title: Police officers under attack: resilience implications of an fMRI study.
abstract: OBJECTIVE
  Crime is now a top-priority public-health issue in many urban areas. Sao Paulo's state police force was the target of gunfire attack on an unprecedented scale. Several officers were killed or wounded, and many more were affected by psychological trauma. We investigated the brain activity underlying trauma, the coping effect of psychotherapy, and resilience in a highly homogenous sample that experienced the same traumatic event. The design applied was a between-group comparison of cerebral blood-oxygenation-level-dependent signals and symptom scores of police officers with and without partial Posttraumatic Stress Disorder (pPTSD).
  
  
  METHODS
  We used functional magnetic resonance imaging (fMRI) to investigate the retrieval of traumatic memories of 36 volunteers divided in three groups: (1) pPTSD policemen submitted to psychotherapy; (2) pPTSD policemen on the wait list; and (3) symptom-free (resilient) policemen. All participants were given a baseline fMRI scan and a follow-up scan some 40 days later. Not given psychotherapy, groups 2 and 3 were controls.
  
  
  RESULTS
  Group 1 showed 37% fewer PTSD symptoms post-psychotherapy and their scores and neural expressions were comparable to Group 3 resilient policemen. A marked increased in medial prefrontal cortex (mPFC) activity was concomitant with decreased amygdala activity during traumatic memory retrieval in both resilient and pPTSD participants (after psychotherapy) and these findings were associated with symptom attenuation.
  
  
  CONCLUSIONS
  Our results provide neurophysiological evidence of resilience in a high-risk group for PTSD. Psychotherapy may help to build narratives and resilient integrated translations of fragmented traumatic memories via mPFC, and thus weaken their sensory content while strengthening them cognitively.
authors.affiliation: Department of Diagnostic Imaging - Radiologia Clinica Universidade Federal de Sao Paulo, Escola Paulista de Medicina, SP, Brazil. julioperes@yahoo.com
authors.forename: Julio F P
authors.initials: JF
authors.lastname: Peres
authors.forename: Bernd
authors.initials: B
authors.lastname: Foerster
authors.forename: Leandro G
authors.initials: LG
authors.lastname: Santana
authors.forename: Mauricio Domingues
authors.initials: MD
authors.lastname: Fereira
authors.forename: Antonia G
authors.initials: AG
authors.lastname: Nasello
authors.forename: Mariângela
authors.initials: M
authors.lastname: Savoia
authors.forename: Alexander
authors.initials: A
authors.lastname: Moreira-Almeida
authors.forename: Henrique
authors.initials: H
authors.lastname: Lederman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000679:Amygdala / Q000503:physiopathology; D016022:Case-Control Studies; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D016495:Police; D017397:Prefrontal Cortex / Q000503:physiopathology; D011613:Psychotherapy; D055500:Resilience, Psychological; D012307:Risk Factors; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D013315:Stress, Psychological / Q000150:complications; D016896:Treatment Outcome