Can Occupational Therapy Help You Manage PBA Symptoms?

Pseudobulbar affect (PBA) can cause distress in your everyday life. Occupational therapy may provide you with tools to navigate these difficulties more smoothly.  

PBA is a condition that causes uncontrolled or exaggerated episodes of laughing or crying. These episodes may be unrelated to how a person feels internally. PBA develops when a brain injury or another neurologic disorder affects the parts of your brain that regulate your emotions.

Occupational therapy aims to help you engage in usual everyday activities when an illness or injury makes it difficult. An occupational therapist may:

• perform a thorough evaluation to determine your needs and challenges in your daily routine
• work with you to develop specific, meaningful goals
• create individualized interventions to help you reach those goals
• regularly assess your progress and adjust your treatment as needed

Many people associate occupational therapy with daily activities like bathing, eating, and dressing. However, occupational therapy can also extend to self-care, leisure activities, work routines, and interactions with others.

You can learn new skills or ways to change the way you do things. Occupational therapy is designed to help you maintain independence and improve your quality of life.

An occupational therapist will start by assessing your medical history and symptoms to understand how PBA affects your life. Depending on the areas you need assistance, interventions may include:

• Coping techniques: Your therapist can work with you on ways to manage your PBA episodes if you feel one coming on. You can practice distracting yourself by thinking about something unrelated or changing your physical position. Slow, deep breaths may help you regain control.
• Relaxation practices: PBA can cause anxiety and stress. Your occupational therapist can help you incorporate regular mindfulness activities, such as meditation, into your daily routine.
• Social skills development: Taking steps to practice communication and interpersonal skills may help you regain confidence, especially if PBA has brought changes in these areas.
• Education and support: Occupational therapy can help you understand PBA and why it occurs, reducing feelings of stigma or embarrassment.

Your doctor will determine the treatment length based on your specific situation. PBA can range from mild to severe. Some people may need to go once a week, while others may need to be seen more frequently. How fast a person progresses with occupational therapy will vary as well.

The underlying cause can also affect the length of PBA treatment. When PBA occurs as a result of a chronic neurological condition, like multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS), symptoms tend to be long lasting. But if the brain recovers after an injury or a stroke, PBA symptoms may go away.

Research from 2013 suggests that certain brain chemicals, namely serotonin and glutamate, are involved in developing PBA. Doctors may prescribe medications to balance these chemicals and lower the frequency and severity of PBA episodes. These medications include:

• Antidepressants: Tricyclic antidepressants, such as amitriptyline, and selective serotonin reuptake inhibitors (SSRIs), such as citalopram, can help manage PBA symptoms.
• Dextromethorphan/quinidine sulfate (Nuedexta): This medication is approved by the Food and Drug Administration (FDA) for PBA treatment. It combines a cough suppressant with a drug that treats irregular heartbeat (cardiac arrhythmias).

Your doctor will consider your overall health and potential medication interactions to determine whether one of these treatments is right for you.

Occupational therapy can be a helpful addition to your medical management for PBA. A physical therapist can develop an individualized treatment plan to help you better navigate your daily challenges while living with this condition.