Editors' ChoiceMENTAL HEALTH

Promoting resilience after childhood adversity

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Science Translational Medicine  05 Jun 2019:
Vol. 11, Issue 495, eaax9560
DOI: 10.1126/scitranslmed.aax9560

Abstract

Engaging prefrontal control regions during reappraisal promotes resilience to depression after childhood maltreatment.

Childhood adversity can exert lasting influences on mental health across the lifespan, including increased risk for depression and anxiety disorders. However, not all youth exposed to adversity go on to develop psychiatric disorders. Identifying mechanisms that promote such resilience is essential for designing interventions that prevent or treat psychopathology among at-risk youth.

Rodman and colleagues investigated resilience to depression and anxiety among youth ages 8 to 17 with or without a history of maltreatment. Participants completed a task of reappraisal—a form of cognitive emotion regulation that involves reinterpreting the meaning of a stimulus to adjust one’s emotional response—during functional magnetic resonance imaging, and reported on their tendency to use reappraisal in daily life. The authors tested whether engagement of frontoparietal circuitry through cognitive reappraisal moderated the association between childhood maltreatment and internalizing symptoms. Notably, increased ability to regulate amygdala reactivity was associated with reduced symptoms of depression over the course of a two-year follow-up period among maltreated youth, whereas there was no association among nonmaltreated youth. Stronger engagement of prefrontal control regions and more frequent use of reappraisal in daily life were associated with lower depressive symptoms at baseline among maltreated youth. Highlighting potential specificity to depression, there was no evidence for a similar mechanism of resilience related to anxiety.

These findings suggest that among youth exposed to early adversity, the ability to regulate negative affect by recruiting frontoparietal circuitry involved in cognitive control may buffer against risk for depression. In addition to the longitudinal design and comparison of neural circuitry between maltreated and nonmaltreated youth, a strength of the study is that it was conducted during development, increasing the potential for the findings to inform early intervention. In particular, targeting the ability and tendency to cognitively regulate emotion may be especially effective for youth exposed to adversity. Future research should assess connectivity to further elucidate the interactions between prefrontal regions and the amygdala that may give rise to resilience. Examining similar processes of resilience in youth exposed to different forms of adversity, as well as testing whether the findings are specific to reappraisal versus other forms of cognitive control of emotion, may also allow for more precise intervention recommendations.

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