Disrupted physiological coregulation in youth at clinical high risk for psychosis: Insights from a dyadic interaction study

Interpersonal difficulties have long been implicated in psychopathology. However, we know quite little about how social (dis-)connection unfolds at the physiological level in real time in clinical populations, including among youth at clinical high risk for psychosis (CHR). The present laboratory-based dyadic interaction study examined physiological coregulation in 70 dyads across 137 participants (32 CHR youth-caregiver dyads; 38 healthy youth-caregiver dyads) and linked coregulation with clinical symptoms-concurrently and prospectively. This study was based in a midsized Midwestern city and recruited from the broader community and from mental health clinics. Data were collected from 2018 to 2022. Dyads engaged in 10-min neutral, conflict, and pleasant conversations while their autonomic physiology was continuously monitored. In conflict and neutral conversations, CHR youth exhibited contrarian physiological coregulation (i.e., slowing heart rate in response to caregiver's escalating heart rate and vice versa). Contrarian coregulation was associated with elevated risk for psychosis, was linked to greater baseline psychosis symptomatology, and prospectively predicted increases in symptoms 1 year later. These findings document alterations in physiological coregulation between CHR individuals and their caregivers, highlight their relevance for clinical symptomatology, suggest novel avenues for relationship-focused treatments, and contribute to a biologically grounded science of social connection. (PsycInfo Database Record (c) 2026 APA, all rights reserved).