Elsevier

Neuroscience & Biobehavioral Reviews

Volume 95, December 2018, Pages 559-567
Neuroscience & Biobehavioral Reviews

Review article
The role of brain reward pathways in stress resilience and health

https://doi.org/10.1016/j.neubiorev.2018.10.014Get rights and content

Highlights

  • Rewarding stimuli can mitigate subsequent stress responses.

  • This effect occurs via connections between the brain’s reward and stress systems.

  • Initial work suggests that rewarding stimuli also have important health benefits.

  • It is possible that dampened stress reactivity is one mechanism for these benefits.

  • Future work should explore this reward-stress buffering effect on health.

Abstract

While it is well established that stress can increase risk for a broad range of health and disease outcomes (e.g., major depression, cardiovascular disease), less is known about factors supporting resilience. An emerging literature indicates that activation of the brain’s reward system can mitigate subsequent stress responses to a broad range of stressors in animals and humans, suggesting reward pathways as a novel mechanistic target for fostering resilience under stress. This perspective will: 1) describe the emerging evidence linking primary and secondary rewards with stress buffering effects; 2) identify plausible neurobiological mechanisms; and 3) introduce new links between brain reward activation and reduced stress-related health and disease outcomes. We conclude with a discussion of research opportunities and clinical implications of brain reward effects.

Section snippets

The role of brain reward pathways for stress resilience and health

Although stress is related to increased health risks such as major depressive disorder and post-traumatic stress disorder (Cohen et al., 2007; Mcewen, 2004), most individuals are remarkably resilient (Bonanno, 2004). Resilience is defined as the capacity to adapt successfully to acute stress, trauma, or chronic adversity (Feder et al., 2009). Despite significant public interest in this area, we still know little about the neurobiological and behavioral mechanisms of resilience (Bonanno et al.,

Activating the reward system reduces stress physiology and behavior: experimental evidence

An organism’s survival depends on the ability to seek out and approach rewarding stimuli in the environment. Primary rewards are those that immediately influence survival, such as food and reproduction, whereas secondary rewards are those that may not directly impact survival but facilitate these survival behaviors, including money and positive social experiences (Berridge and Robinson, 2003; Schultz, 2015; Sescousse et al., 2013). Also key to survival is being able to successfully avoid or

Plausible neurobiological relationships between reward and stress resilience

The reward system is a well-characterized network of regions across the limbic, prefrontal, striatal and midbrain regions (Haber and Knutson, 2010), and neural activity in these regions is relatively consistent across primary and secondary reward types, as shown in a thoughtful review of this work (Sescousse et al., 2013). Like the reward system, the neurobiology of the brain’s fight-or-flight stress response system is well-characterized including regions in limbic, midbrain and prefrontal

Reward-stress resilience pathways: implications for health

If brain reward pathways confer stress resilience, one implication is that they could protect against stress-related health outcomes. It is well-established that stress can trigger the onset and exacerbation of a broad range of psychiatric disorders (e.g., depression, PTSD, addictive disorders) and physical health conditions (e.g., cardiovascular disease, cancer) (Cohen et al., 2007; Hammen, 2005; Jones and Barlow, 1990; Mcewen, 2004; McEwen and Gianaros, 2010; Sinha, 2008). Despite the promise

Discussion and future directions

Large independent literatures have focused on the reward and stress systems, yet much less attention has been paid to how these systems interact. Here, we describe exciting new research linking reward system activation with stress resilience, as well as initial links to stress-related health outcomes. We reviewed a range of human and animal studies linking reward system activation (and rewarding environments) with stress resilience effects (see Table 1). Consistent with this reward-stress

Conclusions

The findings presented here suggest that reward system activation can reduce behavioral and physiological responses to stress in both human and animal models. Neural, behavioral, and pharmacological studies support the neurobiological plausibility for reward-stress resilience effects, highlighting the role of connectivity between reward structures (such as VS and VMPFC) and structures that initiate physiological stress responding (hypothalamus and amygdala), as well as the role of opioids in

Author contributions

Both authors conceptualized and wrote the paper.

Financial disclosures

Both authors reported no financial interests or potential conflicts of interest

Acknowledgements

This work was supported by grants from the National Center for Complementary & Integrative Health (NCCIH) of the National Institutes of Health (NIH) (R21AT008493, R01AT008685) awarded to the last author. This funding source had no involvement in study design; data collection, analysis, or interpretation; writing of this report; or the decision to submit this article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of

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