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. 2021 Oct 5;11:508. doi: 10.1038/s41398-021-01633-y

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Pre-trauma factors of resilience include larger vmPFC and hippocampus volume, greater activation of emotional regulatory regions like the vmPFC, hippocampus, and aPFC, and less activation in threat response regions such as the amygdala, dACC, and LC. Resilient individuals demonstrated fewer functional and structural changes from pre to post trauma compared to those with symptoms of PTSD. However, greater coupling between the vmPFC and hippocampus from pre to post trauma is associated with resilience. Peri-trauma features that predict later resilience include larger structural features in the hippocampus, parahippocampus, vmPFC, sgACC, dlPFC, temporal lobe, as well as greater rACC surface area volume. Similar to pre-trauma, decreased amygdala and increased hippocampal/parahippocampal functional activity soon after trauma are associated with resilience. Increased dlPFC-amygdala and decreased PCC-amygdala or PCC-PAG connectivity positively correlate with later resilience. Notably, however, many of these findings appear the opposite among those at risk for chronic PTSD with dissociative features. Over the course of recovery, functional reactivity in the amygdala, insula, and dACC decrease or return to pre-trauma levels. Amygdala-insula, -thalamus, and -vmPFC connectivity also return to baseline levels, and connectivity between the PCC and PAG continues to weaken over time. Structural increases in frontal regions such as the OFC or vmPFC as well as increases in the thalamus are related to recovery. There is greater activation of emotional regulatory regions like the vmPFC and hippocampus as well as less activity in the dmPFC and PCC. Yellow/blue fill = positive/negative correlations between resilience and functional activation or reactivity. Orange/blue border = positive/negative correlation between resilience and structural volume. Green/blue arrows = positive/negative correlation between resilience and connectivity between regions.