Health can be understood as a state of optimal regulation and adaptive functioning of body, mind and relationships (Siegel, 2012). Health emerges from integration which is the linkage of differentiated parts of a system. Without integration, chaos and rigidity emerge. Psychopathology refers to disturbances of the psyche or mind.

If early experience of emotion is repeatedly met with less-than-optimal responses from caregivers this leads to the development of core maladaptive schemes instead of healthy and resilient ones (Greenberg, 2016). The developing self organises itself to cope with the difficult emotion and the caregiver’s deficit. When the infant cannot be soothed or protected by the caregiver the child experiences unbearable states of anxiety and aloneness leading to pathogenic fear, shame and rage. This results in an inability to regulate emotion. The core maladaptive schemes aim to manage these difficult feelings but result in problems as the person tries navigate life and developmental challenges like the transition to adolescence, changing school, rejection, loss and trauma. Dysfunction arises because present functioning is ruled by the past as the past imposes itself on the present. Dysfunction arises when ‘weak’ or ‘bad’ self-organisation is activated and become dominant. The degree to which these disorganising tendencies persist is based on how early, intensely and frequently they were experienced. An emotionally distressing event becomes ‘burned’ into memory if the emotion is highly arousing create a scheme which recreates the emotional response again and again in the future.

In EFT theory human problems involve having too much or too little emotion (Greenberg, 2016). The development of healthy emotional regulation skills is an important part of emotional development. The secure self is created mainly through the dyadic regulation of affect and failure in this results in an insecure sense of self.

Regulation theory is an interpersonal neurobiological model of development, psychopathogenesis and treatment of the emotional and subjective self that is formed early in life. Schore writes that the beginning of living systems sets the stage for all functioning throughout the lifespan. A paradigm shift has occurred in research and clinical disciplines moving from a focus on behaviour to cognition to bodily-based emotion. This shift includes a move from language of the left brain to emotion in the right brain. The paradigm shift has transformed our understanding of human development.

Psychology, psychiatry and neuroscience are increasingly emphasising the centrality of emotion above cognition in human experience – the ‘primacy of affect’ (Schore, 2019). Right brain affective processes that operate beneath awareness are dominant in development and psychopathogenesis. Affective processes are at the core of the self. These bodily-based phenomena are psychobiological in nature and so models of development from infancy throughout the lifespan are moving toward brain/mind/body conceptualisations. The infant, from the beginning, is emotionally relating with the social world and so the emphasis has shifted from cognitive to emotional development. Updated models of psychological health are now grounded in emotional well-being.

Interest is converging in self-regulation – an organising principle that is at the heart of every biological and psychological discipline, and fundamental to emotional processing (Schore, 2019). Schore cites Fonagy and Target (2002) who come to the conclusion that the whole of child development can be understood as the enhancement of self-regulation. Bowlby’s goal was to integrate psychological and biological models of development. The current focus in research and practice on how affective bodily-based processes are nonconsciously interactively regulated means that attachment theory has shifted to a regulation theory. Sroufe et al. (2005) support this idea arguing that attachment is the dyadic regulation of emotion. Attachment promotes self-regulation, a capacity which then allows for more complex relational interactions between the person and the environment (Schore, 2019). From infancy throughout the lifespan, spontaneous, fast-acting emotional processes are central to allowing the organism to regulate and cope with stresses and challenges which results in emotional resilience and well-being. Attachment interactions during critical periods of the early development of the right brain ‘indelibly’ impacts the trajectory of all socioemotional development throughout the lifespan. Inadequate early parenting creates a vulnerability that may become pathogenic and destructive of development if later experiences too are unfavourable (Fonagy and Target, 2003). This happens when later developments fail to require the use of mentalisation or if they call on the defensive use of these faults in the developing structure.

Regulation theory offers a heuristic and clinically relevant theory of how attachment alters socioemotional development (Schore, 2019). The attachment relationship either facilitates resilience to stress or promotes a predisposition to emotional dysregulation (and therefore psychopathology). This relational trauma in early critical periods of brain development imprints a ‘permanent physiological reactivity’ in the right brain. This leads to a susceptibility to later affect regulation disorders which emerge as a deficit in coping with stress in the socioemotional environment. All personality and psychiatric disorders involve disturbances in the right brain, specifically in relation to affect regulation and intersubjectivity.

By focusing on emotion regulation we can understand how the mind is organised and integrated (Siegel, 2020). An infant’s first challenge is to achieve internal homeostasis through the activity of deep structures in the brainstem. The parent provides hidden regulators that facilitate basic physiological functions in the infant. As development progresses, dyadic regulation allows the infant to monitor and modify more complex states of mind. Attachment is a crucial means through which the experience of self becomes regulated. Intimate attunements create states of mind that resonate and are mutually regulating. Misattunements lead to dysregulation requiring interactive repair to return the child to regulation (equilibrium). Emotional regulation is dependant upon social interaction. Arousal is created through evaluative appraisals through interactions with the environment. In the toddler stage dyadic regulation becomes caregiver guided self-regulation in which the parent helps the child to regulate in an autonomous way. With further maturity increasingly complex self-regulation becomes possible. Emotion is the highest order direct expression of bio-regulation in complex organisms. Emotion regulation is how we use mind and relationships to increase integration. To achieve regulation, which is an integrated state of coherence, the mind monitors and modifies the flow of energy and information. We use the nervous system and relationships to regulate ourselves. Emotion regulation helps the mind to emerge flexibly in interaction with environment. Integration is at the heart of regulation. Emotion dysregulation can be understood as an impairment in the ability to create organised and flexible responses that serve adaptive functions. Dysregulation emerge as forms of incoherence. When integration is impaired, it is not possible for there to be balance and co-ordination and the system moves into patterns of chaos and/ or rigidity. Mind is a process that regulates the flow of energy that is both embodied and relational. Optimal self-regulation involves integration both inwardly and in relationships. Affect regulation is crucial for the functioning of the individual. Many psychiatric problems can be seen as disorders of self-regulation.

The defining features of psychopathology may include an inability to inhibit defensive systems in a safe environment, or, alternatively, an inability to mobilise defensive behaviours in a risky environment (Porges, 2021). Both are maladaptive because they do not match the level of risk in the current environment. Only in a safe environment is it adaptive to inhibit defensive behaviours and exhibit the social engagement system. When neuroception (assessment of safety and danger) is faulty it can contribute to physiological reactivity and defensive responses that are maladaptive, resulting in expressions of psychiatric disorders. When the environment is assessed as safe a neural circuit inhibits the mobilisation of defensive responses for fight, flight, or freeze. Faulty neuroception might lie at the root of several psychiatric disorders. Areas in the temporal cortex that inhibit fight, flight, freeze reactions are not activated in people diagnosed with autism and schizophrenia who struggle with social behaviour. Those with anxiety and depressive disorders have a lessened ability to regulate heart-rate and reduced facial expressiveness resulting in poor social behaviour. When we understand the contexts that inhibit the neural systems which control defensive behaviour we can optimise the development of prosocial behaviour. When neuroception shifts to danger then prosocial behaviour is disrupted and defensive strategies are triggered. The presence of a safe person allows the defensive systems to be controlled and social behaviour can occur. When danger is detected, social approaches are met with aggression or withdrawal. Social engagement depends on how well we can regulate the muscles in the face and head. These are the muscles that control facial expression, gesture with our heads, vocal tone, direct our gaze and distinguish human voices from other sounds.


Fonagy, P., & Target, M. (2003). Psychoanalytic theories: Perspectives from developmental psychopathology. John Wiley & Sons.

Greenberg, L. S. (2016). Emotion-focused therapy. American Psychological Association.

Porges, S. W. (2021). Polyvagal safety: Attachment, communication, self-regulation (IPNB). W. W. Norton & Company.

Schore, A. N. (2019). The development of the unconscious mind (Norton series on interpersonal neurobiology). W. W. Norton & Company.

Siegel, D. J. (2012). Pocket guide to interpersonal neurobiology: An integrative handbook of the mind (Norton series on interpersonal neurobiology). W. W. Norton & Company.

Siegel, D. J. (2020). The developing mind: How relationships and the brain interact to shape who we are (3rd ed.). Guilford Publications.