Emotional lability - rapid changes in mood
Emotional lability refers to rapid, often
exaggerated changes in mood, where strong emotions or feelings
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
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
- 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
- discussing certain topics (e.g. driving, loss of job or
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
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
- Tell people what they should do e.g. "Just ignore me and it
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
- 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 www.health.qld.gov.au/abios/
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