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However, little is known about how these factors interact over time or how underlying cognitive\u2010emotional processes contribute to their complex interconnections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This study followed a Longitudinal Network Approach and explored the interconnections over time between pain (intensity and impact), psychopathological symptoms, sexual distress, and cognitive\u2010emotional processes (cognitive fusion and difficulties in emotion regulation) in adult women with endometriosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data was collected in a sample composed of\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009210 Portuguese cisgender women with endometriosis in a three\u2010wave online assessment spanning 12 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Using multilevel vector autoregressive network analysis, results showed significant temporal pathways in which pain intensity and pain impact predicted future increases in cognitive fusion, depression, and somatization, indicating a directional cascading effect of physical symptoms on psychological processes. Higher sexual distress over time was associated with decreases in cognitive fusion. Results also found strong positive associations among pain, anxiety, depression, and somatization at each time point, as well as between\u2010subjects asymmetrical relationships, with anxiety and somatization more strongly predicting sexual distress than the reverse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, these findings highlight the importance of targeting transdiagnostic cognitive\u2010emotional processes in interventions to improve pain, mental health, and sexual outcomes in women with endometriosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bjhp.70071","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:35:47Z","timestamp":1776058547000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A longitudinal network analysis of pain, psychological processes and psychological and sexual distress in women with endometriosis"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8757-8424","authenticated-orcid":false,"given":"S\u00e9rgio A.","family":"Carvalho","sequence":"first","affiliation":[{"name":"University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC)  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Patafio","sequence":"additional","affiliation":[{"name":"Faculty of Health, School of Psychology Deakin University  Burwood Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia M.","family":"Pascoal","sequence":"additional","affiliation":[{"name":"University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC)  Coimbra Portugal"},{"name":"Universidade Lus\u00f3fona, HEI\u2010Lab: Laborat\u00f3rios Digitais de Ambientes e Interac\u00e7\u00f5es Humanas  Lisboa Portugal"},{"name":"Cl\u00ednica Universit\u00e1ria de Psiquiatria e Psicologia M\u00e9dica, Faculdade de Medicina Universidade de Lisboa  Lisboa Portugal"},{"name":"PSYLAB, Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina Universidade de Lisboa  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Lapa","sequence":"additional","affiliation":[{"name":"Anesthesiology Department Hospitais da Universidade de Coimbra  Coimbra Portugal"},{"name":"Faculty of Health Sciences Universidade da Beira Interior  Covilh\u00e3 Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Skvarc","sequence":"additional","affiliation":[{"name":"Faculty of Health, School of Psychology Deakin University  Burwood Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s43032\u2010020\u201000205\u20107"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471\u20100528.2008.01878.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1933719117707054"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpain.2022.928985"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010clinpsy\u2010050212\u2010185608"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43586\u2010021\u201000055\u2010w"},{"key":"e_1_2_12_8_1","first-page":"305","volume-title":"Avaliac\u00e3o psicol\u00f3gica: Instrumentos validados para a popula\u00e7\u00e3o Portuguesa [Psychological assessment: Validated instruments for the Portuguese population]","author":"Canavarro M. 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