Alcohol, flexible behavior, and the prefrontal cortex: Functional changes underlying impaired cognitive flexibility.

Cognitive flexibility enables individuals to alter their behavior in response to changing environmental demands, facilitating optimal behavior in a dynamic world. The inability to do this, called behavioral inflexibility, is a pervasive behavioral phenotype in alcohol use disorder (AUD), driven by disruptions in cognitive flexibility. Research has repeatedly shown that behavioral inflexibility not only results from alcohol exposure across species but can itself be predictive of future drinking. Like many high-level executive functions, flexible behavior requires healthy functioning of the prefrontal cortex (PFC). The scope of this review addresses two primary themes: first, we outline tasks that have been used to investigate flexibility in the context of AUD or AUD models. We characterize these based on the task features and underlying cognitive processes that differentiate them from one another. We highlight the neural basis of flexibility measures, focusing on the PFC, and how acute or chronic alcohol in humans and non-human animal models impacts flexibility. Second, we consolidate findings on the molecular, physiological and functional changes in the PFC elicited by alcohol, that may contribute to cognitive flexibility deficits seen in AUD. Collectively, this approach identifies several key avenues for future research that will facilitate effective treatments to promote flexible behavior in the context of AUD, to reduce the risk of alcohol related harm, and to improve outcomes following AUD. This article is part of the Special Issue on "PFC circuit function in psychiatric disease and relevant models".

Close Relationships as Sources of Pregnancy-Related Weight Stigma for Expecting and New Mothers.

BACKGROUND: Experiencing weight stigma during pregnancy is detrimental to psychosocial health outcomes, including increasing maternal stress and undermining engagement in health behaviors. Guided by a recent socioecological framework, close interpersonal relationships are integral in pregnancy to facilitate healthy behaviors and protect maternal mental health, but they may also be sources that project weight stigma. The purpose of this study was to characterize weight stigma experienced during pregnancy and postpartum from close relationships including partners, immediate family, extended family, and friends. METHOD: Women who were pregnant or up to 1 year postpartum completed a survey that assessed sources of weight stigma since becoming pregnant. A thematic analysis was performed to code open-ended responses to understand the lived experiences of pregnancy-related weight stigma experienced from close relations. RESULTS: Of the 501 women who completed the online survey, 157 indicated experiencing weight stigma from close relations. Average frequency of weight stigma from close relations was 1.83 ("less than once a month" to "a few times a month"). Weight-stigmatizing examples from close relations during pregnancy included negative assumptions about maternal or fetal health and maternal lifestyle behaviors based on weight gain; comparing women to pregnant body ideals; and making comments that resulted in women judging themselves poorly as a pregnant individual or mother. CONCLUSIONS: Close relationships can be sources of pregnancy-related weight stigma. This may not only increase risk for adverse stigma-related consequences, but also could cut off the important benefits of maternal social support resulting in poor mental health outcomes and health behaviors.

Depression Predicts Chronic Pain Interference in Racially Diverse, Income-Disadvantaged Patients.

BACKGROUND: Chronic pain is one of the most common reason adults seek medical care in the United States, with prevalence estimates ranging from 11% to 40%. Mindfulness meditation has been associated with significant improvements in pain, depression, physical and mental health, sleep, and overall quality of life. Group medical visits are increasingly common and are effective at treating myriad illnesses, including chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence based integrative medicine, and medical group visits and can be used as adjuncts to medications, particularly in diverse underserved populations with limited access to non-pharmacological therapies. OBJECTIVE AND DESIGN: The objective of the present study was to use a blended analytical approach of machine learning and regression analyses to evaluate the potential relationship between depression and chronic pain in data from a randomized clinical trial of IMGV in diverse, income-disadvantaged patients suffering from chronic pain and depression. METHODS: The analytical approach used machine learning to assess the predictive relationship between depression and pain and identify and select key mediators, which were then assessed with regression analyses. It was hypothesized that depression would predict the pain outcomes of average pain, pain severity, and pain interference. RESULTS: Our analyses identified and characterized a predictive relationship between depression and chronic pain interference. This prediction was mediated by high perceived stress, low pain self-efficacy, and poor sleep quality, potential targets for attenuating the adverse effects of depression on functional outcomes. CONCLUSIONS: In the context of the associated clinical trial and similar interventions, these insights may inform future treatment optimization, targeting, and application efforts in racialized, income-disadvantaged populations, demographics often neglected in studies of chronic pain.

The Media as a Source of Weight Stigma for Pregnant and Postpartum Women.

OBJECTIVE: The media often contain weight-stigmatizing material. However, little is known about pregnant and postpartum women's experiences with media-based weight stigma. METHODS: Two studies investigated weight stigma in the media from multiple perspectives. Study 1 analyzed open-response examples of weight-stigmatizing experiences coming from the media, broadly defined, from 123 pregnant and postpartum women (from a larger sample of 501). Study 2 identified online news-media articles about pregnancy and weight published during the study 1 data collection period (August to November 2017). RESULTS: Study 1 revealed that weight stigma was common and frequent in media, manifesting across three themes: (1) ideal appearance of pregnant bodies, (2) pressure to quickly "bounce back" after birth to a prepregnancy appearance, and (3) media praising celebrities for achieving either of the previous themes. Study 2 identified 33 articles. A content analysis revealed that women with overweight or obesity were rarely portrayed in images. Additionally, discussion of weight was often negative, focusing on adverse maternal-child health consequences. Finally, media-communicated ideals for weight and weight loss were often unrealistic and did not reference medical guidelines. CONCLUSIONS: This work is the first to document that online news media are a pervasive and potentially distressing source of pregnancy-related weight stigma, suggesting much-needed reform in media guidelines.

Pregnant and postpartum women's experiences of weight stigma in healthcare.

BACKGROUND: Weight stigma is a societal phenomenon that is very prevalent in healthcare, precipitating poor patient-provider relationships, discontinuity of care, and delayed cancer screening. Little research, though, has investigated weight stigma in prenatal and postpartum healthcare. To address this gap, this study examined the prevalence and frequency of weight-stigmatizing experiences in prenatal and postpartum healthcare. METHODS: 501 pregnant and postpartum women responded to an online survey where they reported whether they had experienced weight stigma in prenatal or postpartum healthcare and, if so, how frequently. Participants also responded to questions about how providers had treated them regarding their weight and their reactions to these experiences. A subset of participants (n = 80) also provided examples of their experiences, and these were subjected to a thematic analysis and coded for overarching themes. RESULTS: Nearly 1 in 5 women (n = 92) reported experiencing weight stigma in healthcare settings. Percentages differed by BMI, with 28.4% of participants with pre-pregnancy obesity endorsing healthcare providers as a source of weight stigma. Experiences occurred between "less than once a month" and "a few times a month." Obstetricians were the most commonly-reported source (33.8%), followed by nurses (11.3%). Participants reported feeling judged, shamed, and guilty because of their weight during healthcare visits. Additionally, 37 participants (7.7%) reported having changed providers because of treatment regarding their weight. Many also reported that they expected to feel or had felt uncomfortable seeking help with breastfeeding from a healthcare professional. Finally, thematic analysis of the open-ended examples identified four key themes: (1) negative attitudes and unkind or disrespectful treatment from providers; (2) evaluative comments about their weight; (3) healthcare providers focusing on their high-risk status and potential negative consequences (often when birth outcomes were ultimately healthy); and (4) inappropriate or demeaning comments. CONCLUSIONS: Weight stigma may be a common experience in pregnancy and postpartum healthcare. Providers need additional training to avoid stigmatizing their patients and inadvertently undermining patient-provider relationships, quality of care, and health outcomes.