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Emotional lability - rapid changes in mood

Information Services

Cognitive effects

Emotional lability - rapid changes in mood

Emotional lability refers to rapid, often exaggerated changes in mood, where strong emotions or feelings occur.

Examples of these include uncontrollable laughing or crying, irritability or sudden angry outbursts.  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 due to injury of parts of the brain that control our:

  • awareness of emotions (ours and others)
  • ability to control how emotions are expressed.


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.


Brain disorders such as traumatic brain injury can cause this emotional overreaction to people or events. There is also weaker emotional control and lower frustration tolerance, particularly if the person is tired or stressed. The person may express their emotions in situations where previously they would have been able to been restrained or in 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 a brain injury

Emotional reactions may be appropriate in the situation, but the behaviour or expression may be stronger, louder or last longer than would be usual for that person. For example, a person may be genuinely happy, but once the laughter has started they may be unable to stop or regulate the behaviour, laughing too loud, too much, or for too long.


After brain injury an individual may also show extreme but genuine emotional responses, including sadness and grief, despair, frustration and irritability, anger, anxiety and depression, and even joy, happiness, and pleasure. These may be appropriate and normal emotional responses.


Coping with emotional lability

Become 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 pressure (too demanding, too noisy, too many people)
  • strong emotions or demands from others
  • very sad or funny situation (e.g. jokes, movies, certain stories)
  • discussing certain topics (e.g. driving, loss of job or relationships).


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 of a few minutes or a 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. 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 or 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 ahead. 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 that are 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 distractions 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 can be helpful if 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 very difficult to cope with.


If there are other emotional adjustment and coping issues, referral to a counsellor such as a psychologist, social worker or psychiatrist may be helpful. Families (parents, siblings, children), friends or carers may also benefit from support and care to help them understand and to cope with these changes.

References and further information

This article is reprinted with permission from the ABIOS fact sheets available at  

ABIOS is a specialist community-based rehabilitation service to enhance the service system for people with ABI and their families. Their mission is to assist people with a brain injury in Queensland, their families and carers to achieve an improved quality of life and community integration through increased independence, choice, opportunity and access to appropriate and responsive services. Ring ABIOS on 07 3406 2311 or email


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