Post-Stroke Emotional Changes

Man Fei Anika Tse, Psy.D. of the University of Kansas Health System presents “Emotional Changes Post Stroke”.

This presentation includes discussion and education on how stroke can affect emotions, common emotional responses, and tips for survivors/others.

How Can Stroke Affect Emotions?

Stroke can impact emotions due to the impacts on the brain. Some may find it difficult to control or regulate their emotions. There may be an adjustment period that stroke survivors will go through to become aware of the changes and how they may be able to compensate or control their emotions.

Common Responses

Some common responses may include upsetting body changes that take away independence, isolation from others or activities, shifts in family roles or responsibilities. Some common emotional responses may include grief, depression, frustration, anxiety, anger, apathy or not caring what happens, and lack of motivation.

It is important to remember that everyone may experience these emotions very differently and react to them differently.

Grief After Stroke

There are different forms of loss. These forms can include loss of abilities such as the ability to walk or talk, or the loss of your sense of self and identity. Grieving these losses are different from grieving the loss of a loved one. This can be because it stays with you and presents as a constant reminder.

  • Denial: May have disbelief that the stroke actually happened
  • Anger: Triggered by different factors, May become frustrated by daily tasks that take more time, Change in independence, Family roles and responsibilities, Insurance coverage
  • Bargaining: Making deals with higher powers (if only i could move my leg again, i could be a better person), Feel like they could have avoided the stroke if they had done different things
  • Depression: Effects ⅓ of stroke survivors at some point in time, Changes in appetite, sleep, and things one used to enjoy
  • Acceptance: This is the new normal, Knowing progress will continue and will require hard work

Anxiety and Flat Affect

Anxiety: Common symptoms of anxiety may include ongoing worrying and fear, restlessness and irritability, increased sweating and heart rate, low energy, poor concentration, muscle tension, feeling panicky and out of breath, rapid heart rate, shaking, headaches, and/or upset stomach.

Flat Affect: The lack of emotional response, which can be often mistaken for depression. Others should ask survivors about their mood rather than guessing how they feel based on how they look. This is because they may be feeling something that isn’t being expressed on the outside.

Pseudobulbar Affect (PBA)

Pseudobulbar Affect (PBA) is a neurological condition that may present as “emotional lability”, “reflex crying”, or “labile mood”.

PBA may cause rapid mood changes and crying or laughing when it does not match the person’s mood. Some symptoms may include crying or laughing at unusual times or crying or laughing longer than seems appropriate. These feelings can feel uncomfortable, but it is just how the body is working during those times.

Tips for Coping with PBA

It takes time, but you may begin to notice signs of when PBA coming on. You may also notice different triggers that may cause it.

It is important to be open about it and let loved ones know if you are noticing symptoms and if you want to seek out a professional. Let people know you can’t always control it, and that it may not reflect your actual emotions. Educate others to ask how you are actually feeling rather than assuming.

Another thing to try is distracting yourself by focusing on something such as counting items in the room to help minimize the PBA. Take note of the posture you take when crying. This posture may be a trigger and when noticing it, you can then work on and adjust your posture.

Try breathing in and out slowly until you are in control. Deep breathing can help by focusing on the sound of your own breathing and the feeling of the air coming in and out of your body. Deep breathing can also be helpful to manage pain. Relax your forehead, shoulders and other muscles that tense up when crying. Focusing on different parts of your muscles in the body can help with muscle relaxation during moments of PBA.

Tips for survivors

Be easy and patient with yourself. You need time to recover. Let go of the mistakes and remember we all have weaknesses. Try to practice positive self-talk. Give yourself credit for progress, celebrate the small gains, and rest when you feel you need to. Also be sure to make time for things that you enjoy, such as spending time with family and friends, and try to stay active

Tips for Family and Friends

A person who has had a stroke may tend to have strong emotional reactions; don’t take it too personally, and remember it may be a result of the stroke. Don’t avoid them and watch for signs of depression. Keep in mind they are not having intense emotional changes on purpose. Encourage non-emotional distractions and help the individual become aware of the effect. Most importantly, take care of yourself as well.

Tips for Everyone

Self-care should be a habit and can look different for everyone. Remember that you have to put the mask on yourself before you help put the masks on others, meaning that you must take care of yourself first in order to help more people.

There are different types of self-care. Self-care may be in the form of physical, emotional, social, spiritual, or professional.


If you or someone you know is considering self-harm or suicidal thoughts, dial 988 to reach the suicide and crisis prevention hotline; available 24/7. It is free to talk to someone and all conversations remain confidential.

The National Alliance on Mental Health (NAMI) is another resource that you can utilize for help if needed. Simply call 800-950-6264 to speak on the phone with an advocate, or text 62640. NAMI is available to help Monday-Friday 10 AM-10 PM Eastern Standard Time.

Lastly, to learn more about stroke and support for those who have experienced stroke, visit the American Stroke Association at their website,