SHORT COMMUNICATION Neuroimaging of resilience to stress: current state of affairs Steven J. A. van der Werff 1,2 *, J. Nienke Pannekoek 1,2 , Dan J. Stein 3 and Nic J. A. van der Wee 1,2 1 Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands 2 Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands 3 Department of Psychiatry, University of Cape Town, Cape Town, South Africa Resilience is defined as a dynamic, multidimensional process encompassing positive adaptation within the context of significant adversity. The complex nature of this construct makes it a difficult topic to study in neuroimaging research; however, in this article, we propose ways to operationalize resilience. The limited amount of structural and functional neuroimaging studies specifically designed to examine resilience have mainly focused on investigating alterations in regions of the brain involved in emotion and stress regulation circuitry. In the future, neuroimaging of resilience is expected to benefit from functional and structural connectivity approaches and the use of novel imaging task paradigms. Copyright © 2013 John Wiley & Sons, Ltd. key words—resilience; stress; neuroimaging; MRI; trauma INTRODUCTION Experiencing a severe stressor or traumatic event is a major contributor to the development of psychopathol- ogy. The estimated lifetime prevalence of the experience of/exposure to a traumatic event ranges between 51.2% and 63.6% (Kessler et al., 1995; Darves-Bornoz et al., 2008). The experience of a traumatic event is necessarily present in posttraumatic stress disorder (PTSD), which is one of the most common mental disorders with an estimated 12-month prevalence of approximately 3.1% in the US (Kessler et al., 2005) and 1.1% in Europe (Darves-Bornoz et al., 2008). However, traumatic events have also been associated with an increased risk for the development of other mental disorders, including affective disorders, eating disorders, sleeping disorders, and suicide attempts (Famularo et al., 1992; Heim and Nemeroff, 2001; McCutcheon et al., 2009; Chen et al., 2010; Stein et al., 2010). At the same time, studies have shown that a traumatic experience does not necessarily lead to the development of psychiatric symptoms (Yehuda and McFarlane, 1995; Dedert et al., 2009). Clearly, there is a degree of inter-individual variation in the way individuals respond and adapt to severe stress, with a spectrum ranging from vulnerable individ- uals on the one side to resilient individuals on the other. In simple terms of outcome, resilience can be defined as the absence of psychopathology after experiencing a traumatic event. Usually, however, more complex and dynamic definitions of resilience are used in the literature. These describe resilience as a dynamic, multidimensional process encompassing positive adaptation within the context of significant adversity, and also, from a more psychobiological standpoint, as short-term and long-term responses that reduce allostatic load (Curtis and Cicchetti, 2003; Charney, 2004). The dynamic aspect implicates that throughout life, an individual’s resilience is subject to change. These changes are the result of an individual’s experiences and changes in resources and biological and psychological characteristics over the life span. Children and adolescents have fewer environmental resources and less experience in developing adaptive coping strategies (Cicchetti and Rogosch, 2009). In this light, studying resilience after adversities in childhood and adolescence might prove exceptionally useful for developing success- ful interventions to increase resilience in vulnerable and high-risk individuals. The multidimensional aspect of resilience is supported by psychological studies that found a relation between resilience and a variety of individual characteristics such as cognitive skills, emo- tion regulation, problem solving skills, and social support (Curtis and Cicchetti, 2003). *Correspondence to: S. J. A. van der Werff, Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. E-mail: S.J.A.van_der_Werff@lumc.nl Received 3 May 2013 Accepted 23 May 2013 Copyright © 2013 John Wiley & Sons, Ltd. human psychopharmacology Hum. Psychopharmacol Clin Exp 2013; 28: 529–532. Published online 17 July 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/hup.2336