Mentalizing—the ability to understand and attribute mental states to others—relies on effective self-regulation and social-cognitive processing, both of which may be shaped by cardiac autonomic responses. While prior research has primarily emphasized the role of cardiac parasympathetic (PSNS) activity in social cognition, the contribution of cardiac sympathetic (SNS) activity and its dynamic interaction with PSNS remains underexplored. This study simultaneously investigated resting and task-related cardiac sympathetic-parasympathetic activity and reactivity to examine the associations with mentalizing performance in healthy young adults (N = 120). Resting heart rate variability and systolic time intervals were used to index cardiac PSNS and SNS activity, respectively, with phasic reactivity calculated as percentage change scores during mentalizing performance. Hierarchical regression analyses showed that higher cardiac PSNS activity and lower cardiac SNS activity at rest jointly predicted better mentalizing performance. Importantly, reduced cardiac SNS reactivity—but not cardiac PSNS reactivity—was a stronger predictor of mentalizing performance, and further mediated the relationship between resting cardiac autonomic activity and mentalizing performance. These findings highlighted the importance of cardiac SNS control, alongside cardiac PSNS control, in supporting socio-cognitive processing. This study suggested the understanding of efficient regulation to physiological arousal and advocated for an integrative cardiac psychophysiological model of social cognition that incorporates both cardiac sympathetic-parasympathetic branches.

Theory of mind (ToM) enables individuals to decode and attribute others’ mental states to predict their behavior. While cardiac autonomic activity, particularly cardiac parasympathetic (PSNS) activity, is linked to social cognition, most previous studies infer cardiac sympathetic (SNS) activity rather than examining both simultaneously. This study aimed to investigate both cardiac PSNS and SNS activities to provide a more comprehensive understanding of ToM ability in young adults. Cardiac PSNS and SNS activities were simultaneously measured at rest in 146 participants (mean age = 20.84, SD = 2.86 years) in a cross-sectional study, and in 73 of these participants (mean age = 21.56, SD = 2.70 years) 12 months later. ToM ability was assessed using the Chinese version of the Faux Pas Recognition Test. The results indicated significant uncoupled but reciprocal associations between ToM ability and both cardiac PSNS and SNS activities. Hierarchical regression analysis further revealed that higher cardiac PSNS activity and lower cardiac SNS activity together predicted better ToM ability and its cognitive component, after controlling for possible covariates. Preliminarily, a two-wave cross-lagged panel model demonstrated a significant inverse bidirectional relationship between cardiac SNS activity and ToM ability, along with a positive predictive relationship between ToM ability and cardiac PSNS activity 1 year later. In conclusion, the present study provides direct evidence for a relationship between ToM ability and the simultaneous combination of both cardiac PSNS and SNS activities in young adults. Notably, these findings suggest the possibility that cardiac SNS activity may play an equally important, if not more crucial, role in social-cognitive processes.