{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T23:48:03Z","timestamp":1782949683824,"version":"3.54.5"},"reference-count":54,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T00:00:00Z","timestamp":1709337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Research Foundation Flanders (Fonds voor Wetenschappelijk Onderzoek Vlaanderen)","doi-asserted-by":"publisher","award":["T001117N"],"award-info":[{"award-number":["T001117N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Research Foundation Flanders (Fonds voor Wetenschappelijk Onderzoek Vlaanderen)","doi-asserted-by":"publisher","award":["945380"],"award-info":[{"award-number":["945380"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EUTOPIA Science and Innovation Fellowship Programme","award":["T001117N"],"award-info":[{"award-number":["T001117N"]}]},{"name":"EUTOPIA Science and Innovation Fellowship Programme","award":["945380"],"award-info":[{"award-number":["945380"]}]},{"name":"European Union Horizon 2020 programme","award":["T001117N"],"award-info":[{"award-number":["T001117N"]}]},{"name":"European Union Horizon 2020 programme","award":["945380"],"award-info":[{"award-number":["945380"]}]},{"name":"Vrije Universiteit Brussel, Brussels, Belgium","award":["T001117N"],"award-info":[{"award-number":["T001117N"]}]},{"name":"Vrije Universiteit Brussel, Brussels, Belgium","award":["945380"],"award-info":[{"award-number":["945380"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: This exploratory study aims to explore the relationship between nonspecific chronic spinal pain (nCSP) and insomnia symptoms, by examining the interconnections, strengths, and directional dependence of the symptoms. In addition, we aim to identify the key symptoms of the nCSP\u2013insomnia relationship and shed light on the bidirectional nature of this relationship. (2) Methods: This study is a secondary analysis of the baseline data (cross-sectional) from a randomized controlled trial, which examined the added value of Cognitive Behavioral Therapy for Insomnia (CBT-I) combined with cognition-targeted exercise therapy, conducted in collaboration with the Universiteit Gent and Vrije Universiteit Brussel (Belgium). One hundred and twenty-three nCSP patients with comorbid insomnia were recruited through the participating hospitals, advertisements, announcements in local newspapers, pharmacies, publications from support groups, and primary care. To explore the interconnections and directionality between symptoms and the strengths of the relationships, we estimated a regularized Gaussian graphical model and a directed acyclic graph. (3) Results: We found only one direct, but weak, link between sleep and pain, namely, between average pain and difficulties maintaining sleep. (4) Conclusions: Despite the lack of strong direct links between sleep and pain, pain and sleep seem to be indirectly linked via anxiety and depression symptoms, acting as presumable mediators in the network of nCSP and comorbid insomnia. Furthermore, feeling slowed down and fatigue emerged as terminal nodes, implying their role as consequences of the network.<\/jats:p>","DOI":"10.3390\/jcm13051452","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T04:36:21Z","timestamp":1709526981000},"page":"1452","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Role of Anxiety and Depression in Shaping the Sleep\u2013Pain Connection in Patients with Nonspecific Chronic Spinal Pain and Comorbid Insomnia: A Cross-Sectional Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3988-0119","authenticated-orcid":false,"given":"Zosia","family":"Goossens","sequence":"first","affiliation":[{"name":"Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium"},{"name":"Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5673-7314","authenticated-orcid":false,"given":"Thomas","family":"Bilterys","sequence":"additional","affiliation":[{"name":"Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium"},{"name":"Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"},{"name":"Institute of Advanced Study, University of Warwick, Coventry CV4 7AL, UK"},{"name":"Department of Psychology, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eveline","family":"Van Looveren","sequence":"additional","affiliation":[{"name":"Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium"},{"name":"Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0598-7038","authenticated-orcid":false,"given":"Anneleen","family":"Malfliet","sequence":"additional","affiliation":[{"name":"Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium"},{"name":"Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"},{"name":"Research Foundation-Flanders (FWO), 1000 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Meeus","sequence":"additional","affiliation":[{"name":"Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium"},{"name":"MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieven","family":"Danneels","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0751-6504","authenticated-orcid":false,"given":"Kelly","family":"Ickmans","sequence":"additional","affiliation":[{"name":"Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium"},{"name":"Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"},{"name":"Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Cagnie","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6648-0831","authenticated-orcid":false,"given":"Aurore","family":"Roland","sequence":"additional","affiliation":[{"name":"Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium"},{"name":"Research Foundation-Flanders (FWO), 1000 Brussels, Belgium"},{"name":"Brussels University Consultation Center, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0577-5449","authenticated-orcid":false,"given":"Maarten","family":"Moens","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universitair Ziekenhuis 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et Addictologie, CHU\/UVC Brugmann, 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bilterys, T., Siffain, C., De Maeyer, I., Van Looveren, E., Mairesse, O., Nijs, J., Meeus, M., Ickmans, K., Cagnie, B., and Goubert, D. (2021). Associates of Insomnia in People with Chronic Spinal Pain: A Systematic Review and Meta-Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10143175"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/AJP.0b013e3181f3bdd5","article-title":"The Association Between Chronic Low Back Pain and Sleep A Systematic Review","volume":"27","author":"Kelly","year":"2011","journal-title":"Clin. J. Pain"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.bjpt.2018.10.007","article-title":"The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: Protocol of a randomized controlled clinical trial","volume":"23","author":"Malfliet","year":"2019","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.mehy.2006.06.033","article-title":"Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms","volume":"68","author":"Langevin","year":"2007","journal-title":"Med. Hypotheses"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Dekker, K., Blanken, T.F., and Van Someren, E.J.W. (2017). Insomnia and personality\u2014A network approach. Brain Sci., 7.","DOI":"10.3390\/brainsci7030028"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e16749","DOI":"10.2196\/16749","article-title":"Symptom distribution regularity of insomnia: Network and spectral clustering analysis","volume":"8","author":"Hu","year":"2020","journal-title":"JMIR Med. Inform."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/j.2044-8287.2011.02045.x","article-title":"Bidirectionality between pain and insomnia symptoms: A prospective study","volume":"17","author":"Boersma","year":"2012","journal-title":"Br. J. Health Psychol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Agmon, M., and Armon, G. (2014). Increased Insomnia Symptoms Predict the Onset of Back Pain among Employed Adults. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0103591"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/s41386-019-0439-z","article-title":"Sleep deficiency and chronic pain: Potential underlying mechanisms and clinical implications","volume":"45","author":"Haack","year":"2020","journal-title":"Neuropsychopharmacology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1037\/hea0000245","article-title":"The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial","volume":"35","author":"Koffel","year":"2016","journal-title":"Health Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.sleep.2021.06.029","article-title":"Subtypes of insomnia and the risk of chronic spinal pain: The HUNT study","volume":"85","author":"Skarpsno","year":"2021","journal-title":"Sleep Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00702-019-02067-z","article-title":"Sleep and pain: Recent insights, mechanisms, and future directions in the investigation of this relationship","volume":"127","author":"Beetz","year":"2020","journal-title":"J. Neural Transm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1111\/papr.12746","article-title":"The Role of Sleep Quality and Fatigue on the Benefits of an Interdisciplinary Treatment for Adults With Chronic Pain","volume":"19","author":"Racine","year":"2019","journal-title":"Pain Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s40675-019-00159-6","article-title":"Sleep and Pain: The Role of Depression","volume":"5","author":"Dzierzewski","year":"2019","journal-title":"Curr. Sleep Med. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101793","DOI":"10.1016\/j.smrv.2023.101793","article-title":"The interplay between symptoms of insomnia and pain in people with osteoarthritis: A narrative review of the current evidence","volume":"70","author":"Runge","year":"2023","journal-title":"Sleep Med. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1111\/j.1526-4637.2007.00357.x","article-title":"Defining patient-centered, multidimensional success criteria for treatment of chronic spine pain","volume":"9","author":"Brown","year":"2008","journal-title":"Pain Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101609","DOI":"10.1016\/j.jbtep.2020.101609","article-title":"Feasibility and efficacy of a digital CBT intervention for symptoms of Generalized Anxiety Disorder: A randomized multiple-baseline study","volume":"70","author":"Miller","year":"2021","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.jad.2014.07.020","article-title":"Insomnia before and after treatment for anxiety and depression","volume":"168","author":"Mason","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1002\/erv.2634","article-title":"Illness pathways between eating disorder and post-traumatic stress disorder symptoms: Understanding comorbidity with network analysis","volume":"27","author":"Fried","year":"2019","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1017\/S0140525X09991567","article-title":"Comorbidity: A network perspective","volume":"33","author":"Cramer","year":"2010","journal-title":"Behav. Brain Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1037\/abn0000181","article-title":"Identifying highly influential nodes in the complicated grief network","volume":"125","author":"Robinaugh","year":"2016","journal-title":"J. Abnorm. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1037\/abn0000715","article-title":"Estimating the Symptom Structure of Bipolar Disorder via Network Analysis: Energy Dysregulation as a Central Symptom","volume":"131","author":"McNally","year":"2022","journal-title":"J. Psychopathol. Clin. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1146\/annurev-clinpsy-050212-185608","article-title":"Network analysis: An integrative approach to the structure of psychopathology","volume":"9","author":"Borsboom","year":"2013","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3758\/s13428-017-0862-1","article-title":"Estimating psychological networks and their accuracy: A tutorial paper","volume":"50","author":"Epskamp","year":"2018","journal-title":"Behav Res Methods"},{"key":"ref_25","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":"Epskamp","year":"2018","journal-title":"Multivar. Behav Res."},{"key":"ref_26","unstructured":"Epskamp, S., Maris, G.K.J., Waldorp, L.J., and Borsboom, D. (2016). Network Psychometrics. arXiv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1177\/1948550617709827","article-title":"Network Analysis on Attitudes: A Brief Tutorial","volume":"8","author":"Dalege","year":"2017","journal-title":"Soc. Psychol. Personal. Sci."},{"key":"ref_28","unstructured":"Iber, C. (2024, January 15). The AASM manual for the scoring of sleep and associated events: Rules, terminology, and technical specification. (No Title). Available online: https:\/\/scholar.google.com\/citations?view_op=view_citation&hl=en&user=mLTec7cAAAAJ&citation_for_view=mLTec7cAAAAJ:tOudhMTPpwUC."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.sleep.2022.04.017","article-title":"Psychometric properties of the Insomnia Severity Index for people with chronic obstructive pulmonary disease","volume":"95","author":"Jun","year":"2022","journal-title":"Sleep Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.sleep.2016.03.008","article-title":"Sleep quality in the general population: Psychometric properties of the Pittsburgh Sleep Quality Index, derived from a German community sample of 9284 people","volume":"30","author":"Hinz","year":"2017","journal-title":"Sleep Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"15026","DOI":"10.1038\/nrdp.2015.26","article-title":"Insomnia disorder","volume":"1","author":"Morin","year":"2015","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1378\/chest.14-0970","article-title":"International classification of sleep disorders","volume":"146","author":"Sateia","year":"2014","journal-title":"Chest"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e14035","DOI":"10.1111\/jsr.14035","article-title":"The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia","volume":"32","author":"Riemann","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1080\/15402002.2017.1395336","article-title":"The Brugmann Fatigue Scale: An Analogue to the Epworth Sleepiness Scale to Measure Behavioral Rest Propensity","volume":"17","author":"Mairesse","year":"2019","journal-title":"Behav. Sleep Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1093\/sleep\/30.11.1547","article-title":"Dysfunctional Beliefs and Attitudes about Sleep (DBAS): Validation of a Brief Version (DBAS-16)","volume":"30","author":"Morin","year":"2007","journal-title":"Sleep"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jpainsymman.2010.05.008","article-title":"Using confirmatory factor analysis to evaluate construct validity of the Brief Pain Inventory (BPI)","volume":"41","author":"Atkinson","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/AJP.0000000000000306","article-title":"The Dutch Central Sensitization Inventory (CSI)","volume":"32","author":"Kregel","year":"2016","journal-title":"Clin. J. Pain"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1093\/occmed\/kqu024","article-title":"The Hospital Anxiety and Depression Scale","volume":"64","author":"Stern","year":"2014","journal-title":"Occup. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1080\/21642850.2018.1521283","article-title":"Network analysis: A brief overview and tutorial","volume":"6","author":"Hevey","year":"2018","journal-title":"Health Psychol. Behav. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1002\/eat.22890","article-title":"Social anxiety and eating disorder comorbidity and underlying vulnerabilities: Using network analysis to conceptualize comorbidity","volume":"51","author":"Levinson","year":"2018","journal-title":"Int. J. Eat. Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"102625","DOI":"10.1016\/j.janxdis.2022.102625","article-title":"A network approach to climate change anxiety and its key related features","volume":"93","author":"Heeren","year":"2023","journal-title":"J. Anxiety Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S80","DOI":"10.4103\/sja.SJA_203_17","article-title":"Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine","volume":"11","author":"Tsang","year":"2017","journal-title":"Saudi J. Anaesth."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/s43586-021-00055-w","article-title":"Network analysis of multivariate data in psychological science","volume":"1","author":"Borsboom","year":"2021","journal-title":"Nat. Rev. Methods Primers"},{"key":"ref_46","unstructured":"Carter, J.S., Rossell, D., and Smith, J.Q. (2021). Partial Correlation Graphical LASSO. arXiv."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102267","DOI":"10.1016\/j.janxdis.2020.102267","article-title":"Bridging maladaptive social self-beliefs and social anxiety: A network perspective","volume":"74","author":"Heeren","year":"2020","journal-title":"J. Anxiety Disord."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1037\/met0000479","article-title":"A tutorial on Bayesian Networks for psychopathology researchers. Network theory comes with","volume":"28","author":"Briganti","year":"2022","journal-title":"Psychol. Methods"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"zpac001","DOI":"10.1093\/sleepadvances\/zpac001","article-title":"Comparing polysomnography, actigraphy, and sleep diary in the home environment: The Study of Women\u2019s Health Across the Nation (SWAN) Sleep Study","volume":"3","author":"Lehrer","year":"2022","journal-title":"Sleep Adv."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1097\/AJP.0000000000000055","article-title":"The bidirectional relationship between pain intensity and sleep disturbance\/quality in patients with low back pain","volume":"30","author":"Alsaadi","year":"2014","journal-title":"Clin. J. Pain"},{"key":"ref_51","first-page":"675","article-title":"Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: A multilevel daily process study","volume":"35","author":"Tang","year":"2012","journal-title":"Sleep"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1177\/2167702614553230","article-title":"Mental disorders as causal systems: A network approach to posttraumatic stress disorder","volume":"3","author":"McNally","year":"2015","journal-title":"Clin. Psychol. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e02010","DOI":"10.1002\/brb3.2010","article-title":"A network structure of manic symptoms","volume":"11","author":"Briganti","year":"2021","journal-title":"Brain Behav."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1037\/ccp0000336","article-title":"Does centrality in a cross-sectional network suggest intervention targets for social anxiety disorder?","volume":"86","author":"Rodebaugh","year":"2018","journal-title":"J. Consult. Clin. Psychol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1452\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:08:18Z","timestamp":1760105298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,2]]},"references-count":54,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["jcm13051452"],"URL":"https:\/\/doi.org\/10.3390\/jcm13051452","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,2]]}}}