{
  "abstract": "Background: 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. Objective: 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. Methods: Patients with cancer (n = 132) completed Ecological Momentary Assessments for 14 days, 5 times a day, 3–7 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). Results: 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 ≤0.14). Conclusion: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands",
    "Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands",
    "Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands",
    "Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands",
    "Isala, Oncology Center, Zwolle, The Netherlands",
    "Department of Medical Oncology, Rijnstate Hospital, Arnhem, The Netherlands",
    "Department of Medical Oncology, Radboud Medical Center, Nijmegen, The Netherlands",
    "Department of Anesthesiology, Pain and Palliative Care, Radboud Medical Center, Nijmegen, The Netherlands",
    "Department of Medical Oncology, Slingeland Ziekenhuis, Doetinchem, The Netherlands",
    "Department of Medical Oncology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands",
    "Erasmus Medical Center, Department of Medical Oncology, Rotterdam, The Netherlands"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "G. Elise Doppenberg-Smit"
    },
    {
      "affs": [
        1
      ],
      "name": "Adriaan W. Hoogendoorn"
    },
    {
      "affs": [
        2
      ],
      "name": "Annemarie M.J. Braamse"
    },
    {
      "affs": [
        3
      ],
      "name": "Jan Willem B. de Groot"
    },
    {
      "affs": [
        4
      ],
      "name": "Rutger Koornstra"
    },
    {
      "affs": [
        5
      ],
      "name": "Evelien J.M. Kuip"
    },
    {
      "affs": [
        6
      ],
      "name": "Rune A.W. van de Wetering"
    },
    {
      "affs": [
        7
      ],
      "name": "Lia van Zuylen"
    },
    {
      "affs": [
        8
      ],
      "name": "Henk M.W. Verheul"
    },
    {
      "affs": [
        9
      ],
      "name": "Joost Dekker"
    },
    {
      "affs": [
        10
      ],
      "name": "Myra E. van Linde"
    },
    {
      "name": "Aartjan T.F. Beekman"
    },
    {
      "name": "Femke Lamers"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8ervy4zmm9gak.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0341290",
  "fulltext_url": null,
  "id": "8ervy4zmm9gak",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0341290",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3205|Mental Health Research Topics"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Cognitive neuroscience/Cognitive neurology/Neuropsychological testing"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive neuroscience/Cognitive neurology/Neuropsychological testing"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Neuropsychology/Neuropsychological testing"
    ],
    [
      "plos",
      "/Biology and life sciences/Psychology/Emotions"
    ],
    [
      "plos",
      "/Biology and life sciences/Psychology/Neuropsychology/Neuropsychological testing"
    ],
    [
      "plos",
      "/Computer and information sciences/Network analysis/Network theory"
    ],
    [
      "plos",
      "/Medicine and health sciences/Diagnostic medicine"
    ],
    [
      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Cancer detection and diagnosis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Mental health and psychiatry"
    ],
    [
      "plos",
      "/Medicine and health sciences/Neurology/Cognitive neurology/Neuropsychological testing"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancer detection and diagnosis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancer treatment"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancers and neoplasms"
    ],
    [
      "plos",
      "/Social sciences/Psychology/Emotions"
    ],
    [
      "plos",
      "/Social sciences/Psychology/Neuropsychology/Neuropsychological testing"
    ]
  ],
  "openalex": "W7221015179",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0341290&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-08",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/8ervy4zmm9gak.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:30Z",
      "native_id": "10.1371/journal.pone.0341290",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0341290"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:cognitive neuroscience",
      "subfield": "neuroscience"
    },
    {
      "field": "medicine",
      "origin": "plos:oncology",
      "subfield": "oncology"
    }
  ],
  "title": "Adaptive and maladaptive emotions in patients with cancer: A network perspective",
  "title_text": "Adaptive and maladaptive emotions in patients with cancer: A network perspective",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:30Z",
  "url": "https://research.draconitic.com/paper/8ervy4zmm9gak",
  "venue": "PLOS One",
  "versions": []
}