Pseudobulbar Affect

The investigators aim to elucidate characteristics of structural and functional brain connectivity in patients with amyotrophic lateral sclerosis (ALS) and pseudobulbar affect (PBA) using diffusion kurtosis imaging (DKI) and magnetoencephalography (MEG).

The aim of this mutli-phasic systematic case series is to explore if the Attention Training Technique (ATT) can improve symptoms of Post Stroke Emotionalism. It will teach the ATT to at least three people who have had a stroke at least six months ago, have PSE and are currently receiving support from a Community Neurorehabilitation service in the North West of England. Stroke survivors will also require the support of a carer/loved to record their symptoms on a daily basis. Stroke survivors will attend weekly appointments either at the community service site or via video-call for up to 15 weeks. There is also the option to complete an interview to discuss their experiences of learning the ATT. This study hopes to be the first step in establishing evidence in support of a novel psychological intervention to help improve PSE symptoms. Phase 1 of the study aims to explore the effects associated with the ATT on PSE symptoms. The primary research questions are: 1a. Is the ATT associated with an improvement of PSE symptoms? 1b. Does this replicate across individual cases? If these are not initially supported, the ATT delivery will be extended, addressing: 1. c. Is the ATT associated with an improvement of PSE symptoms when some parameters (e.g., frequency and dose) are modified? Only if a clear association between ATT and symptom change is demonstrated, will Phase 2 begin. Phase 2 aims to understand the relative mechanisms underlying any treatment effect. The primary research question for Phase 2 is: 2. a. Is the ATT associated with a greater change in PSE symptoms than a comparator passive listening intervention (controlling for non-specific factors, (e.g., provision of a credible intervention, task practice and therapist involvement))? The comparator intervention will be a passive version of the ATT whereby participants are instructed to not follow the instructions on the audio-recording. Secondary research questions throughout Phase 1 and 2 will address: 1\. Is the active ATT (and passive ATT) associated with an improvement in executive functioning, attention, mood and quality of life and is there any difference between the two interventions?