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Background: Both exercise addiction (EA) and muscle dysmorphia (MD) primarily involve the compulsive practice of physical exercise and are classified as behavioral addictions in different lines of research. These types of addictions are frequently comorbid with other addictive pathologies, such as emotional dependence (ED), which is closely related to childhood attachment. This study is presented to address the scarcity of research relating EA and MD with other behavioral addictions. The aims are to analyze the sex differences found in emotional dependence, attachment dimensions, EA and MD; to analyze the association between EA and MD and other behavioral addictions, such as emotional dependence and attachment dimensions; and to analyze the possible role that childhood attachment plays in mediating the interaction between emotional dependence and EA and MD. Method: The sample comprised 366 participants (54.6% women) aged 17-31 (M = 23.53; SD = 6.48). Results: There are sex differences, with men scoring higher in EA, MD, and ED. The positive relationship between EA and ED (values between 0.16 and 0.28), MD (presenting values between 0.42 and 0.70), and attachment styles based on preoccupation, interference, permissiveness, and value of parental authority (values between 0.11 and 0.14) is highlighted. On the other hand, MD was positively related to ED (values ranging from 0.24 to 0.36) and attachment styles based on the value of parental authority, self-sufficiency, and resentment toward parents (between 0.17 and 0.18), and negatively related to secure attachment (values between -0.13 and -0.18). Likewise, the predictive role of ED and attachment styles in EA and MD was tested. And it was observed how attachment styles mediated the relationship between EA and ED, as well as the relationship between MD and ED. Thus, it has been shown that people with EA and MD present attachment styles that may influence negatively the decision-making process when choosing inappropriate strategies to achieve adequate emotional regulation, even selecting inappropriate goals for physical exercise with negative consequences. Conclusions: The dissemination of the findings among mental health and sports science professionals is necessary to develop prevention and intervention strategies for people affected by EA and MD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Olave, Estévez, Momeñe, Muñoz-Navarro, Gómez-Romero, Boticario and Iruarrizaga.)

Introduction: In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU). Methods: Multicenter, randomized controlled trial involving 300 patients recruited from PC centers in Madrid, Spain, with symptoms or possible diagnosis of anxiety, mood (mild or moderate), or somatoform disorders. Patients will be randomized to one of two groups: an experimental group, which will receive group-based transdiagnostic cognitive-behavioral therapy (TD-CBT); and a control group, which will receive TAU (mainly pharmacological interventions) prescribed by their general practitioner (GP). Clinical assessment will be performed with the Patient Health Questionnaire (PHQ). Direct and indirect costs will be calculated and relevant socio-demographic variables will be registered. The Spanish version of the EuroQol 5D-5L will be administered. Patients will be assessed at baseline, immediately after treatment finalization, and at 6 and 12 months post-treatment. Discussion: To our knowledge, this is the first study to compare TD-CBT to TAU in the PC setting in Spain. This is the first comparative economic evaluation of these two treatment approaches in PC. The strength of the study is that it is a multicenter, randomized, controlled trial of psychotherapy and TAU for EDs in PC. Trial registration: Protocol code: ISCRCTN58437086; 20/05/2013.                                        EUDRACT: 2013-001955-11.                                        Protocol Version: 6, 11/01/2014.