The Importance of Co-Regulation (Coregulation) — and Why It Might Be Missing in the Chronically Ill World
This holiday season, I’m not going to send you another list of material things you “need” for endometriosis — the supplements, the heat packs, the books (although, let’s be honest, mine is stellar 😉).
Instead, I want to talk about something that sits at the very heart of the holiday spirit and at the heart of human healing — especially perhaps for those of us living with chronic illness. It's one of the most powerful, yet perhaps least talked-about factors in health:
Meaningful relationships.
But I'm actually going to even go a bit deeper here. There is actually a word for the communication style within these deep, supportive relationships that actually helps regulate the body at a cellular level, lowers inflammation, regulates the immune system, and supports healing. It's called co-regulation.
It may be a new word to you, so you can think of it as being with someone without fixing. Offering presence without judgment. Supporting without trying to control the outcome. Listening with your whole body, not just your ears. It’s like how maybe a loving grandparent listened to you bemoan a 1st grade drama without belittling you, lecturing, or redirecting—perhaps they nodded and felt the injustice deeply with you (even if it was only a classmate eating your Elmer's glue). Or, like how a close friend allowed you to vent for 30 whole minutes about your relationship, knowing she didn’t need to offer advice (no, you weren’t really seeking divorce, you were just really pissed about that thing), she was just there holding the container so you could process through some emotions.
It sounds simple. And yet… it’s surprisingly rare. We’re living through a well-documented loneliness epidemic, where many people are surrounded by noise, messaging, and surface-level interaction — but starved for the kind of attuned, regulating connection our nervous systems actually require. In other words, we’re communicating more than ever, while receiving less true co-regulation than at any point in human history.
And for anyone rolling their eyes thinking, “Katie, just give me my holiday supplement list,” hang on for a moment — because research consistently shows that deep social connection (or the lack of it) has measurable effects on chronic illness outcomes. Serious! This isn’t just about “feeling supported.” It’s about how the stress response, immune system, and nervous system function in real time.
As you read on, you may even notice that true co-regulation — real, meaningful relational presence — feels more uncomfortable than you expected. The good news? It’s a skill. And like any skill, it can be practiced and learned.
Not to mention that now, in the midst of both the holidays AND an unprecedented loneliness epidemic, we can all do some major healing together in the next few weeks without the focus being on dopamine-rocking consumerism. Win-win :)
So if you’re curious about this quietly powerful, deeply human piece of healing, read on.
What, Exactly, is Co-Regulation?
As I mentioned, true co-regulation is different than just any old interaction. It’s a way of communicating that brings our stress levels down, and our feel-good chemicals (like oxytocin and endorphins) up. It leaves your nervous system feeling warmer, steadier, and more settled—whether you’re in a hard spot or not. You feel heard, seen, supported, and less alone afterward (so yes, the opposite of social media).
Now, because this type of communication is less common (I would argue some of us rarely co-regulate with others, which is not good), I have a very simple example of what it looks like in real time.
A few weeks ago, we went up to our family cabin in Kōkeʻe, high in the mountains of Kauaʻi. We met other family there, and my youngest, Nola, who is four, spent most of her time with her cousin Ian, who is five.
One afternoon, I took them on a small forest hike together. Somewhere along the trail, they invented a game that, at first glance, kind of freaked me out, tbh.
Ian began pointing out places where his “favorite pets” were buried. Yup, dead. At each stop, he would pause, look down at the forest floor, and explain who had been laid to rest there — and how much he missed them. There was Sandy, his frog. Brute, his dog. And, somehow, a 400-year-old grandfather was buried beneath a rock (apparently, longevity runs in the family). The details were childlike, but Ian’s grief was real. He embodied it fully — I swear the kid had tears in his eyes over that 400-year-old grandpa.
I was just about to redirect what felt like a fairly dark game and suggest therapy to his mom… when Nola responded enthusiastically.
She didn’t try to fix him. She didn’t distract him, joke, or reassure him that everything was okay. She didn’t tell him it wasn’t real or suggest they move on and play tag. Instead, she met him exactly where he was — in some sort of forest funeral parlor, I suppose—and played along.
“Yes, Ian,” she said quietly, nodding. “He was your favorite frog. And you miss him.” Sometimes she placed a hand on his back. Sometimes she looked him in the eyes and asked gentle questions. “Did you play together a lot?”
And there I was — the adult — internally squirming. Isn’t this a sad game? Aren’t kids supposed to be happy? Shouldn’t I fix this?
At this point it should be obvious that I have a tendency to overthink, so I stopped hovering and just watched. But that’s when I started to realize something surprising: The kids were calm. Regulated. Completely absorbed. I may have been uncomfortable, but they weren’t distressed at all. They were deeply engaged, connected, and at ease in a way that felt unexpectedly … mature.
I realized I was witnessing something deep yet human: these kids were practicing true co-regulation just the same as if they were playing house.
Why was this hard for me to grasp at first? Because, I suppose, it’s really not that common.
If you grew up in a family that prized emotional toughness or “getting over it,” this kind of response may feel downright wrong! Others of us learned that being a good friend means offering solutions to problems ASAP, quickly cheering someone up superficially, minimizing pain, or changing the subject (insert awkward joke here and ask about holiday plans).
Sitting with sadness — without trying to improve it — can feel deeply uncomfortable. Accepting or giving compliments freely, offering a shoulder to lean on instead of a lecture, allowing an uncomfortable moment become friendship glue … these are the moments that matter deeply, yet make many of us feel a little awkward.
Yet what Nola and Ian were doing is not just emotionally kind — it’s biologically necessary. This is how humans evolved to cope with stress, loss, and uncertainty together. It’s not wallowing; It’s processing emotion, the same way we process language or movement. So yah, pretty important.
How Co-Regulation Works: Emotional Regulation and the Nervous System
We hear a lot about self-regulation, especially in parenting and wellness spaces. We’re told we need to teach children to regulate their emotions, and as adults, many of us are encouraged to self-soothe or “manage stress better.” While self-regulation skills matter, what often gets overlooked is this:
Self-regulation development only occurs after many moments of co-regulation.
Yes — really.
Before a person can self-regulate, they rely entirely on others to help regulate emotional responses through supportive interactions, just like the ones Nola and Ian were naturally practicing. You have to co-regulate before you can self-regulate. That’s a crucial point — especially if you struggle with regulation as an adult reading this. Sometimes the work isn’t about trying harder; it’s about realizing your nervous system may need to go back a few steps and finally receive what it missed the first time around.
The reason for this is simple and well-established in child development.
Babies and young children cannot regulate their nervous systems on their own. Their brains — particularly the prefrontal cortex and autonomic nervous system — are still immature, and infant behavior reflects that. Instead, young children rely on calm, attuned caregivers to regulate with them, using tone of voice, facial expressions, eye contact, body language, and steady presence. These co-regulatory interactions are how the nervous system learns what safety feels like.
You may have heard phrases like, “Mom’s mood rocks the house,” or “Moms aren’t allowed to have a bad day because everyone else will feel it.” This isn’t about gender stereotypes (although those exist) — this one is actually more about the biological need for co-regulation. An immature nervous system doesn’t yet know how to self-regulate, so it automatically picks up the frequency of the caregiver it’s attuned to.
Not fair — but deeply illuminating (especially for those of us who are chronically stressed and don’t yet realize how much it affects those around us).
It was certainly a wake-up call for me many moons ago, when I realized that my own nervous system dysregulation was quietly creating chaos in our home — and even contributing to illness patterns I couldn’t explain at the time. Oops. #Humbled.
Childhood Co-Regulation and Child Development in the Early Years
If you miss out on co-regulation as a wee tyke, your nervous system will be missing a pivotal piece. This is why early childhood professionals emphasize childhood co-regulation as foundational to full emotional development.
Repeated experiences of being soothed teach the nervous system what safety feels like. This is how children grow emotional awareness, how kids learn to handle big emotions, and how regulation skills form across the early years. Only then can we, as adults, handle big emotions, regulate properly without drugs or alcohol, and be emotionally mature.
Moreover (this is big for those of us with high levels of inflammation or chronic illness) developmental neuroscientists like Allan Schore and Dan Siegel have shown that early co-regulation shapes stress hormone patterns and immune function later in life! In plain language, co-regulation is about full-body health!
There’s more, of course. Stephen Porges’ work on Polyvagal Theory helps explain why co-regulation allows for lower inflammation and stronger immune function (rather than dysfunction). Our nervous systems are constantly scanning for cues of safety or threat — a process called neuroception.
Warm eye contact, a calm voice, relaxed posture, and steady presence signal safety, allowing the nervous system to shift out of fight-or-flight and into repair. This is how emotional regulation happens in real time, not through logic or willpower.
You already know this intuitively. Walk into a room where someone you know is quietly enraged, and you feel it immediately — in their posture, their tension, their energy. Your own cortisol spikes without a word being said!
Conversely, when someone sits with you in emotional distress without urgency or judgment, your body receives a different message: I’m not alone. I’m safe enough right now. Heart rate, breathing, hormone release, oxytocin levels, and inflammatory signaling all shift.
That's right, it's a "magic supplement" that is not only free, but it also heals those around you, and it also is so much more fullfilling than any other holiday gift :)
Co-Regulating Beyond Childhood: Emotional Regulation in Adult Relationships
There’s a common assumption that co-regulation is something adults provide for children — and that mature adults should regulate themselves independently. The science doesn’t support that, which is also why this information is super important. You reading this need co-regulation! And so do all your family, friends, colleagues, peers, and strangers passing you on the street.
We continue co-regulating throughout life, across age groups. In adult relationships — family, friendship, and romantic relationships — regulation remains essential.
In healthy relationships, one or both partners will experience emotional distress throughout their lives. Totally normal. What matters is whether supportive interactions are available to help both nervous systems settle. Do you gloss over the partners’ sadness or pain, or do you constantly try to fix, redirect, or even, perhaps, shame them?? How do they hold you when you yourself are dealing with distress? These are essential questions to ask and talk about as partners.
Of course, both self-regulation and mutual regulation are required as adults. One does not replace the other. Emotional connection, healthy relationships, and long-term mental health depend on both. But when nearly all of the emphasis nowadays is put on self-regulation alone, we are missing a HUGE, ENTIRE piece.
This helps explain why loneliness is now considered a major health risk factor. It’s not just the absence of people — it’s the absence of felt safety in a relationship. When co-regulation is missing, people adapt. They become hyper-independent, emotionally contained, people-pleasing, or relentlessly solution-oriented. These aren’t character flaws—They’re nervous system strategies. And over time, they come at a cost.
Dun dun dunnnnnn
When Co-Regulation Is Missing: Emotional (Dys)regulation, Chronic Illness, and the Nervous System
This is where my work in chronic illness keeps circling back: bodies that never learned to feel safe often remain stuck in survival mode — no matter how many supplements, diets, physical activity plans, or protocols are layered on top. (Which is why I’m not telling you to buy more things this holiday season.)
And loneliness (the feelings of being so deeply alone) is a heavy sign of DANGER when you come from a biologically tribal animal. Like separating a wolf from her pack, a solo pack animal human will also feel despair. This is where we’re quietly reminded that chronic illness isn’t just about what’s happening inside the body — inflammation, hormones, pain, fatigue. It’s also about what’s been missing around the body: nervous system support and relational safety.
Humans are not designed to regulate stress alone. Our nervous systems evolved in groups — we are tribal people, whether we like it or not. Co-regulation is as biologically necessary as sleep, water, movement, and nourishment. When co-regulation is present, stress can rise, resolve, and the system can return to baseline. The body repairs.
When it’s missing, vigilance becomes chronic. Cortisol and adrenaline remain elevated. The body spends less time in repair and more time bracing. Over time, this chronic state of activation begins to look like disease or, a term I use often, we end up living in sickness ecology.
Illness itself can then further reduce opportunities for co-regulation. Pain, fatigue, and repeated medical invalidation often lead to withdrawal. Relationships strain. And sometimes — this part matters — those of us who are ill, not having learned how to co-regulate either, may unintentionally push people away in moments of vulnerability, shrinking our support even further. Others can suck at it, yes, but we can too. It’s a two-way street.
And now, what began as a physiological challenge of illness quietly becomes a relational one, and a lonely one.
So as the holidays roll around, remember this when Aunt Jessa misunderstands your disease again at Christmas dinner (no, Aunt Jessa, it’s not “just your period”). Healing does not require perfect relationships or perfectly informed people. It requires enough experiences of being emotionally met for the nervous system to remember that connection is still possible.
Let Aunt Jessa care about you in her own strange way of gifting you tampons — it’s her care for you that matters. Let your neighbor bring you gluten cookies even though you’re gluten-free, it’s the thought that counts.. Let people show up imperfectly — and practice letting that be enough. And just as importantly, do your best to show up for others, too. Co-regulation isn’t about getting it right, it’s about staying connected.
Co-Regulation vs. Unhealthy Communication: Effective Communication Matters
Just as a quick PSA: Not all communication is co-regulation. And not all closeness is healthy. Co-regulation is effective communication that leaves your nervous system feeling warmer, steadier, and more settled. You feel heard, seen, supported, and less alone afterward.
What it is not is communication that consistently escalates the stress response. Patterns like chronic complaining, circular venting, gossip, emotional dumping, lecturing, or constant negativity tend to activate the nervous system rather than calm it. The body leaves those interactions more dysregulated, not less.
A simple test: how do you feel afterward? More grounded — or more amped up? A connection that consistently dysregulates is not the same as a connection that heals.
OK, PSA over.
Co-Regulation Skills and Co-Regulation Strategies You Can Practice
If you have read this far (good on ya!), you may be wondering exactly how to co-regulate more. If you're nervous, here's something cool to remember: Co-regulation skills are teachable and learnable! And, they often start simple (no one is asking you to act like a $500/hr New York therapist).
Easy behaviors to practice include: staying present, remaining calm, and keeping love/care at the forefront, offering supportive interactions, using soft facial expressions, maintaining steady eye contact, using grounded body language, and taking a few deep breaths together before trying to problem-solve (if you need to do that at all).
If you have a tendency to feel awkward and chat over the silences or talk the entire time without asking anyone else about their lives, you do things like, literally, count to 10 in your head before you respond to a solemn or heavy statement (allow yourself to digest what they’re saying). If you have a hard time listening to others, make a list before you go of 10 questions you can ask people that show you are really interested in their life beyond small talk (I will jot some down at the end if you want to borrow mine). Take your time with people, don't feel pressured to "know it all," and be okay with processing in real time.
Easy Question Ideas to Show You are Genuinely Interested in a Soul:
What’s been keeping you busy these days?
Have you been enjoying anything recently — a show, a project, a hobby, a walk you love?
What’s something you’re looking forward to right now?
What’s been feeling good in your life lately?
What have you been learning or getting into recently?
What’s been bringing you a little joy or ease these days?
How have you been spending your weekends or free time lately?
Is there anything fun or interesting coming up for you?
What’s something that’s been lighting you up lately — even in a small way?
Heck, sometimes it’s as simple as agreeing with how someone feels (rather than agreeing or disagreeing with the event they're talking about), saying:
“That was hard.”
“I get why you feel that way.”
“I’m here.”
This is a great time to channel those little preschoolers, Nola and Ian.
Always, it's about being comfortable making eye contact with folks—this makes some of us nervous! So practice eye contact and warmth with the cashier, waitress, Uber driver, strange colleague with purple hair, and anyone else. The more you practice (and feel warmth back, guaranteed most of the time), the less isolated and more co-regulated you will feel, and the easier steady eye contact will feel.
Co-regulation drills like these are especially helpful during the social holiday season — a time that makes some of us with social anxiety want to hide entirely. Why? Deeply listening and genuinely caring takes all the pressure off needing to perform (which is where a lot of social anxiety comes from: wondering what we’re going to say, how we’re going to entertain, or how we’re coming across). Instead, lead with warmth, ask about people’s lives, and listen with real care. Chances are, not many people have been deeply listened to in a while — and they will love you simply for being there and paying attention. No entertaining required 😉
These co-regulatory interactions shape emotional regulation in the moment — not just emotional insight afterward. It's allowing emotions to simply exist and pass through, rather than stick around. Ever say something out loud that was bothering you for EONS and suddenly you realize it's not that big of a deal, and feel better? Yah, you passed that emotion through. And this is how you can help others as well.
Fixing Less, Co-Regulating More: Emotional Connection Across the Lifespan
At its core, co-regulation is not a parenting trick or a therapeutic buzzword — it’s a dynamic interpersonal process that sits at the foundation of human development. Before a child can learn to manage big feelings, they must first experience emotional coregulation: being met, mirrored, and soothed by other adults during moments of distress. This is how a child learns how emotions move through the body, how stress resolves, and how safety feels. Those early experiences shape emotional intelligence, influence how we relate to our own emotions later in life, and quietly program our stress response. And while individual differences absolutely matter, the same effect shows up again and again across cultures and age groups: regulation is learned in relationship. It’s a critical precursor to developing our own self-regulation skills — not a replacement for them.
The hopeful part? This process doesn’t end in childhood. Even if early experiences were inconsistent, co-regulation remains available to us across the lifespan. Through practicing co-regulation with safe people — partners, friends, therapists, family members, even brief moments of attuned connection with strangers — we continue refining our own thinking, calming our nervous systems, and expanding our capacity to feel without becoming overwhelmed.
Over time, these interactions support our ability to self-regulate, to tolerate discomfort, and to respond rather than react. From shared speech rhythms to subtle emotional cues, the body remembers how to settle when it’s not alone. And while future research will continue to refine how this works, the takeaway is already clear: healing doesn’t happen in isolation. It happens when we allow ourselves to be human — shaped by connection, softened by presence, and supported by one another as we grow.
Watching a four- and five-year-old that day, it struck me how co-regulation doesn’t require perfect words or therapeutic skill. It asks something simpler and harder: that we simply show up. That we tolerate our own discomfort long enough to stay with someone else’s. That we resist the urge to fix and instead offer presence. That we share joy with successes instead of judgment.
In an isolated world that prizes self-sufficiency, this kind of presence is quietly radical. It reminds the body of something deeply ancient and deeply human:
We were never meant to do this alone.
Nola and Ian didn’t know the science. They didn’t need to. Their nervous systems knew exactly what to do — and it felt so natural they turned it into a game.
Maybe it's simple enough this holiday season to remember that healing doesn’t always have to be about doing more. It can easily begin with being with.