Understanding Social Disconnect in Psychosis: A New fNIRS Study at Yale

Have you ever noticed how naturally we look into someone’s eyes during a conversation?

Eye contact and facial expressions play a crucial role in how we communicate emotions and connect with others. But what happens when this instinctive social process is disrupted?

In mental health conditions like schizophrenia and First Episode Psychosis (FEP), this fundamental form of human connection can be significantly impaired. Researchers have long struggled to study these real-time social interactions in a laboratory setting—until now.

Breaking Barriers: Studying Real-Time Eye Gaze in Psychosis

Researchers at Yale University’s Hirsch lab have developed a groundbreaking method to study live, emotionally rich interactions using a novel two-person setup. In this study, two participants engage face-to-face. One is the "movie watcher," and the other is the "face watcher."

The movie watcher views short video clips categorized as “adorable,” or “creepy”. For example, a clip of a puppy might elicit a smile, while a decaying object could trigger a frown or grimace. After each video (lasting around 4 seconds), the movie watcher is instructed to look directly at the face watcher or slightly off to the side, mimicking everyday social interactions. The face watcher, meanwhile, always looks directly at the movie watcher’s face.

This interactive setup provides an ideal framework to study the social brain in action.

Measuring Brain Activity with FNIRS

To understand what's happening in the brain during these interactions, the face watcher wears a cap equipped with Functional Near-Infrared Spectroscopy (fNIRS) technology. This non-invasive neuroimaging tool tracks brain activity by measuring blood flow changes in the cortex, particularly in areas related to social cognition, such as the right temporo-parietal junction (rTPJ).

Social Brain Differences in First Episode Psychosis

In typically developing individuals—those without neurodevelopmental or psychiatric disorders—the right TPJ becomes active during eye contact and social engagement. This region plays a key role in empathy, perspective-taking, and emotional connection.

But what about individuals experiencing first-episode psychosis (FEP), a condition where psychotic symptoms emerge within the past three years?

In collaboration with Yale’s STEP (Specialized Treatment Early in Psychosis) Program, the Hirsch Lab investigated this exact question. 30 typically developing individuals and 24 participants experiencing FEP took part in the study.

The findings suggest that unlike the typically developing participants, the key social processing regions in right TPJ are inactive in individuals experiencing FEP, especially during direct eye contact. Instead, we found brain activity in the corresponding regions on the left. These findings correlated with performance at work/school. These insights could help us understand better the reasons for social disconnection in psychosis and could pave way for more targeted interventions for the same.

Why This Matters

Psychosis often leads to social withdrawal, isolation, and difficulty forming relationships. Understanding the neural mechanisms behind social disconnection can help researchers develop therapies that address not just the symptoms of psychosis, but also the profound social challenges that come with it.

This research marks a significant step toward more empathetic, neuroscience-informed care for individuals living with psychosis.

References

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