The role of brain reward pathways in stress resilience and health

Neurosci Biobehav Rev. 2018 Dec;95:559-567. doi: 10.1016/j.neubiorev.2018.10.014.


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.

Keywords: Health outcomes; Resilience; Reward; Stress.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Brain / diagnostic imaging
  • Brain / physiology*
  • Brain / physiopathology*
  • Humans
  • Mental Disorders / diagnostic imaging
  • Mental Disorders / physiopathology
  • Neural Pathways / diagnostic imaging
  • Neural Pathways / physiology
  • Neural Pathways / physiopathology
  • Resilience, Psychological*
  • Reward*
  • Stress, Psychological / diagnostic imaging
  • Stress, Psychological / physiopathology*