Differential Reward Circuitry Engagement During Anticipation in Highly Resilient World Trade Center Responders

Background. Capacity to experience positive emotions supports psychological resilience. Reward neural circuitry, implicated in positive emotionality, tends to be dampened in individuals with posttraumatic stress disorder (PTSD). Less understood is the relationship between neural response to reward and being highly resilient in the face of trauma exposure.Method. We recruited World Trade Center rescue and recovery workers (N=94) from three groups: “Highly Resilient” (higher WTC-related trauma exposure plus no current/lifetime psychopathology; n=34), “Lower WTC-exposed” (lower WTC-related trauma exposure plus no current/lifetime psychopathology; n=31), and “PTSD” (chronic WTC-related PTSD; n=32). We examined reward anticipation during the Incentive Flanker Task, focusing on a priori regions of interest associated with reward salience (nucleus accumbens) and reward valuation (ventromedial prefrontal cortex; vmPFC).Results. Highly Resilient and Lower WTC-exposed groups scored comparably on self-report measures of positive emotionality, and higher than those in the PTSD group. However, left nucleus accumbens modulation by cue valence (reward, neutral, loss) was significantly greater in the Highly Resilient group compared to the Lower WTC-exposed group (Cohen’s d=0.70) and, after statistically adjusting for psychotropic medication, the chronic WTC-related PTSD group (d=0.62), Similar results were observed for the vmPFC. Conclusions. Findings support the premise that neural responsivity to potential rewards may enable resilience, potentially by buffering negative effects of substantial trauma exposure. Integrating neurobiological assessments with psychological measures may help better understand how positive emotionality is linked to psychological resilience. Improved understanding of this link could be leveraged for clinical assessment and intervention in trauma-exposed populations.