Data were obtained from a pilot RCT conducted at a large hospital ( Identifier NCT01897064). The medical center’s institutional review board approved the study, and all participants provided written informed consent. Participants were recruited from outpatient mental health clinics in the greater New York City area. The inclusion criteria were a DSM-IV diagnosis of schizophrenia or related disorders; age 18–55 years; English-speaking; taking antipsychotic medication for at least 8 weeks and on current doses for 4 weeks and/or injectable depot antipsychotics with no change in the last 3 months; and medically cleared by a physician to take part in AE training. The exclusion criteria were a DSM-IV diagnosis of alcohol/substance abuse within the past month or alcohol/substance dependence within the past 6 months; recent use of street drugs (confirmed by a urine toxicology test); a history of seizures/head trauma with loss of consciousness resulting in cognitive sequelae/rehabilitation; significant clinical abnormalities in physical examination, electrocardiogram, or lab assessments; untreated hyper- or hypothyroidism; extreme obesity (BMI ≥ 40); being pregnant/nursing; having serious suicidal/homicidal risk; presence of moderate or more severe disorganization (SAPS global positive formal thought disorder ≥ 3); more than a mild level of depressive symptoms (BDI > 18); and participation in a study involving neurocognitive assessment in the previous 3 months. All data were collected between May 2012 and July 2014.

Sample Characteristics: Forty-one individuals consented to participate in the study. Eight participants discontinued their participation prior to randomization due to difficulties keeping research appointments (n = 3), psychotic exacerbation (n = 1), diagnosis of cancer (n = 1), discovery of a benign brain tumor (n = 1), BDI > 18 (n = 1), and conflict with changed school schedule (n = 1). The remaining 33 individuals were randomized (AE = 16, TAU = 17) of which 26 completed the study (79%). In the AE group, all three non-completers dropped-out during the first week of the AE training after 0, 1, and 3 sessions, respectively, due to loss of contact (n = 1), long commute-time to AE site (n = 1), and not liking the AE program (n = 1). In the TAU group, four participants dropped-out due to relocation (n = 1), hypomanic episode (n = 1), and protocol violations (n = 2). The status of 3 of the 33 randomized participants (9%) became un-blinded to raters - 1 in the TAU group (self-disclosure) and 2 in the AE group (1 self-disclosure, 1 accidental disclosure by clinical staff). Of note, we did not exclude participants who were prescribed beta-blockers or other medications known to influence heart rate out of concern that such exclusion would result in a non-representative sample as individuals with schizophrenia may be prescribed such medications for cardiac and/or other problems (e.g., akathisia). Only 2 out of the 33 randomized participants (6%) were prescribed beta-blockers.

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