain injury and for others.
Emotional responses after Acquired Brain Injury - become aware of triggers
• Be aware of triggers for emotional lability and try to avoid these when you can. Triggers can include: excessive fatigue or tiredness
• Stress, worry or anxiety
• High stimulation (too demanding, too noisy, too many people) and too much pressure
• Strong emotions and demands from others
• Very sad or funny situation (such as jokes, movies, certain stories or books)
• Discussing certain topics (e.g. driving, loss of job, relationships, death of a family member)
• Speaking on the telephone or in front of a group or where a person feels under pressure.
Have a break
Have a short break away from the situation so the person can regain control of emotions, and to give the opportunity for emotions to settle.
Sometimes a break for a few minutes or longer period is enough to regain control of emotions – taking a short walk, doing a different activity all can help to cope with these strong emotions.
Ignore the behaviour
Try to ignore the emotional lability as much as possible. Try to get others to ignore it too and continue on with the conversation or task.
Focussing on the lability, or giving the person too much attention when it is happening, can reinforce the problem. It is important that other people don’t laugh too, as this will also reinforce and increase the behaviour.
Change the topic or task
Changing the topic or activity (redirection and distraction) can reduce stimulation or stress (particularly if the topic was a trigger). Try to distract or divert the person’s attention by engaging them in a different activity or task.
Provide information and education
Uncontrolled crying or laughing can be upsetting frightening or confusing for other people if they don’t understand so:
Provide simple explanations of information to other people about the lability e.g. “I cry a lot since I had my stroke….don’t worry about it” or “Sometimes when I am nervous I get the giggles”.
Tell people what they should do e.g. just ignore me and it will stop”.
When there is severe emotional lability, one-to-one, brief and fun activities in a quiet environment will be better. Try to avoid putting the person in stressful situations or environments e.g. noisy, busy, high levels of activity or a too demanding.
Plan activities that are within the person’s ability, and plan more demanding activities or appointments after rests, or when the person has the most energy. Plan for rests between activities.
Use cognitive techniques
Some simple cognitive strategies can also assist in managing emotional lability:
• Relaxation and breathing exercises to reduce tension and stress
• Use distraction e.g. thinking of something else, imagining a peaceful image or picture, counting
• Do an activity (going for a walk)
• Discuss cognitive and behavioural strategies (e.g. ‘thought stopping’|) with a psychologist.
Counselling and support
Sometimes a person has had many losses and changes to cope with after the brain injury – loss of work, ability to drive, independence, changes in relationships or finances, and lower quality of life. These changes can happen suddenly with little chance to prepare for them.
These feelings of sadness, grief, anger, frustration, disappointment, jealousy or depression after an injury are common and may be difficult to cope with.
If there are other emotional adjustment and coping issues, referral to a councillor such as a psychologist, social worker or psychiatrist may be helpful. Families (parents, siblings, partners, children), friends and carers may also benefit from support and care to help them understand and to cope with these changes.
Thank you to The Brain Injury Association of Queensland for the article in Synapse Bridge Magazine the official journal of BIAQ. This article was first printed from the ABIOS fact sheets available at www.health.qld.gov.au/abios.