Some authors theorize that relationship attachment difficulties play an etiological role in the development of hypersexual behavior. The research in support of this theory is plagued by small sample sizes and analyses that are limited to averages within 4 forced-choice categories of attachment. The present study seeks to further the understanding of relationship attachment styles and hypersexual behavior by analyzing both categorical and dimensional measures of attachment among a large sample of men (N = 136) seeking treatment for excessive sexual behaviors. Many, but not all, subjects reported attachment difficulties. Using cluster analysis, 4 distinct clusters appeared to be unique on measures of attachment, demographics, and shame proneness. The utility of the categorical versus the dimensional model of attachment, as well as the assessment and treatment implications for hypersexual behavior, are discussed.

Background Manualized cognitive and behavioral therapies are increasingly used in primary care environments to improve nonpharmacological pain management. The Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) intervention, recently implemented by the Defense Health Agency for use across the military health system, is a modular, primary care–based treatment program delivered by behavioral health consultants integrated into primary care for patients experiencing chronic pain. Although early data suggest that this intervention improves functioning, it is unclear whether the benefits of BCBT-CP are sustained. The purpose of this paper is to describe the methods of a pragmatic clinical trial designed to test the effect of monthly telehealth booster contacts on treatment retention and long-term clinical outcomes for BCBT-CP treatment, as compared with BCBT-CP without a booster, in 716 Defense Health Agency beneficiaries with chronic pain. Design A randomized pragmatic clinical trial will be used to examine whether telehealth booster contacts improve outcomes associated with BCBT-CP treatments. Monthly booster contacts will reinforce BCBT-CP concepts and the home practice plan. Outcomes will be assessed 3, 6, 12, and 18 months after the first appointment for BCBT-CP. Focus groups will be conducted to assess the usability, perceived effectiveness, and helpfulness of the booster contacts. Summary Most individuals with chronic pain are managed in primary care, but few are offered biopsychosocial approaches to care. This pragmatic brief trial will test whether a pragmatic enhancement to routine clinical care, monthly booster contacts, results in sustained functional changes among patients with chronic pain receiving BCBT-CP in primary care.

Chronic pain management services are often provided in group formats, as they are cost effective, increase access to care, and provide unique and needed social support to patients, but mixed outcomes for these groups indicate room for improvement. A small but growing body of research suggests routine assessment of and feedback on group cohesion may improve individual patient outcomes, though this has not been studied among chronic pain groups. Provided in this article is a rationale for assessing group cohesion in pain management programs, along with considerations for how and when to use routine outcome monitoring of cohesion in clinical practice. Clinical Impact StatementQuestion: This article hopes to address using routine process feedback monitoring to improve outcomes in group therapy for chronic pain. Findings: Group clinicians in chronic pain programs can use the ideas in this article to inspire using cohesion measures in pain management programs, with the hope that it could improve their patient outcomes. Meaning: The conclusions in this article indicate that group clinicians in chronic pain programs can look at cohesion as a possible contributor to outcomes and that there are ways to improve cohesion in these groups through progress monitoring. Next Steps: Group clinicians could begin to assess cohesion and alter their interventions based on the continuous progress monitoring described.

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