Heart rate variability (HRV) and social cognitive predictors of functional outcomes in individuals with psychotic-like experiences.

The social and nonsocial cognitive deficits found in schizophrenia (SZ) and in individuals at risk for the illness are relatively treatment-resistant and yet are the best predictors of real-world functioning. As such, pathophysiological markers that have been shown to be remediable, and associated with cognitive and functional targets, may serve as an indirect approach to improved outcomes. Heart rate variability (HRV), a measure of autonomic adaptability, is suppressed in individuals with SZ and predictive of psychosocial function. Here, we aimed to clarify the relationships between autonomic adaptability, social cognition, and psychosocial dysfunction in individuals who may be at risk for psychosis. HRV was measured before and after a stressor task to assess baseline and recovery, and social cognition was assessed with affective valence recognition in 25 at-risk individuals who report distress to psychotic-like experiences (PLE) and 30 healthy comparisons. PLE demonstrated blunted baseline HRV, worse performance for neutral, but not positive or negative, affective faces, as well as role and social dysfunction. In PLE, significant relationships were found between negative valence accuracy and baseline HRV and role function, as well as between recovery HRV and social and role function. Group classification revealed 70.9% accuracy when using recovery HRV and role function. Results are the first to demonstrate that aberrant autonomic arousal is predictive of maladaptive social cognitive and functional behaviors in individuals who may be at risk for psychosis. Early identification of those at risk may mitigate functional decline. (PsycInfo Database Record (c) 2025 APA, all rights reserved).