“They Feel What We Show”: Mirroring and Emotional Contagion in Dementia Care

Imagine this.

You walk into the room where the person you support is sitting. It might be a living room at home, a lounge in a care setting, or a quiet corner where you usually spend time together.

You’re already running late. You’re thinking about appointments, medication times, the phone call you still need to make. Your walk is brisk, your jaw is tight, your face is “busy”. You haven’t said a word yet.

Within minutes, the atmosphere shifts.

The person you care for starts fidgeting, pacing, or looking around anxiously. Someone who was settled a moment ago now looks frightened and asks, “What’s wrong? What’s happening?”

You haven’t changed the care plan.

You’ve changed your presence.

What you’re seeing is what many of us in dementia care call mirroring.

What Do We Mean by “Mirroring”?

In everyday care, “mirroring” describes how people with dementia:

Pick up on and reflect back our mood, facial expression, tone of voice, and body language

Become more agitated, fearful, or unsettled when we are rushed, tense, or frustrated

Become more relaxed, engaged, or reassured when we are calm, gentle, and emotionally present

Scientifically, this overlaps with:

Non-verbal communication – how we communicate through facial expression, posture, movement, and tone of voice

Emotional contagion – the automatic spread of emotions from one person to another

Preserved emotional reactivity – the way people with dementia can still respond strongly to emotional signals, even when memory and language are severely affected

The important point is this: what many carers see and describe as “mirroring” is strongly supported by what the research tells us about how people with dementia experience the world.

What the Research Tells Us

1. People with dementia rely heavily on non-verbal communication

As dementia progresses, spoken language becomes harder to process. That doesn’t mean communication stops. It means the person is:

Watching our faces

Listening to our tone of voice

Noticing our pace and posture

The Alzheimer’s Society emphasises that people with dementia will read and interpret your body language, and that tense expressions, abrupt movements, or a harsh tone can be confusing or frightening, even when your words are kind.

Research on communication in dementia care consistently shows that carers’ non-verbal behaviour strongly influences whether the person feels safe, respected, and understood (Savundranayagam & Orange, 2011; McGilton et al., 2017).

2. Emotional reactions to facial expressions can remain intact

One study looked at people with severe dementia and found something striking (Mograbi et al., 2010):

They struggled to label facial expressions (for example, to say “that’s anger” or “that’s sadness”)

But their emotional reactions to those expressions were still present

In simple terms:

they might not be able to tell you that you look angry,

but their body and behaviour still feel your anger.

This helps explain why someone can suddenly become distressed or suspicious when we are stressed, even if no one has raised their voice or said anything obviously upsetting.

3. Emotional contagion may be heightened in dementia

“Emotional contagion” is the process by which we unconsciously “catch” other people’s emotions. There is emerging evidence that people with cognitive impairment and dementia can show increased emotional contagion – reacting more strongly to others’ emotional states.

In everyday life, that means:

One anxious, rushed person in the room can unintentionally trigger a wave of anxiety

A consistently calm, gentle presence can create a buffer of safety that the person feels, even if they can’t explain why

A Short Story: Two Ways to Enter the Same Space

Let’s come back to that busy moment.

Scenario 1: The “marching about” entrance

You walk into the room thinking about everything you have to do. Your walk is fast, your shoulders are up, your face is tight. You move quickly towards the next task.

The person you support, who is sensitive to noise and movement, starts pacing or asking repeated questions

Another person looks frightened and asks, “What’s happening?”

You now have to “manage behaviour” you never meant to trigger

Scenario 2: The “attuned” entrance

Same day. Same workload. But before you walk in, you pause at the doorway.

You take three slow breaths.

You consciously soften your face and shoulders.

You walk in at a steady pace, make eye contact, and say, “Hello, it’s me. I’m here now,” in a warm, even tone.

The person glances up, then returns to what they were doing

Their body language stays settled

The room feels safer, and you’ve done nothing more “dramatic” than change how you arrived

The care plan hasn’t changed.

Your emotional presence has.

This is mirroring in action: the person is reflecting the emotional climate you bring into the space.

How Carers Can Use Mirroring to Support Wellbeing

We can’t remove all stress from caring. But we can use what we know about mirroring and emotional contagion to make small, powerful changes.

1. Start with your own state

Before you approach someone:

Take a brief pause – even 5–10 seconds

Notice: What is my face doing? How am I holding my shoulders? How fast am I moving?

Aim for:

Softer facial muscles

Slower, more deliberate movements

A gentle, steady tone of voice

This isn’t about pretending everything is fine. It’s about recognising that your emotional state is part of the care you are giving.

2. Approach from a place of safety

Evidence-based dementia communication suggests:

Approach from the front, at or near eye level

Use an open posture (uncrossed arms, relaxed shoulders)

Make gentle eye contact and use the person’s name

These signals help the person’s brain register:

“This person is safe. I am not being rushed or threatened.”

3. Match, then gently lead

Instead of trying to “snap someone out of it”, try matching and leading:

First, acknowledge and match the emotion you see (without copying distress)

If someone looks worried, your face shows concern and empathy, not a forced grin

You might say, “You look worried. It’s okay, I’m here with you”

Then, gradually lead towards calm:

Soften your expression

Slow your speech

Lower your volume

Sit rather than stand over them, if appropriate

This kind of emotional attunement – sometimes called affective mirroring – helps the person feel seen, then gently guided to a more settled state.

4. Use positive non-verbal reinforcement

Small, consistent non-verbal signals can support connection:

A genuine smile when it feels appropriate

Nods and “mm-hm” sounds to show you’re listening

Gentle, consented touch (offering a hand, a light touch on the forearm) if the person is comfortable with it

Research on person-centred dementia care links these behaviours with more positive emotional expressions and engagement (Edvardsson et al., 2008; Williams et al., 2017).

5. Tidy up the “emotional background noise”

Even when you’re not directly interacting, people are still reading the room:

Raised, tense voices in the background can be experienced as threat

Slamming doors, clattering equipment, and rushed footsteps can increase arousal and anxiety

Calm, coordinated movement and conversation – even in busy periods – helps create a background of safety

Whenever possible, move difficult conversations away from the person you support, and be mindful of volume and tone.

This Isn’t Just About Dementia

Although this article focuses on dementia, the same principles often apply to:

Other forms of neurodiversity (for example, people who are autistic or highly sensitive to sensory and emotional input)

Colleagues and teams in care settings

You might notice this at work:

You feel “absolutely fine”, just busy – but you’re walking quickly, speaking sharply, and your face is tight

A colleague asks, “Are you okay? What’s wrong?” or says, “You’re stressing everyone out”

The room feels more tense, even though nothing specific has “happened”

In reality, your body is broadcasting stress, and the people around you – residents, family members, and colleagues – are picking it up and mirroring it back.

Being aware of mirroring isn’t about blaming yourself. It’s about:

Understanding that your presence has real impact

Noticing when your pace, tone, or expression might be adding to the load in the room

Giving yourself permission to pause, reset, and come back in a way that supports everyone’s nervous system – including your own

Bringing It All Together

What many carers describe as “mirroring” – people reflecting our mood, pace, and facial expression – is strongly supported by research on:

Non-verbal communication

Emotional contagion

Preserved emotional reactivity in dementia

People with dementia may not always understand our words, but they often feel our presence very clearly.

When we walk in rushed, tense, and “marching about”, they mirror our stress.

When we arrive grounded, gentle, and attuned, they mirror our calm.

We can’t control every situation. But we can:

Pause before we enter a room

Notice what our face and body are saying

Choose to bring as much safety, warmth, and steadiness as we can

Those small, invisible decisions are not “extra”.

They are care.

Selected References

Alzheimer’s Society. (2023). Non-verbal communication and dementia.

Brooker, D., & Latham, I. (2016). Person-Centred Dementia Care: Making Services Better with the VIPS Framework.

Edvardsson, D., Winblad, B., & Sandman, P. O. (2008). Person-centred care of people with severe Alzheimer’s disease: current status and ways forward. The Lancet Neurology, 7(4), 362–367.

Kitwood, T. (1997). Dementia Reconsidered: The Person Comes First.

McGilton, K. S., et al. (2017). Communicating with persons living with dementia: Examining nurse–patient interactions. Journal of Gerontological Nursing.

Mograbi, D. C., Brown, R. G., & Morris, R. G. (2010). Impaired facial emotion recognition and preserved reactivity to facial expressions in people with severe dementia. Neuropsychologia, 48(13), 3681–3687.

Savundranayagam, M. Y., & Orange, J. B. (2011). Matched and mismatched appraisals of the effectiveness of communication strategies by family caregivers of persons with Alzheimer’s disease. International Journal of Language & Communication Disorders.

Williams, K. N., Perkhounkova, Y., Jao, Y. L., Bossen, A., Hein, M., & Chung, S. (2017). Person-centered communication for nursing home residents with dementia: four communication analysis methods. Western Journal of Nursing Research, 39(10), 1294–1313).