Understanding Aggression in Dementia: The Science Behind Compassionate Care
One of the most common questions I hear from carers is: "What do I do when the person I love becomes angry, aggressive or verbally abusive?"
It is one of the most distressing parts of caring for someone living with dementia. The person may shout, accuse, threaten, resist care or become physically aggressive. Family members often feel frightened, rejected or exhausted, particularly when this behaviour is completely out of character.
Many people who support someone living with dementia may have heard of dementia care specialist, Teepa Snow. She offers both education and practical strategies to help caregivers respond more effectively to the challenging situations that can arise when supporting someone living with dementia – this includes supporting people experiencing significant distress and aggression.
While watching her videos, it struck me that it isn’t simply how calm she remains in her interactions; but how much her approach closely aligns with many of the evidence-informed principles psychotherapists use every day when helping people whose brains are overwhelmed by fear, confusion or emotional dysregulation. Although the behaviours may look different, the psychology underpinning her approach is remarkably similar.
Behaviour Is Communication
One of the core principles in psychology is that behaviour serves a purpose.
For someone living with dementia, aggression is rarely about being difficult or intentionally hurtful. More often, it is an expression of an unmet need.
A person may be frightened. They may feel trapped. They may be in pain. They may be overwhelmed by too much stimulation. They may simply no longer have the cognitive ability to explain what they are experiencing.
As dementia affects memory, language, reasoning and emotional regulation, the presenting behaviour increasingly becomes the person's primary form of communication.
Rather than asking, "How do I stop this behaviour?" a more helpful question becomes, "What is this person trying to tell me?"
Validation Before Redirection
One of the most powerful techniques Teepa Snow demonstrates is validation. Instead of correcting the person's reality, she first acknowledges their emotional experience.
If someone believes people are stealing from them, arguing about whether it is true rarely reduces distress. In fact, it often increases it.
Instead, she might respond with something like, "That must feel really upsetting."
Psychology has long recognised that people calm more quickly when they feel understood rather than corrected. Validation does not mean agreeing with a false belief. It means acknowledging that the emotion is real, even when the facts are not.
This principle is used across many therapeutic approaches, including person-centred therapy, Dialectical Behaviour Therapy (DBT), and trauma-informed practice.
Feeling understood reduces threat. Feeling argued with often increases it.
We Regulate Through Other People
One of the most fascinating areas of modern psychology and neuroscience is the understanding that human beings regulate their nervous systems through connection with others. This process is known as co-regulation.
Babies cannot calm themselves. Young children borrow the calm nervous system of a trusted adult. Adults do this too, especially during periods of overwhelming stress, trauma or fear.
When dementia damages the brain's ability to regulate emotions independently, many people once again rely heavily on external regulation. This is exactly what Teepa Snow models in her interactions with people living with dementia.
She lowers her voice. She slows her movements. She softens her facial expression. She reduces sensory input. She remains emotionally steady even when the other person cannot. Rather than trying to overpower distress, she offers her own calm nervous system as something the other person can gradually synchronise with. In many ways, she becomes the emotional anchor.
Mirroring Emotions Builds Connection
Another subtle strategy she uses is emotional mirroring. If the person is highly distressed, she acknowledges that distress with her voice, expression and body language—but at a lower intensity.
She communicates, "I can see this is really upsetting” without becoming distressed herself. This mirrors what some therapists call affect matching.
Research in infant development, attachment theory and psychotherapy suggests that people feel safer when another person's emotional response matches their own experience closely enough that they feel understood, while remaining calm enough to provide stability. Too little emotion feels dismissive. Too much emotion escalates the situation. The balance creates connection.
The Brain Cannot Learn When It Feels Threatened
When we feel threatened, the brain shifts into survival mode. This means the parts of the brain responsible for reasoning, problem-solving and flexibility become less available, so we lose our capacity to be reasonable and rational. This is true for all of us.
It becomes even more pronounced in dementia, where these brain networks are already compromised. This explains why reasoning, arguing or lengthy explanations rarely work during moments of aggression. Our nervous system must first experience safety before our thinking can return to its base line.
Calm first. Problem-solve second.
Person-Centred Care Is Trauma-Informed Care
Another feature of Teepa Snow's work is that she consistently preserves the person's dignity. She avoids confrontation. She offers choices. She notices what the individual can still do rather than focusing on what they have lost.
This reflects the principles of person-centred dementia care and aligns with trauma-informed practice. Both approaches recognise that every interaction can either increase a person's sense of threat or increase a sense of safety. Small changes in OUR approach often produce significant changes in the behaviour of OTHERS.
The Research Behind These Strategies
The reasons Teepa Snow's approach is so effective is that it aligns with decades of research in psychology, neuroscience and dementia care. While she teaches these ideas through practical demonstrations rather than academic language, many of her techniques reflect well-established principles that help explain why they work.
Attachment Theory: We Are Wired for Connection
Psychiatrist John Bowlby and psychologist Mary Ainsworth demonstrated that human beings are biologically wired to seek safety through trusted relationships. Although attachment theory is often associated with infancy, research shows that our need for connection continues throughout life. When someone is frightened, confused or overwhelmed—as often happens in dementia—they naturally look to another person for cues of safety. A calm, reassuring caregiver can help reduce distress simply through their presence.
Co-Regulation: Borrowing Someone Else's Calm
Modern psychology recognises that emotional regulation is not something we always do alone. When our own ability to regulate emotions is compromised—whether through infancy, trauma, neurological illness or dementia—we often rely on another person's calm nervous system to help us settle.
This process, known as co-regulation, explains why slowing your breathing, lowering your voice and remaining emotionally steady can have such a powerful effect on someone living with dementia. The goal is not to control another person's emotions, but to create an environment where their nervous system has the best chance of settling.
Validation Reduces Emotional Threat
Research consistently shows that people become less defensive when they feel understood. Validation acknowledges the emotional reality of another person's experience without necessarily agreeing with the facts of what they are saying.
For someone living with dementia, correcting mistaken beliefs often increases distress because the brain may no longer be able to process new information or reconsider its interpretation. Responding instead to the emotion—fear, sadness, frustration or confusion—often helps the person feel safer and more connected.
Validation Therapy has influenced dementia care internationally by encouraging caregivers to enter the person's emotional world rather than repeatedly trying to orient them to ours.
Person-Centred Dementia Care
Perhaps one of the greatest shifts in dementia care came through the work of psychologist Tom Kitwood. Rather than seeing dementia only as a disease affecting memory, Kitwood argued that wellbeing is profoundly shaped by the quality of relationships and interactions surrounding the person.
His model of person-centred care reminds us that every interaction either supports or undermines a person's dignity, identity and sense of safety. Teepa Snow's work reflects these principles beautifully by focusing on the person before the diagnosis.
What This Means for Carers
When someone with dementia becomes aggressive, it is natural to wonder what you have done wrong. Usually, the answer is nothing.
The behaviour is often the result of a brain that can no longer process information, regulate emotions or communicate needs in the way it once did. Your role is not to win an argument. It is to become a source of safety.
That may mean:
Slowing your own breathing before responding.
Lowering your voice.
Validating the person's emotional experience.
Looking for the unmet need beneath the behaviour.
Reducing environmental stress where possible.
Remembering that connection is often more effective than correction.
Maybe even apologising for upsetting the person, even if you did nothing wrong.
These approaches are not about giving in. They are about working with the brain that remains rather than expecting the brain that has been lost.
One of the reasons Teepa Snow's work resonates with so many families is that it reminds us that dementia care is fundamentally about relationships. When we understand the psychology behind behaviours, aggression becomes less about "challenging behaviour" and more about responding to a frightened, overwhelmed human being whose brain is struggling to make sense of the world.
Compassion is not simply kindness. It is a practical intervention. Sometimes the greatest gift we can offer someone living with dementia is our calm presence when they can no longer find their own.
A Final Thought - When Connection Isn't Enough
While psychological strategies such as validation, co-regulation and person-centred communication can significantly reduce distress for many people living with dementia, it is equally important to recognise that they are not a guaranteed solution to every episode of aggression.
Behaviour is often influenced by factors that are not immediately visible.
A person living with dementia may be experiencing:
Physical pain that they can no longer describe.
A urinary tract infection or another acute illness.
Delirium.
Medication side effects or interactions.
Hunger, thirst or fatigue.
Constipation or discomfort.
Changes in hearing or vision.
Environmental overstimulation or unfamiliar surroundings.
In these situations, even the most skilled communication techniques may have limited effect until the underlying cause has been identified and addressed. This is why the best dementia care is always multidisciplinary.
Psychological approaches help us understand the person's emotional experience and preserve connection. Medical professionals investigate whether there are physical or neurological factors contributing to the behaviour. Family members and support workers provide invaluable observations about what has changed and what usually helps. Each perspective contributes an important piece of the puzzle.
Rather than asking, "How do I stop this behaviour?" it is more helpful to ask: "What might this person be trying to communicate, and what could be contributing to their distress?"
Approaching aggression with curiosity leads to better care and reminds carers that they are not expected to have all the answers on their own. The goal is never to choose between psychological care and medical care. The goal is to bring both together so that the person living with dementia receives support that addresses the whole person—their mind, body, emotions and relationships.
