• Attachment;
  • Affective dysregulation;
  • Social anxiety;
  • Depression;
  • Ultra-high risk of psychosis


Embedded in attachment theory is its association with affect regulation, which provides a framework for affective dysregulation in the emerging psychosis.


Fifty-one participants meeting criteria for ultra-high risk (UHR) of developing psychosis were recruited from a youth mental health service within the United Kingdom. At intake baseline, prior to starting therapeutic intervention, all clients were assessed on measures of affective dysregulation and attachment.


A large proportion of our sample (N = 51) reported clinically significant levels of depression (78%), state anxiety (59%), and social anxiety (65%). Eighty per cent of the UHR sample was insecurely attached. Insecure attachment was significantly associated with elevated depression and social anxiety. Attachment styles were associated with anxiety, depression, and social anxiety. There was no support for a mediating role of social anxiety between attachment styles and depression.


Clinically significant levels of distress and anxiety experienced by the young people at high risk of psychosis. Clinical implications for the treatment of affective dysregulation in young people at UHR in relation to their attachment styles have been discussed.

Practitioner points

  • The treatment of affective dysregulation has implications on social integration, crucial to the recovery of young people in the emerging psychosis.
  • Assessment of adult attachment difficulties may bring to the forefront specific negative internal working models (and interpersonal schemas) which may indicate vulnerability to social anxiety and depression.
  • Young adults at ultra-high risk of psychosis with emotional difficulties may be better at help seeking and therefore over-represented in this sample.
  • Cross-sectional data analysis makes it difficult to draw aetiological links between adult attachment and affective dysregulation.