Abstract
The Intimacy Frontier: Exploring the Use of AI Companionship in Emotional Healing and Intimacy

Loneliness has emerged as a significant public health concern; this doctoral project presents an evidence-based practitioner guide that examines how AI companionship may influence emotional healing, intimacy, and connection, and how to assess its problematic use. The study analyzed research on the relational and psychological effects of AI companionship, including implications for well-being, attachment, and loneliness, and created a practical guide for clinicians working with clients who use AI companions or might benefit from them as part of a therapeutic treatment plan. The project used an integrative review methodology with thematic synthesis to summarize, evaluate, and integrate findings from empirical and theoretical literature, including scholarly, gray, and clinical materials on AI companionship, sex technology, loneliness, and attachment. The analysis integrated psychological theory, historical accounts, ethical discourse, and clinical observation to develop a structured, practice-oriented guide for therapists and coaches. Themes included motivations for AI use, emotional and sexual bonding with AI companions, potential benefits for regulation and skill-building, and risks such as dependence, avoidance of human relationships, and boundary confusion. The Intimacy Frontier: A Therapist’s Guide to Assessing and Integrating AI Companionship In Clinical Practice offers clinicians a framework, an AI-use assessment tool, and case-informed questions to support assessment and treatment planning. AI companionship is positioned as a possible adjunctive resource for individuals who face barriers to traditional mental health care, with emphasis on informed consent, realistic expectations, and careful attention to power and vulnerability in AI-mediated relationships. Future research should examine user experiences, clinical outcomes, and long-term relational effects so that practice guidelines and policy can evolve alongside technological change.

Keywords: artificial intelligence; loneliness; AI companionship; psychotherapy; thematic analysis

Abstract
Examining Gender Differences in the Sexual Digital Media Inventory: A Validation and Comparison Study

Sex addiction is not in the DSM-5 for a number of reasons, one of them being that there are very few validated assessments for sex addiction. Further, there is little research on women with sex addiction. With the rise of the internet, a newer form of sex addiction has been discussed in the literature, online sex addiction. People who did not have the precursors for developing a sex addiction were finding themselves addicted to sexual digital media. Also, concerns were raised about being exposed to sexual digital media at younger ages and how it affects arousal templates as adults. An assessment, the Sexual Digital Media Inventory (SDMI, Carnes, 2020), measures the impact of online sex behaviors, as well as the interests of the user. It has been in use since 2020, but has not been validated. Thus, this study had three aims: 1. To examine if the SDMI was a valid instrument for both females and males; 2. To examine if females score differently than males, based on the different dimensions of the assessment, and each person’s personal experiences; and 3. To examine how online digital media affects females generationally. Each of the subscales of the SDMI was found to have strong internal consistency for both males and females. Concurrent validity between the pornography subscale, the SAST core, and the CSBD-DI was conducted, and there was a strong concurrent correlation between the scales, adding to the validity of the SDMI. Mann-Whitney U tests and chi-square tests with Cramer’s V were conducted for the second aim, with findings showing that females and males differed significantly in their responses to the impact and interest subscales and to yes/no questions. Kruskal-Wallis tests were conducted for the third research question, and the results showed an influence on younger generations. Generation Z scored significantly higher on several dimensions of online sexual media compared to Millennials. There was not a sufficiently large sample of Generation X or Baby Boomers to examine comparisons with other generations. All three hypotheses were supported, though it is recommended that there be further research with larger female sample sizes and age groups.

Abstract
Reconstructing Connection: Enhancing Intimacy Skills in Sex Offender Treatment Protocols: A Narrative Synthesis of Integrative Theoretical Interventions

Clinicians frequently cite intimacy deficits as drivers of sexual offending behavior, yet standard treatment models have not consistently defined or targeted the relational, emotional, and developmental mechanisms that shape intimacy. I addressed that gap by synthesizing interdisciplinary literature to clarify intimacy-related treatment targets for individuals with sexual offense histories and to organize those targets into a cohesive conceptual model. I selected a qualitative narrative synthesis, grounded in a constructionist framework, to guide the review and integration of theoretical and empirical sources from psychology, criminology, and relational theory. I identified literature using explicit inclusion criteria and analyzed it through transparent deductive coding and thematic synthesis to identify convergent mechanisms associated with intimacy deficits in treatment contexts. The synthesis emphasized conceptual integration rather than effect-size aggregation or intervention efficacy testing. Findings indicated three mechanisms that consistently converged across the reviewed literature: (a) attachment disruption, (b) affect dysregulation associated with trauma, and (c) social and interpersonal skill deficits. Evidence across sources suggested that attachment disruption shaped expectations for closeness and safety, affect dysregulation constrained vulnerability and relational learning, and skill deficits functioned as the observable behavioral pathway through which relational impairment manifested. I integrated those mechanisms into the reconstructing connection model, which organized how relational history, emotion regulation capacity, and interpersonal functioning interacted to sustain intimacy difficulties within sexual offender treatment settings. The model provided an organizing scaffold to guide clinical reasoning, sequencing of treatment targets, and future research without prescribing a single protocol. Recommendations emphasized empirical testing of the model, refinement of measurement strategies for intimacy-related mechanisms, and evaluation of integrated, developmentally sensitive, trauma-informed approaches within established risk-focused treatment contexts.

Keywords: Intimacy deficits; sexual offender treatment; attachment disruption; affect regulation; narrative synthesis

Abstract
Quality of Life Among Adult Transgender Individuals Following Adolescent Puberty Suppression or Hormone Replacement Therapy: A Grounded Theory Study

Background and Purpose: Studies indicate that transgender adults suffer disproportionately from mental health concerns in comparison to the general population. Several studies indicate that the quality of life (QoL) of transgender individuals may be enhanced by gender-affirming interventions, including hormone replacement therapy (HRT). This pilot study is aimed to identify the impact of early HRT (administered in adolescence) on the QoL of transgender adults.

Method: This pilot study utilized an Evolved Grounded Theory methodology to determine the impact of early HRT on the QoL of transgender adults. Data were gathered via semi-structured interviews with seven adult participants (over the age of 20) who initiated HRT between the ages of 17 and 19.

Results: This study determined that early medically supervised HRT enhances the QoL of transgender adults. All seven participants reported a higher QoL in the areas defined by Flanagan’s Quality of Life Scale: Physical and Material Well-being, Relations with Other People, Social, Community and Civic Activities, Personal Development and Fulfillment, and Recreation.

Abstract
Exploring the Experiences of Sexual Intimacy in the Context of a Monogamous Relationship: An Interpretive Phenomenological Analysis of Women in Recovery for Sex Addiction after at Least One Year of Active Participation in Recovery

The purpose of this study was to examine how women in recovery from sex addiction experience healthy sexual intimacy within monogamous relationships. The study focused on women who self-identified as sex addicts, had maintained at least 1 year of recovery, and were in committed monogamous partnerships. A trauma-informed, attachment-based, and relational framework guided the inquiry into meaning, embodiment, and connection. Data came from in-depth semi-structured interviews with a purposive sample recruited through recovery-oriented networks. Interpretive phenomenological analysis guided iterative reading, coding, and thematic development. Findings indicated that participants redefined healthy sexual intimacy as emotional richness and authentic connection grounded in safety, consent, and mutual presence rather than performance or intensity. Participants described movement from pre-recovery patterns of control, coping, and disconnection toward patient, negotiated intimacy supported through boundaries, honest communication, spiritual practices, and recovery tools. Behavioral shifts included slower pacing, gentle touch, greater capacity to remain present in their bodies, and use of shared rituals of affection in daily life. Participants also described ongoing work with triggers, fear of relapse, aging, health changes, and mismatched desire, using strategies such as pausing, grounding, and co-regulation with partners to sustain intimacy. Monogamous commitment functioned as both stabilizing structure and context shaped through culture and faith. Implications include the need for trauma-informed, somatic, and relational approaches that normalize nonlinear intimacy recovery, support emotional and bodily safety, and involve partners when appropriate.

Keywords: Sex addiction recovery; healthy sexual intimacy; women; monogamous relationships; interpretive phenomenological analysis

Abstract
Personality Organization and Early Maladaptive Schemas in Help-Seeking Adults with Pedophilic Interests: A Quantitative Study Using the STIPO-R and YSQ-S3

Research on pedophilia has largely focused on offending and forensic populations, leaving non-offending, help-seeking individuals underrepresented in the literature. This study aimed to provide a descriptive profile of early maladaptive schemas and personality organization in a non-offending, help-seeking sample of adult males with persistent pedophilic interests (N = 30). Participants completed the Young Schema Questionnaire-Short Form 3 (YSQ-S3) and were interviewed using the Structured Interview of Personality Organization-Revised (STIPO-R). At the schema level, participants endorsed maladaptive patterns across all five domains, though vulnerabilities were most pronounced within the Disconnection and Rejection domain, particularly Social Isolation and Defectiveness and Shame. Findings from the STIPO-R indicated mild-to-moderate disturbance across all domains of personality functioning, with the greatest impairments observed in object relations, defenses, and identity. While group averages suggested mild to moderate impairments, distributional patterns revealed a substantial subset whose impairments were consistent with clinically significant personality pathology. These individuals showed marked difficulties with self-cohesion, relational functioning, and defensive operations, underscoring the heterogeneity of this population.

Taken together, the results suggest that among non-offending, help-seeking individuals, clinically meaningful vulnerabilities in personality functioning are common. While not universal, such difficulties highlight the importance of individualized assessment and therapeutic approaches.

Keywords: Minor-attracted person, Pedophilia, Non-offending, Early maladaptive schemas, Personality organization, Schema therapy, Object relations.

Abstract
The Fertile Mind: A Clinician’s Guide to Treating Male Factor Infertility

Infertility affects approximately half of couples who seek treatment for reproductive concerns, yet male factor infertility often receives limited clinical and research attention. The purpose of this doctoral project was to develop an integrative clinician’s manual and companion clinical training curriculum that address the psychological, sexual, and relational consequences of male factor infertility through hypnotherapy and cognitive behavioral strategies. The project sought to equip hypnotherapists and sexology clinicians with a structured, evidence-informed approach that can be used alongside medical fertility care. A systematic review of peer-reviewed literature on male factor infertility, oxidative stress, sexual dysfunction, hypnotherapy, cognitive behavioral therapy, and adult learning was conducted to identify common psychological and relational problems faced by infertile men and to select appropriate assessment tools and intervention components. These findings guided the design of a four module treatment manual that includes intake and assessment procedures, psychoeducation, cognitive behavioral interventions, and a series of structured hypnotherapy sessions, as well as a clinical training curriculum grounded in experiential learning theory and adult learning theory. The resulting manual, The Fertile Mind: A Clinician’s Guide to Treating Male Factor Infertility, organizes care into four modules: intake and assessment, psychoeducation, cognitive behavioral therapy, and six targeted hypnotherapy sessions addressing stress reduction, depression, anxiety, self-esteem, sexual dysfunction, and intimate connection. Standardized measures of anxiety, depression, and self-esteem are used at baseline, mid-treatment, and post-treatment to support outcome monitoring. The training curriculum provides a 14-hour program that integrates didactic instruction, role-plays, supervised practice, and structured reflection to support clinician competency in delivering the protocol. The project offers a structured treatment option for male factor infertility that can be integrated with medical care and sets the stage for future empirical evaluation of outcomes, refinement of session content, and wider dissemination in fertility and sexology settings.

Keywords: Male factor infertility, hypnotherapy, cognitive behavioral therapy, oxidative stress, clinical training curriculum

Abstract
The Influence of Social Stigma on Sexual Satisfaction Across Alternative Relationship Styles: A Comparative Study of High and Low Stigma Experiences

This study examined the influence of social stigma on sexual satisfaction among individuals engaged in consensually nonmonogamous (CNM) relationships. A total of 193 participants completed self-report measures assessing perceived stigma, relationship satisfaction, and sexual well-being. The goal was to better understand how social stigma impacts the quality of sexual and relational experiences for those practicing alternative relationship structures such as polyamory and open relationships. Results indicated that perceived stigma did not significantly predict sexual satisfaction; however, a slight positive trend suggested that individuals with stronger community connections may experience less negative impact from stigmatizing experiences. These findings highlight the importance of community belonging and social support as possible protective factors that buffer against the psychological effects of stigma. The study offers implications for clinicians, educators, and policymakers to improve cultural competence, reduce bias, and promote inclusive approaches when addressing diverse relationship styles. Greater awareness of CNM experiences can enhance understanding and reduce the marginalization that often affects these communities.

Keywords: consensual nonmonogamy, stigma, sexual satisfaction, relationships, community support

Abstract

The Sexual Sense of Self: Developmental Origins and Therapeutic Intervention for Psychogenic Erectile Dysfunction 

This doctoral project introduces an innovative intervention for psychogenic erectile dysfunction centered on enhancing the sexual sense of self-defined as the capacity to maintain connection with one's own experience while in intimate contact with another, while simultaneously being transformed through this encounter. Drawing from developmental psychology, neurobiological research, and clinical sexology, this project proposes that the sexual sense of self originates in early feeding experiences, where patterns of connection and separation establish the capacity to recognize authentic needs and desires and boundaries. The infant's experience at the breast creates templates for adult sexuality through limbic system patterns that influence pleasure, boundary regulation, and intimate connection. The intervention employs an 8-session clinical treatment protocol delivered through treatment sessions, integrating hypnotic intervention, body based awareness practices, and relational exploration. This project makes three significant contributions: (1) introducing the original construct of the sexual sense of self for understanding psychogenic erectile dysfunction; (2) developing a comprehensive therapeutic protocol that integrates multiple therapeutic modalities; and (3) creating a comprehensive approach addressing both immediate symptoms and developmental origins of psychogenic erectile dysfunction.

Keywords: Erectile Dysfunction, adult sexuality, intervention, coping mechanisms, relationships.

Abstract
Sexual Self-Care and Therapeutic Engagement: Examining Female Cisgender Therapists’ Sexual Satisfaction, Frequency, and Variety, and Willingness to Treat Sexually Focused Clients

The study examined whether three facets of therapists’ sexual self-care predict willingness to treat clients who present sexual concerns. The conceptual model positioned sexual satisfaction, sexual frequency, and sexual variety as predictors of willingness to treat. The work also sought to clarify whether any single facet stands out once the three are considered together. A cross-sectional, correlational design used a composite instrument: a shortened NSSS-B for sexual satisfaction, a collapsed single-item indicator for sexual frequency over six months, a seven-item sexual variety set, and the four-item Willingness to Treat Sexual Issues scale. All items used a six-point Likert response format without a midpoint. Multiple linear regression tested the model with willingness to treat as the outcome. Descriptive summaries showed variation in all predictors and in the outcome. Bivariate checks yielded small associations, including a weak negative link between sexual satisfaction and willingness to treat. The multivariable model produced non-significant coefficients for sexual satisfaction, sexual frequency, and sexual variety, with low explained variance. Null hypotheses were retained for all three predictors. Findings suggest willingness to treat does not depend on the specific sexual self-care indicators assessed here. Future work should add variables that capture therapist regulation skills, training exposure, and practice context, and should test the expanded model with larger and more diverse samples and with longitudinal designs.

Keywords: Sexual self-care; sexual satisfaction; sexual frequency; sexual variety; willingness to treat

Abstract
Unveiling the Hidden Struggle: A Grounded Theory Exploration of Sex Addiction in Married Orthodox Jewish Males

Sex addiction within Orthodox Jewish communities remains underexplored, despite growing clinical awareness of its emotional and relational impacts. I conducted a qualitative grounded theory study to investigate how cultural, religious, and psychological factors contribute to the development and maintenance of sex addiction among married Orthodox Jewish men. Understanding these dynamics is essential for improving culturally responsive treatment and reducing stigma in religious settings. I collected data through semi-structured interviews with 8 adult participants, recruited using purposive and snowball sampling. Grounded theory methodology guided open, axial, and selective coding to support theory generation. Findings is supporting the development of the Shame-Regulation Cycle, a theoretical model illustrating how unresolved trauma, moral conflict, secrecy, and emotional avoidance drive compulsive sexual behavior. Participants described sex not as a source of pleasure, but to regulate distress. Shame emerged as both a trigger and product of the behavior, reinforcing a feedback loop that deepened emotional isolation and obstructed recovery. Results indicate that therapeutic approaches must move beyond behavior management to address the underlying emotional and spiritual conflicts shaping addiction. Interventions should integrate emotional regulation therapies with cultural fluency and linguistic accessibility, particularly for Yiddish-speaking individuals. Community-based education and rabbinic support may also reduce stigma and foster safer avenues for early intervention.

Keywords: Sex addiction, Orthodox Judaism, grounded theory, shame, emotional regulation

Abstract

The Yoga of Sex: A-MYSTERY

Awakening-Mindfulness-based, Yoga-centered Sexuality: Therapeutic and Educational Resources for Young-adults

Background:

Sexual wellness is important and integrative with overall health, wellbeing, and identity. Many individualized factors contribute to sexual meaning, pleasure, vitality, and creativity in our personal selves. Comprehensive holistic sex education (CHSE) views sexuality holistically in the context of emotional and social health. It has evolved to encompass developmentally appropriate knowledge and skills in a participatory process of exploring ones’ own values to be empowered to make decisions, communicate skillfully and take responsibility for one’s own and others’ sexual wellbeing in contributing to a compassionate and just society. Sexuality is multidimensional and intersects with personal, interpersonal, social, cultural, economic, political, and spiritual dimensions. According to Tibetan Vajrayana Buddhism and certain other spiritual teachings, sexuality is in inherent aspect of our blissful enlightened nature and wisdom can be consciously interwoven to enlighten worldly experiences of sexuality to be integrated in a path of enlightenment. Promoting awareness of energy-based sexuality can be part of a process creating liberation from heteronormative conceptualizations of sexuality and other possible sociocultural factors youth may be navigating, such as sexual media socialization in the digital era. Additional problems youth are facing include systems shaped by harmful views, beliefs and behaviors such as sexism, misogyny, homophobia, rigid gendered roles, sexual double standards, and sexual objectification.

Aims:

The promotion of sexual and relational health is vitally important for young adults and can have implications towards their wellbeing. To meet the need for sexual wellness education programs for young adults, the Yoga of Sex: A-MYSTERY includes embodied contemplative practices that integrate inner inquiry processes of investigating and transforming physiological and psychological experiences towards balance and mental, sexual, and physical health. This curriculum has a focus on cultivating self-awareness, compassion, personal wellbeing, and growth. This experiential and personalized program seeks to create a space for young adults to support their healthy sexual development in a holistic context of body, energy, and mind. In smartphone application-based learning modules, information provided in video, audio, and text formats can be explored in a self-paced style with a community forum, tracking and motivating features. Relaxation-based and arousal-based yoga methods and practices are integrated to provide a foundation of back-to-basics-connection with oneself in a harmonious, peaceful, and loving way. In addition to exploring their own unique development although being introduced to practices that support connection to themselves, they will also investigate the systems they live in. A-MYSTERY is a sexual violence prevention and sexual pleasure promoting program by focusing attention, learning, and experiencing in an individual, and in an embodied emotionally informed context. This approach cultivates sexual intelligence, emotional empathy, and sexual empathy, which are required for effective communication.

Abstract
An Assessment of the Effectiveness of an Educational Program to Improve Parental Self-Efficacy in Managing Children's Addictive Internet Use

Addictive internet usage is at the forefront of an ongoing mental health epidemic affecting all people, but landing hardest on children. Addictive internet use affects neurodevelopment in children, altering brain regions critical for language and emotional regulation (Darnai et al., 2022), in addition to a multitude of negative effects on social belonging, increased loneliness, and emotional dysregulation (Haidt, 2024; Vismara et al., 2022; Spruit et al., 2020; Tironi et al., 2021). A significant barrier to improving the trajectory of this social issue’s impact on our modern world is parents’ limited self-efficacy in their ability to accurately recognize addictive behavior in their children online and respond with appropriate parental mediation strategies like limit setting and ongoing active dialogue about digital life (Beyens & Beullens, 2016; Nagata et al., 2022a; Muppalla et al., 2023). The purpose of this study was to evaluate the effectiveness of a 2-hour interactive educational program (The Digital-Age Parenting Workshop: How to identify addictive behavior online and set limits) aimed at enhancing parents' self efficacy in establishing age-appropriate screen limits for their children. Specifically, this research investigated whether participation in the program increases parents' self-efficacy in effectively monitoring their children’s internet usage, with a focus on reducing exposure to high-risk online behaviors such as excessive gaming, pornography use, social media, and vulnerability to online sexual solicitation. This study addressed a critical gap in current literature by providing empirical evidence on a brief educational intervention designed to empower parents to implement protective screen time boundaries, thereby protecting the social, neurological, and sexual development of their children. The primary outcome measured was the degree of change in parental self-efficacy in regards to accurately recognizing addictive internet use and ability to set age appropriate limits. The secondary outcome measured was the behavioral change participants engaged in at one-month 4 post participation. Attachment theory was used as the primary theoretical framework of the study, due to its relevance to the focus on preserving the healthy development of children. Transformative Learning Theory was chosen as the secondary theoretical framework guiding this study as it served as the foundational learning strategy for the program being evaluated. This study was conducted using a mixed-methods design that collected pre- and post-test surveys from a total of six parents, including using a convenience sampling method, that participated in a two-hour educational program. The data analysis for the study was conducted using Cohen’s d to measure the magnitude of change in learning outcomes and a thematic qualitative analysis to glean insight from the parent participants’ experience to better inform future research.

Abstract

The Power of Connection: How Attachment and Loneliness Influence Sexual Satisfaction in Entrepreneurial Marriages

Entrepreneurs are often celebrated for their ambition, innovation, and relentless drive, but what is the cost of that success in their personal relationships? This study explores how emotional connection, specifically through the lenses of attachment styles and loneliness, influences sexual satisfaction among married entrepreneurs in the United States whose businesses gross over one million dollars annually. Despite the growing attention to the emotional and relational challenges of high-achieving individuals, little is known about how these internal dynamics manifest in their intimate lives. Using a quantitative research design, data was collected from 125 married entrepreneurs through an anonymous, web-based survey that included validated instruments measuring adult attachment, loneliness, and sexual satisfaction. Statistical analysis revealed that secure attachment styles were positively associated with greater sexual satisfaction, while higher levels of loneliness were strongly linked to diminished sexual fulfillment. Interestingly, certain dimensions of attachment insecurity, such as anxiety and avoidance, also played a significant role in shaping relational and sexual dynamics within entrepreneurial marriages. The findings of this study suggest that emotional closeness and relational security are not only desirable but essential for maintaining sexual intimacy in high-demand lifestyles. These insights have important implications for clinical sexologists and relationship professionals working with entrepreneurial couples, as they underscore the need to address both emotional and relational wellness as part of a holistic approach to sexual satisfaction. Future research could further examine how entrepreneurship-specific stressors, such as financial risk and work-life imbalance, may compound or moderate these relational outcomes.

Abstract
The Self in Sex Therapy Certification: An Exploration of Certified Sex Therapists’ Experiences With Self-of-the-Therapist Work

When the development of the sex therapist’s self is included in training experiences, they become aware of how their personal aspects impact the therapeutic relationship and develop skills to use their self in a clinical context. This exploration into who a therapist is and how their personhood impacts their clinical work is often referred to as self-of-the-therapist work. In this qualitative study, the experiences certified sex therapists had with self-of-the-therapist work during sex therapy certification was investigated. Interviews of 25 certified sex therapists were conducted. The interviews focused on their experiences with sex therapy training which attended to personal aspects (such as personal histories, values, biases, and triggers) and how the exploration of their personhood impacted their clinical work. Most of the participants in this study identified a lack of explicit self-of-the-therapist work during their sex therapy training; however, they revealed various ways they engaged in self-of-the-therapist work on their own. The themes which emerged identified perceived areas of strength and areas of growth for how their sex therapy certification programs included self-of-the-therapist work into their training; they also identified a desire for increased attention to self-of-the-therapist work during the sex therapy certification process.

Abstract
The New Client’s Emergence? Should Young Adults Who Are Problematically Engaged in Online Pornography Without Real-Life Sexual Experiences Be Assessed and Treated Differently?

The current study examined the profiles and the treatment needs of young adults presenting with problematic pornography use who have no real-life sexual experiences (or have few unsatisfactory attempts). This knowledge is vital to fill a gap in the field on the assessment and the treatment needs of this population. An online survey, targeted at young adults in the 18– 25 age range who self-identify with problematic porn use and consider turning to treatment, was distributed among participants from Reddit communities and social media sites (e.g., Facebook). The final sample consisted of 138 participants from 37 countries. This study combined quantitative and qualitative methods. History of traumatic experiences, mental health comorbidities, co-occurring problematic substance use and behavioral addictions, patterns of use, current concerns with the use, relapse course and experiences, previous treatment experiences, and expectations from treatment were assessed. In line with the existing clinical evidence, problematic pornography use by the subjects was unrelated to the history of traumatic experiences, nor was it related to being diagnosed with a mental health disorder. Most of the subjects described years of struggling with their pornography use, with multiple attempts to reduce or to stop the behavior, and the hardship of relapses following periods of abstinence. A high prevalence of problematic engagement in addictive behaviors (video gaming, overeating, excessive shopping, problematic online sexual activity [OSA], and overworking) was remarkable. Among the main concerns of the participants were the constant urges to use porn, the adverse effects of the prolonged and excessive use on cognitive function, sexual function, and their ability to integrate socially, relationally, and professionally. High levels of stress were described by participants relative to these concerns. Among the main treatment objectives considered by participants were stopping or learning to manage the behavior, learning more about the condition, learning how to cope better with life stressors and relational and sexual loneliness, learning how to repair their sexuality, and learning how to have intimate relationships outside of the Internet. The preferred treatment modality was individual therapy, though many participants stressed that they would undergo treatment only on the condition that was anonymous. Overall, the findings support the notion that the population of young adult clients with problematic engagement in porn who have no real-life sexual experiences requires a different approach and different treatment. Future research and clinical applications are discussed.

Abstract
A PREGNANCY AND PREGNANCY PREVENTION PILOT PROGRAM FOR TEENAGERS IN KENYA, EAST AFRICA

In Kenya, the need for Comprehensive Sexuality Education (CSE) is not only important, but necessary. Advocating for knowledge dissemination for young people enables them to make healthier choices when it comes to pregnancy and pregnancy prevention, and to avoid unintended pregnancies and unhealthy relationships. This population currently does not have the resources to help them deal with these challenges, and various literature across Sub Saharan Africa highlights how young people desperately need the appropriate skills, knowledge, and attitudes to understand these areas. Because young people have not had the opportunity to understand sexuality based on science through CSE, this population has not been able to make informed decisions on identified country problems such as unplanned pregnancies, practicing unsafe sex, high abortion rates and marked incidences of gender-based violence (GBV).

This dissertation project addresses a specific country need so that young people in a specific age group (15–17-year-olds) may receive appropriate knowledge in one area (Pregnancy and Pregnancy Prevention). As it was not possible to roll out this program directly to young people due to them being a vulnerable population, a pilot program was developed for and tested by 30 adult professionals, living, and working in Kenya – namely health workers, parents/caregivers, and teachers. As hypothesized, the consensus amongst the population tested proved that the information in this pilot program was useful, informative, and relevant, whether they had teenage children and/or when comparing their own personal teenaged experiences and the quality of the information (if any) that they received on sex and sexuality from caregivers, peers or at school. It is hoped that by improving the quality of the educational content provided by a CSE curriculum in Kenyan schools will help in reducing the rate of teenage pregnancies and illegal abortions, and improve the level of knowledge, skills and attitudes that young people require to make healthy decisions as they transition into adulthood. They say the best contraception is knowledge and not abstinence; therefore, having more programs like this to address all age groups and all recommended CSE topics are needed.

Abstract
Polyvagal-Informed Treatment Approach for Compulsive Sexual Behavior Disorder

Compulsive sexual behavior disorder (CSBD) is a new diagnosis in the latest publication of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems, 11th Revision, marking the first time a negative impact associated with out-of-control sexual behavior, rooted in repetitive sexual urges and impulses, has been recognized as an independent psychiatric disorder. With a worldwide prevalence of 5%, the occurrence of CSBD parallels that of the other major psychiatric disorders. However, based on the recency of its formal recognition as a mental health disorder, research on CSBD, including its etiology and treatment, has been comparatively more limited.

The previous research on maladaptive sexual behaviors, using various terminology such as sexual addiction, compulsive sexual behavior, hypersexual disorder, and out-of-control sexual behavior, has yielded several clinical approaches efficacious in treatment of those behaviors, including cognitive behavior therapy, acceptance and commitment therapy, mindfulness, psychoeducation, and self-help groups. While beneficial, those approaches do not seem to specifically focus on the role of the autonomic nervous system (ANS) functioning and its association with CSBD.

This doctoral project aims to close that gap by introducing an additional treatment approach for CSBD rooted in the principles of polyvagal theory (PVT) and the ANS functioning. PVT conceptualizes compulsive sexual behavior as a state regulation strategy, attempting to regulate ANS retuned to support defense, i.e. ANS in the state of danger or life threat. While that strategy may be an adaptive survival response in the short term (e.g. numbing distressing emotions), it is inefficient on a long-term basis (e.g. adverse consequences to self or others).

This project’s goal is to develop a polyvagal-informed treatment approach for CSBD, which also includes a clinical training curriculum, to be used as a complement to the current treatment approaches, offering an additional lens of the role of ANS as an intervening variable in conceptualization of CSBD. The overall objective of the approach is to facilitate ANS recruitment for safety, i.e. the neural platform incompatible with compulsive sexual behavior and whose emergent properties of co-regulation and self-regulation represent more adaptive state regulation strategies and foster co-regulated sexuality and intimacy.

Abstract
Experiences of New Relationship Energy in Consensually Nonmonogamous Relationships

This constructivist grounded theory study explores how participants in consensually nonmonogamous relationships (CNM) navigated challenges associated with the new relationship energy (NRE) period of a relationship, either as the established partner (EP) of someone experiencing NRE, or as the new relationship energy partner (NREP). Through qualitative interviews with eleven participants, the researcher was able to find common themes in narratives shared by the participants. The findings reveal that there are many biopsychosocial factors, especially around attachment and identity, that influence how the participants interacted with their NRE or their NREP during this time. The findings also supported the idea that NRE is another word for limerence, and that NREPs’ experiences were similar to that of people who describe limerent experiences, explaining the volatility of this phase of a relationship. The research also suggests several strategies participants commonly used to learn to successfully navigate the NRE period. This study contributes to existing research on attachment and needs fulfillment, which has mostly been done in the context of monogamous relationships.

Keywords: Nonmonogamy, attachment, needs, coping mechanisms, relationships.

Abstract
Healing the “Angry Black Woman”: A Power Exchange with Your Pain

An Exploration of the Potential Healing Powers of Therapeutic BDSM as a Form of Somatic Experiencing in Treating Black Women with a History of Sexual Trauma

Are American Black women angry? They have cause to be. However, the more pressing question is, why are we not collectively angry about their historical and present-day abuse? A lack of authority over the body is the legacy that lives in their DNA. From chattel slavery to current-day debasement, the Black woman finds herself isolated on the island of intersectionality. Rendered invisible are the needs of the Black woman living with conditions uniquely her own based on experiences, unlike any others. This has led to a dearth of resources that centers the Black woman’s history of sexual trauma. The trauma she has undergone requires specialized treatment. Traditional therapy is only the beginning, and somatic work will be necessary in most cases. This project explores how trauma is stored in the body, how that looks when expressed explicitly by Black women, introduces somatic therapy and the potentiality of using “therapeutic BDSM” (bondage and discipline, dominance and submission, and sadism and masochism) as a form of somatic experiencing, and produces a resource that centers her lived experience and sexual trauma history.

Abstract

Examining Attitudes, Biases, and Knowledge of Staff Working with Sex Workers and Survivors of Sex Trafficking

The writer reviewed the need for an interactive practicum for service providers who work. The writer reviewed the need for an interactive practicum for service providers who workwith sexually exploited victims and survivors of sex trafficking and survival sex.

The writer aims to develop future gaming for a training instrument tool to address service providers’ attitudes, biases, and knowledge. The sexually exploited victims and survivors are populations of people who, in dire need, exchange sex for food, shelter, a place to sleep, seek masculinizing or feminizing hormones, or use substances, such as drugs and alcohol.

The purpose of the provider bias training (PBT) tool is to provide an interactive environment in which service providers can socially engage, psychologically connect, learn harm reduction strategies, interventions, and use metrics with avatars that model the corrective action behavior protocols.

The prototype will consist of several scenes that address scenarios that hindered survivors from accessing early interventions sought-after from healthcare providers and law enforcement. The writer will determine the scripts mirrored by many survivors from literature reviews and incidences who reported attitudes, biases, lack of knowledge in service providers, what attitudes look and sound like to survivors, and what lack of knowledge looks and sounds like tothe advocates from the anti-trafficking movement.

The future PBT tool will be from constructs gathered from the research, through which emotional assimilation can occur or improve to help inform the elements needed to develop the prototype. The goal is to enrich the training, improve the performance of service providers, and enhance learning.

Keywords: Attitudes about sex work,implicit biases, biases about sex, sex work, sex trafficking, survival sex work, human trafficking,sexually exploited children, gaming for training.

Abstract
3C2T Workshop Caribbean Cultures and Comorbidities in Transgender Treatment:

A Training Workshop Guide for health providers to deliver services in a culturally sensitive manner to the LGBTQ+ community, specifically Transgender people with a cultural highlight on the Haitian and Cuban cultures.

The authors' daily experiences working as mental health professionals inmultidisciplinary therapeutic wraparound community teams have led to the development of this Caribbean Culture and Comorbidities in Transgender Treatment (3C2T) Training Workshop.

The intention of the 3C2T Training Workshop is to increase cultural sensitivity in mental health providers in the field regarding the journey of transgender diverse people who carry comorbid mental health diagnoses, which may have a reciprocal impact of symptomatology between the journey of transition and their mental health diagnoses. An additional goal is to expand the knowledge of the providers about their own thoughts and assumptions, and how these may affect the therapeutic process. As the authors are second generation Caribbean, the underlying impact

of the dynamics of the Caribbean culture, Haitian & Cuban will be emphasized. This training should lead to providers recognizing personal biases and, importantly, understanding how such biases may affect the messages conveyed to clients and the quality of the overall experiences of the persons seeking mental health services.

Research has been done and studies are available for mental health providers that focus

on the implementation of inclusion in the workplace, but such are very limited in how to train both direct and indirect mental health providers with a procedure that helps them offer best practices to this population in a culturally sensitive manner. This project presented by the authors is a progressive movement toward creating awareness and expanding education to those providing services in the mental health field whose clients are transgender diverse people in the LGBTQ+ community who carry comorbid mental health diagnoses and are often discouraged to 10 seek mental health services due to shaming and experiencing rejection due to their journey of

transition.

Abstract

Exploring the Potential of Exoskeleton Technology to assist Sexual Function in Individuals with Mobility Limitations Due to Accident, Aging, Disease, or Congenital Conditions

This dissertation examines how exoskeleton technology can enhance sexual function and intimacy for individuals experiencing mobility limitations due to accident, aging, disease, or congenital conditions. While sexual health is acknowledged as essential to overall well-being, assistive technologies typically emphasize movement and functionality while overlooking intimacy, desire, and relational dignity.

Using a constructivist grounded theory methodology, the study draws on qualitative interviews with ten participants. Findings indicate that technology acceptance depends not only on performance and usability but also on the ability to sustain confidence, agency, and dignity in intimate life. Participants viewed intimacy, spontaneity, and pleasure as inseparable from everyday usability. Devices that felt stigmatizing or reinforced dependence were rejected, whereas those fostering discretion, adaptability, and emotional safety were welcomed.

From these insights emerged the LIFT model; Linking, Identity, Flourishing, Technology, a framework that integrates intimacy into design thinking. Linking examines how technology mediates closeness and relational dynamics; Identity addresses embodiment and self-perception; Flourishing positions erotic well-being as vital to autonomy and motivation; and Technology reframes devices as facilitators of connection and possibility. LIFT expands on UTAUT2 and empathy-driven design by establishing intimacy as a precondition for adoption.

The study concludes that intimacy should be embedded within universal design principles rather than treated as peripheral. By affirming intimacy as a core human capability, exoskeletons and related technologies can move beyond restoring function to promoting flourishing, relational dignity, and inclusion; broadening the scope of clinical sexology, rehabilitation, and design policy.

Abstract
Cannabis for the Management of Female Orgasm Difficulty/Disorder:  An Observational Study

This mixed-methods observational study, conducted between March 24, 2022, and February 28, 2023, is the first to evaluate cannabis use and female orgasmic disorder (FOD). Up to 41% of women experience FOD, a statistic unchanged for 50 years. A paucity of validated treatments exists. Researchers have suggested cannabis as a treatment for FOD for decades. This study’s statistically significant results align with and expand upon 50 years of cannabis research, revealing that cannabis helps women orgasm and increases orgasm frequency, satisfaction, and ease for women with and without FOD.

A survey collected data on demographics, sexual behavior, mental health, cannabis use, and the Female Sexual Function Index (FSFI) orgasm subscale questions with and without cannabis before partnered sex. The interviews evaluated cannabis-assisted orgasm, dosage, preferred strains, and timing of cannabis use before partnered sex.

Of the 1,037 survey responses, 387 were suitable for analysis. Among respondents reporting orgasm difficulty, 45% were between the ages of 25-34, 75% reported their race as white, and 82% were married or in a relationship. Cannabis use before partnered sex increased orgasm frequency (72%), improved orgasm satisfaction (67%), or made orgasm easier (71%). Frequency of cannabis use before partnered sex correlated with increased orgasm frequency. The reasons for cannabis use by women with FOD before partnered sex that created the most positive orgasm response was to manage pain or enhance sexual pleasure.

Not all women found cannabis helpful in orgasm. Moreover, the study’s findings may not be generalizable to women who rarely or do not use cannabis before sex or who have never experienced an orgasm. The researcher did not assess the cultivar of cannabis for effectiveness, nor were study participants asked about their cannabis chemotype of choice or the amount of cannabis used.

The study suggests that treatment for women with orgasm difficulty should incorporate cannabis and that U.S. states and countries with medical marijuana programs should make it a condition for use. At the same time, the researcher emphasizes the need for prioritizing further randomized controlled studies to assess cannabis dosage, timing, and other clinical implications for women experiencing orgasm difficulty.

I dedicate this work to the 1,037 women who responded to my survey, the 167 women who shared their contact information with me, the 40 women I interviewed and their partners, and all women who have had orgasm difficulty. I also dedicate this work to the future of cannabis becoming a recognized treatment for female orgasm difficulty and a statistical reduction in the persistently high percentage of women suffering from orgasm difficulties.

I was inspired to hear women’s stories of perseverance and overcoming hardships, coming to terms with their orgasm difficulty, and navigating with it and through it, uncovering and healing from shame, learning to orgasm, and discovering the use of cannabis and how it helped many of the women I interviewed orgasm.