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Hi Deigh,Never!!!!!We will get NZ added, and I will let you know here.Very remiss of us!Diana

Ahh, very pleased about that, was not keen on ending up a misplaced person. At this time I should thank Victoria for giving me a temporary home.I read somewhere someone's comments about heightened senses. One of the first problems I had after my stroke was trying to control the emotions, I couldn't even have a pleasant thought without bursting into tears. I found this a hurdle in being able to mix with people again.I find now after four months that I have got it mainly under control, but it has not vanished completely and I have to avoid serious TV films and keep away from any discussion about children getting hurt, bullied or inflicted with illnesses. My right eye still has slight weeping problems and I use this as an excuse to dab at it with a tissue if anything sensitive comes on while watching the news on TV.Deigh

Hi Deigh,Many people experience emotional lability after stroke. What are the strategies that you use? We did a blog about it (see below), could you please give me some feedback on it? We can add some of your strategies or experiences if you are open to it.Understanding emotional labilityBrain injury can change parts of the brain that regulate or control emotional behaviour and feelingsEmotional 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 emergingWhen 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 breakHave 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 behaviourTry 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 taskChanging 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 educationUncontrolled 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”.Plan aheadWhen 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 techniquesSome 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 supportSometimes 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.Diana

Hi Diana,Another emotional lability sufferer here. Your blog covers it well. But getting people to understand that actually you're really happy or just overcome when all you can do is cry is hard. People are programmed to respond to tears with comfort, which is actually the one thing you don't need. I never did find a strategy for getting other people not to reinforce the problem. I tried the cognitive stuff at first but after a few months when it didn't really help and I was going back to work in the office. My psychiatrist prescribed SSRIs which I've found work extremely well. When I retire I'll think about weaning off them. But while I'm in the office every day I can't have the uncontrollable emotional stuff getting in the way.-Heather

Hi Heather,Thanks for sharing. I can't imagine how tough it is - especially when you are trying to get back to work. I hope that we get more of a discussion going on about this.Dxx

It's amazing how many people who have had a stroke are not told about this. It is important that the health professionals tell people that what's happening is a result of the brain injury. You can be perfectly well adjusted to what's happened to you and still be crying every time something good happens. Depression is not linked to crying. and crying may not be linked to sadness too.In my case the nurses at the Talbot reported my uncontrollable crying ( it was keeping me awake at night) and psychology appointments were added to my care plan/schedule without anyone talking to me. I really resented it at the time, because I thought I'd adjusted well to what was happening. As it happens I had. But without the psychologist I'd have never got the referral to psychiatrist who could prescribe the SSRIs. It would have been so much better if they had explained lability to me before they sent me to be "head shrunk" or if the psychologist could have told me this might be what was happening up front. But the Talbot attitude always seemed to be that patients are idiots and that having a stroke meant you'd lost your ability to reason. Although to be fair it started in Scotland rehab and they just assumed I was homesick, and tried to comfort me.So Simone please keep educating the professionals so that they can educate the patients. Thanks for your efforts-Heather