SOCIAL COGNITION IN PEOPLE WITH A DIAGNOSIS OF SCHIZOPHRENIA: GLOBAL DEFICIT OR ADAPTIVE, THREAT-SENSITIVE STATE SHAPED BY RELATIONAL CONTEXT?

Background: Social cognition (SC) encompasses mental processes for understanding social information, including emotion recognition (EmR) and Theory of Mind (ToM). In people with a diagnosis of schizophrenia (DxoSZ), SC difficulties often precede other symptoms and contribute to functional challenges. Such difficulties also occur in the general population. Moreover, people with DxoSZ show reduced adaptability to acute stress, reporting heightened fear and elevated resting autonomic and cortisol levels, reflecting chronic stress exposure. Because stress-regulatory brain systems overlap with those supporting SC, here, we examined how everyday social stress responses shape social information processing.
Methods: We quantified electrocardiographic activity, salivary cortisol levels (ELISA) and subjective and SC psychometric responses in individuals with or without DxoSZ before and after an experimental social exclusion task (verbal Cyberball, vCB). In this group interaction, participants were initially included in conversation and then gradually excluded by two trained confederates.
Results: Self-reported transient distress did not significantly change after the social exclusion task in either group. Physiological measures revealed distinct stress profiles: controls showed a transient, adaptive autonomic and cortisol response to vCB, whereas patients displayed blunted stress reactivity, suggesting habituation to social exclusion. vCB modulated EmR, improving fear detection in controls but impairing it in patients. Sadness recognition declined in both groups. ToM performance was largely unaffected. Patients reported higher severity of early life adversity, which will be examined alongside clinical and social moderators.
Conclusion: SC in individuals with DxoSZ appears context- and threat-dependent rather than globally impaired, with stress sensitivity shaped by perceived safety and experience.