{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:55:53Z","timestamp":1791482153750,"version":"4.3.4"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004622","name":"KWF Kankerbestrijding","doi-asserted-by":"publisher","award":["grant 11839"],"award-info":[{"award-number":["grant 11839"]}],"id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Receiving a cancer diagnosis frequently evokes a wide range of emotions. Emotions may help to cope with cancer: these are adaptive emotions. When emotions become disproportionate to the situation or interfere with functioning, emotions are maladaptive. According to the network theory of mental disorders, symptoms are reciprocally associated with each other; if there are strong connections between symptoms, the symptom network remains activated. A strongly connected network indicates maladaptive emotions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether patients with cancer with maladaptive emotions are characterized by stronger associations among emotional (and among emotional and cancer-treatment-related) symptoms as compared to patients with adaptive emotions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with cancer (n\u2009=\u2009132) completed Ecological Momentary Assessments for 14 days, 5 times a day, 3\u20137 months after start of systemic treatment. Patients were categorized as having adaptive or maladaptive emotions, based on a reference standard (psychiatric diagnostic assessment or self-reported subjective need for professional mental healthcare). Multilevel Vector Autoregression models were built in R (mlVAR package), and associations among symptoms in networks were compared (mnet package).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with maladaptive emotions did not show stronger associations among symptoms than patients with adaptive emotions. This result of no statistically significant differences was consistently found for both emotional and cancer-treatment-related symptoms, both reference standards (psychiatric diagnostic assessment and subjective need for professional mental health care), and both contemporaneous and temporal networks (maximal edge differences \u22640.14).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Contrary to our hypothesis, associations among emotional symptoms and of emotional and cancer-treatment-related symptoms were not stronger in patients with maladaptive emotions, as compared to patients with adaptive emotions. This raises doubts about the validity of network theory as an explanation for maladaptive emotions in patients with cancer. Since network strength did not differentiate between adaptive and maladaptive emotions, clinical assessment should continue to be guided by symptom intensity, patient functioning, and the expressed need for mental health care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0341290","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:27:36Z","timestamp":1791480456000},"page":"e0341290","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adaptive and maladaptive emotions in patients with cancer: A network perspective"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7567-1680","authenticated-orcid":true,"given":"G. 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The relation between positive and negative affect and reactivity to positive and negative events","author":"E Bennik","year":"2015"},{"key":"pone.0341290.ref021","unstructured":"Item library. https:\/\/itemlibrary.eortc.org\/ 2018. Accessed 2023 October 1."},{"issue":"1","key":"pone.0341290.ref022","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/0022-3956(94)90036-1","article-title":"Reliability and validity studies of the WHO--Composite International Diagnostic Interview (CIDI): a critical review","volume":"28","author":"HU Wittchen","year":"1994","journal-title":"J Psychiatr Res"},{"key":"pone.0341290.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/13548506.2021.1883685","article-title":"Validation of the Four-Dimensional Symptom Questionnaire (4DSQ) in a mental health setting","volume":"26","author":"M Kleinst\u00e4uber","year":"2021","journal-title":"Psychol Health Med"},{"issue":"4","key":"pone.0341290.ref024","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1002\/cncr.23622","article-title":"Screening and referral for psychosocial distress in oncologic practice: use of the Distress Thermometer","volume":"113","author":"MA Tuinman","year":"2008","journal-title":"Cancer"},{"issue":"4","key":"pone.0341290.ref025","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1002\/pon.5347","article-title":"Clinical assessment of emotions in patients with cancer: Diagnostic accuracy compared with two reference standards","volume":"29","author":"ME van Linde","year":"2020","journal-title":"Psychooncology"},{"issue":"2","key":"pone.0341290.ref026","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1038\/bmt.2013.155","article-title":"Distress, problems and supportive care needs of patients treated with auto- or allo-SCT","volume":"49","author":"AMJ Braamse","year":"2014","journal-title":"Bone Marrow Transplant"},{"key":"pone.0341290.ref027","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. https:\/\/www.R-project.org\/ 2021."},{"issue":"2","key":"pone.0341290.ref028","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1007\/s11336-012-9254-8","article-title":"Regime Switching State-Space Models Applied to Psychological Processes: Handling Missing Data and Making Inferences","volume":"77","author":"EL Hamaker","year":"2012","journal-title":"Psychometrika"},{"issue":"4","key":"pone.0341290.ref029","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1080\/00273171.2018.1454823","article-title":"The Gaussian Graphical Model in Cross-Sectional and Time-Series Data","volume":"53","author":"S Epskamp","year":"2018","journal-title":"Multivariate Behav Res"},{"issue":"4","key":"pone.0341290.ref030","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1080\/00273171.2025.2469055","article-title":"Missing Data in Discrete Time State-Space Modeling of Ecological Momentary Assessment Data: A Monte-Carlo Study of Imputation Methods","volume":"60","author":"LR Slipetz","year":"2025","journal-title":"Multivariate Behav Res"},{"issue":"1","key":"pone.0341290.ref031","doi-asserted-by":"crossref","first-page":"207","DOI":"10.32614\/RJ-2017-009","article-title":"ImputeTS: Time series missing value imputation in R","volume":"9","author":"S Moritz","year":"2017","journal-title":"The R Journal"},{"key":"pone.0341290.ref032","unstructured":"Epskamp SD, M K, Bringmann LF. Package \u2018mlVAR\u2019. https:\/\/cran.r-project.org\/web\/packages\/mlVAR\/mlVAR.pdf 2019."},{"issue":"3","key":"pone.0341290.ref033","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1177\/2167702617744325","article-title":"Personalized Network Modeling in Psychopathology: The Importance of Contemporaneous and Temporal Connections","volume":"6","author":"S Epskamp","year":"2018","journal-title":"Clin Psychol Sci"},{"issue":"4","key":"pone.0341290.ref034","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s10865-019-00084-7","article-title":"Exploring the interconnectedness of fatigue, depression, anxiety and potential risk and protective factors in cancer patients: a network approach","volume":"43","author":"MPJ Schellekens","year":"2020","journal-title":"J Behav Med"},{"key":"pone.0341290.ref035","doi-asserted-by":"crossref","unstructured":"Haslbeck JMB. 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