Adaptive and maladaptive emotions in patients with cancer: A network perspective
11 affiliations
- 1Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- 2Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- 3Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- 4Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 5Isala, Oncology Center, Zwolle, The Netherlands
- 6Department of Medical Oncology, Rijnstate Hospital, Arnhem, The Netherlands
- 7Department of Medical Oncology, Radboud Medical Center, Nijmegen, The Netherlands
- 8Department of Anesthesiology, Pain and Palliative Care, Radboud Medical Center, Nijmegen, The Netherlands
- 9Department of Medical Oncology, Slingeland Ziekenhuis, Doetinchem, The Netherlands
- 10Department of Medical Oncology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- 11Erasmus Medical Center, Department of Medical Oncology, Rotterdam, The Netherlands
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.
Related
- Timing Determines Fate: Temporal Dynamics of Jasmonate Signaling Distinguish Adaptive from Maladaptive Salt Stress Responses in Rice
- Why Is Spontaneous Blink Timing Informative? An Adaptive Scheduling Perspective
- Evaluating Pedestrian Crossing Safety: Implementing and Evaluating a Convolutional Neural Network Model Trained on Paired Aerial and Subjective Perspective Images (Vol 11, E42428, 2025)
- A framework for understanding mast cell activation syndrome from a complex adaptive systems perspective
- Optimization of landscape connectivity: A directed dynamic ecological network topology perspective
BibTeX
@article{doppenbergsmit2026adaptive,
title = {{Adaptive and maladaptive emotions in patients with cancer: A network perspective}},
author = {G. Elise Doppenberg-Smit and Adriaan W. Hoogendoorn and Annemarie M.J. Braamse and Jan Willem B. de Groot and Rutger Koornstra and Evelien J.M. Kuip and Rune A.W. van de Wetering and Lia van Zuylen and Henk M.W. Verheul and Joost Dekker and Myra E. van Linde and Aartjan T.F. Beekman and Femke Lamers},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0341290},
url = {https://doi.org/10.1371/journal.pone.0341290},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adaptive and maladaptive emotions in patients with cancer: A network perspective
AU - G. Elise Doppenberg-Smit
AU - Adriaan W. Hoogendoorn
AU - Annemarie M.J. Braamse
AU - Jan Willem B. de Groot
AU - Rutger Koornstra
AU - Evelien J.M. Kuip
AU - Rune A.W. van de Wetering
AU - Lia van Zuylen
AU - Henk M.W. Verheul
AU - Joost Dekker
AU - Myra E. van Linde
AU - Aartjan T.F. Beekman
AU - Femke Lamers
PY - 2026
DA - 2026/10/08
JO - PLOS One
DO - 10.1371/journal.pone.0341290
UR - https://doi.org/10.1371/journal.pone.0341290
AB - 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.
SN - 1932-6203
ER -