Pseudobulbar Affect (PBA) in Occupational Therapy – Emotional Incontinence?

Pseudobulbar Affect Featured

Pseudobulbar affect. It goes by many names – emotional lability, emotional incontinence, involuntary emotional control disorder, and more. Is your patient really depressed or bipolar, or is there another root cause for this?


Pseudobulbar affect typically affects patients with a neurological condition such as stroke, ALS, Parkinson’s, MS, TBI, and dementia.

It is often misdiagnosed as another psychological disorder such as depression.

Pseudobulbar affect is believed to be caused by a disconnect between the frontal lobe and the cerebellum and brainstem, such as due to a stroke.


How does pseudobulbar affect present?

When I worked with patients in occupational therapy, typically the patient’s emotional response such as laughing or crying seems out of place. I could be doing an interview for an evaluation and the patient starts to cry when asked a “regular” question. Or I could be doing ADLs with my patient such as brushing teeth or grooming and they start to have uncontrolled episodes of laughing.

A someone similar analogy is if you ever played with a baby, they may sometimes have those laughing episodes and anything you do seems funny to them and they keep laughing. Or the opposite occurs and they keep crying.

The most telling symptom of pseudobulbar affect is that it seems out of place and may have frequent episodes of laughing or crying. To someone untrained such as a student, it may seem like the patient is really in distress such as when they are crying. Knowing that they may have pseudobulbar affect will not alarm you and better prepare you to handle the situation.

The doctors and specialists on my team were pretty good about bringing it up in meetings when they believed the patient had pseudobulbar affect. Although OT’s do not diagnose conditions – once you experience it with a patient, you get pretty good at suspecting it compared to other conditions such as depression.


What can be done to treat this condition? There are ongoing trials with medications to treat psuedobulbar affect.

• Antidepressants
• Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta)

Occupational therapy can also play an important role in helping patients manage psuedobulbar affect with their occupations. Think about how stressful or difficult it may be to have uncontrolled emotions that you may not be able to stop. It may be very embarrassing, especially in public and lead to social isolation and occupational deprivation.

It is important to educate both the patient and family members about the condition so that they are aware of it. There can be ways to cope when the patient believes they may have an episode with distraction of thoughts, therapeutic breathing, changing position, and relaxation. Overall, occupational therapists can help patients who have pseudobulbar affect function in their daily tasks and other occupations using a holistic approach that is tailored to the patient and their caregivers in their environment.

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.