Maria Karekla

University of Cyprus · Department of Psychology

Acceptance and Commitment Therapy (ACT) is purported to work via targeting six interrelated processes summarized as the Psychological Inflexibility/Psychological Flexibility (PI/PF) model. However, the theoretical structure and interconnections of this model have not been sufficiently explored. Lacking are examinations of the interrelations among i...

Chronic health conditions (CHCs) afflict millions of individuals worldwide. One promising intervention for CHC management is Acceptance and Commitment Therapy (ACT). Current literature is limited on examining ACTs' efficacy in CHCs without following a uniform definition of CHCs, even though such definitions exist (e.g., World Health Organization)....

[This corrects the article DOI: 10.3389/fpsyg.2021.640955.].

This study compared acceptance vs. avoidance coping with acute physical pain, in a pain-induction experiment and examined both between and within-group differences, multi-methodically and multi-dimensionally using behavioral, physiological and self-report measures. The sample consisted of 88 University students (76.1% females; Mage = 21.33 years)....

Objective: Patients suffering from psychological disorders report decreased quality of life and low mood. The relationship of these symptoms to daily upsetting events or environments, and in the context of active coping mechanisms is poorly understood. The present study thus investigates the association between mood, psychological flexibility, ups...

Background Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, p...

Introduction: We aim to understand the factors that drive citizens of different countries to adhere to recommended self-protective behaviors during the COVID-19 pandemic. Methods: Survey data was obtained through the COVID-19 Impact project. We selected countries that presented a sufficiently complete time series and a statistically relevant sam...

Background: Despite the declining prevalence of cigarette smoking in the United States, socioeconomically disadvantaged veterans receiving care from the Veterans Health Administration have a high prevalence of smoking. Currently, available treatment options for these veterans focus on tobacco users who are ready to quit and have limited reach. Con...

Introduction: Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions. Objective: The Choose Change trial tested whether psychotherapy was effective in treating chronic pat...

In response to the COVID-19 pandemic, the Psychological Science Accelerator coordinated three large-scale psychological studies to examine the effects of loss-gain framing, cognitive reappraisals, and autonomy framing manipulations on behavioral intentions and affective measures. The data collected (April to October 2020) included specific measures...

Despite the growing body of evidence for the effectiveness of clinic-based interventions in increasing daily functioning in individuals with chronic pain, many sufferers still remain untreated or inadequately treated. Digital psychological interventions have been proposed as a means to overcome many of the barriers to face-to-face treatment (e.g.,...

Body image flexibility (BIF) has been suggested as a transdiagnostic process of change in eating disorder (ED) interventions, but data remain sparse. The current study examined the relationship between BIF and treatment effects in a randomized controlled trial comparing a digital ACT-based intervention to a waitlist control for early ED interventio...

Tailored tobacco cessation interventions focusing on minoritized communities are proliferating, but the extent to which these interventions address the needs of individuals with multiple minoritized social identities is unclear. We developed Empowered, Queer, Quitting, and Living (EQQUAL), an avatar-led digital smoking cessation intervention tailor...

BACKGROUND Despite the declining prevalence of cigarette smoking in the United States, socioeconomically disadvantaged veterans receiving care from the Veterans Health Administration have a high prevalence of smoking. Currently, available treatment options for these veterans focus on tobacco users who are ready to quit and have limited reach. Conse...

Increasing vaccination hesitancy that burdens global health and safety can be attributed to multiple reasons. Individuals’ social environment seems to be the catalyst for vaccination hesitancy perpetuation, thus it is important to examine the influence of different social network mechanisms in vaccination attitudes’ contagion. The proposed pilot ex...

The rapidly increasing rate of climate change is a major threat of our time. Human behaviors contribute to climate change. These behaviors are malleable. To change human behavior in significant and sustainable ways, we need a scientific understanding of motivation and behavior change. One area in psychological science that provides precision, scope...

Introduction While online consultations have shown promise to be a means for the effective delivery of high-quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative stands...

The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in t...

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about...

Psychological responding to stressful situations such as experiential avoidance (EA) is central to the development of several psychopathologic conditions, yet it tends to be assessed solely via retrospective self-report. The purpose of this study is to utilize machine-learning algorithms to delineate and predict individuals classified as high vs. l...

Acceptance and Commitment Therapy (ACT) is increasingly used to treat eating disorders (EDs); however, the evidence for ACT with EDs has not been the subject of a systematic review. The current study reviews the evidence of ACT for EDs through January of 2022. PubMed and PsycInfo were searched for treatment studies using three or more ACT processes...

Background Digital early-intervention programs for a variety of psychological conditions, including eating disorders (EDs) are increasing. Yet, none to date have leveraged gamification and vicarious learning components grounded in empirically-supported therapeutic approaches to engage young people at risk for developing EDs in behaviour change. Pu...

Significance Communicating in ways that motivate engagement in social distancing remains a critical global public health priority during the COVID-19 pandemic. This study tested motivational qualities of messages about social distancing (those that promoted choice and agency vs. those that were forceful and shaming) in 25,718 people in 89 countries...

Vaccination hesitancy is an important barrier for the effective control of the COVID-19 pandemic. Identifying determinants of COVID-19 vaccination hesitancy is essential in order to reduce mortality rates. Further, given the variability of the factors and the different recommendations used in each country, it is important to conduct cross-country r...

More than half of cancer patients are dealing with moderately severe pain on a monthly basis and most of them report a breakthrough pain experience at least once. Despite the importance of pain management for cancer patients, cancer pain remains undertreated. With computer technology and especially Virtual Reality offering open endless opportunitie...

Eating disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat, as these disorders are ego-syntonic, and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs...

Considering the high impact strain that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has put on medical personnel worldwide, identifying means to alleviate stress on healthcare professionals and to boost their subjective and psychological wellbeing is more relevant than ever. This study investigates the extent to which...

Araştırmanın amacı, COVID-19 pandemisinde uygulanan ‘evdekal’ (sokağa çıkma yasakları/kısıtlamaları) sürecinde çeşitli demografik değişkenlerin (yaş, cinsiyet, çalışma durumu, sağlık sektöründe çalışma, koronavirüse yakalanma, ekonomik durum, yaşama biçimi) ve olumlu-olumsuz duyguların algılanan stresi ne ölçüde yordadığını ve bireylerin ‘evdekal’...

Eating Disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat as these disorders are ego-syntonic and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs fo...

The coronavirus disease (COVID-19) pandemic fundamentally disrupted humans’ social life and behavior. Public health measures may have inadvertently impacted how people care for each other. This study investigated prosocial behavior, its association well-being, and predictors of prosocial behavior during the first COVID-19 pandemic lockdown and soug...

We aim to understand the factors that drive citizens of different countries adhere to recommended self-protective behaviors during the COVID-19 pandemic. Survey data obtained through the COVID Impact project was used. We combined previous evidence and change-point detection analysis to establish variations in self-protective behaviors across partic...

A population-based cross-sectional study was conducted during the first COVID-19 wave, to examine the impact of COVID-19 on mental health using an anonymous online survey, enrolling 9565 individuals in 78 countries. The current sub-study examined the impact of the pandemic and the associated lockdown measures on the mental health, and protective be...

Global incidence for legal and illegal substance abuse is increasing, with marginalized groups and adolescents bearing the brunt. Substance use disorders (SUDs) are linked with serious and enduring physical health consequences, persistent psychological problems, criminality, homelessness, unemployment, and diminished educational opportunities. The...

Anxiety disorders differ in the association between subjective distress and physiological reactivity towards threat. For some anxiety disorders, like Social Anxiety Disorder (SAD), the relationship among emotion responses remains unclear. The current study examines how different components of subjective distress relate to autonomic arousal (Heart R...

The COVID-19 pandemic has had a great impact on the mental health and well-being of different populations including young adults. This study replicates and extends previous research by evaluating the impact of the COVID-19 pandemic on the well-being of college students in Cyprus, a Mediterranean island with unique sociocultural and genetic characte...

Introduction: Following the onset of the COVID-19 pandemic, most countries imposed strict governmental lockdowns. Research investigating the psychological impact of pandemic-induced lockdowns is accumulating, though to date no study has examined the psychological health and associated parameters of well-being in countries that underwent additional...

Background Medication nonadherence of patients with chronic conditions is a complex phenomenon contributing to increased economic burden and decreased quality of life. Intervention development relies on accurately assessing adherence but no “gold standard” method currently exists. Purpose The present scoping review aimed to: (a) review and describ...

Background: Medication nonadherence of patients with chronic conditions is a complex phenomenon contributing to increased economic burden and decreased quality of life. Intervention development relies on accurately assessing adherence but no "gold standard" method currently exists. Purpose: The present scoping review aimed to: (a) review and descr...

Background: The COVID-19 pandemic is a massive health crisis that has exerted enormous physical and psychological pressure. Mental healthcare for healthcare workers (HCWs) should receive serious consideration. This study served to determine the mental-health outcomes of 1,556 HCWs from 45 countries who participated in the COVID-19 IMPACT project, a...

Background: Digital prevention programs for a variety of psychological conditions, including eating disorders (EDs) are increasing. Yet, none to date have leveraged gamification and vicarious learning components grounded in empirically-supported therapeutic approaches to engage young people at risk for developing EDs in behavior change. The current...

Background: Medication adherence (MA) is a serious problem for people diagnosed with chronic health conditions, contributing to increased economic burden and poor health outcomes. Implementing effective interventions depends on accurately assessing MA but no gold standard method currently exists. The present scoping review aimed to: a) describe the...

Background: Medication non-adherence (MNA) is prevalent across chronic health conditions, with almost one in two patients reporting low adherence to their prescribed medication. The purpose of this scoping review was to identify the barriers associated with medication adherence (MA) and the interventions and techniques developed to improve adherenc...

Interest in using digital methodologies and devices in research has grown immensely in the last years. The use of mobile applications during the daily life of individuals to assess behaviors, thoughts and feelings in real-time, namely ecological momentary assessment (EMA), is widely used as it appears to be a valid and reliable method overcoming th...

Background The COVID-19 pandemic is a massive health crisis affecting our planet, with over 166,346,635 confirmed cases and 3,449,117 deaths globally till 24 May 2021. The COVID-19 pandemic is a massive health crisis which has brought enormous physical and psychological pressure. Mental health care for health care workers (HCWs), should receive ser...

Psychological flexibility is increasingly studied in various contexts including clinical studies. The construct has been hypothesized to be a major determinant of mental health. Existing measures lack context-sensitivity (e.g, implicitly measuring it as a trait) and/or reference to a limited time frame. We developed a short self-report measure that...

No abstract submitted N/A.

Introduction: The COVID-19 pandemic has impacted individuals, communities, and whole populations. Experts across many different fields contributed their time and efforts in different ways to respond to the pandemic. Psychologists working in healthcare provided support and led many initiatives, both regionally and nationally. However, it is unknown...

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about...

Background Despite the demonstrated effectiveness of behavioural headache interventions, it is not yet known which intervention processes account for treatment responses. Acceptance and commitment therapy (ACT), an emerging behavioural intervention for headaches, proposes psychological flexibility (PF) processes as the mechanisms via which interven...

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about...

Background: Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. Objective: To address these challenges as well as their preferences for sexual and gender minority-targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficac...

The COVID-19 pandemic has impacted individuals, communities, and whole populations. Experts across many different fields contributed their time and efforts in different ways to respond to the pandemic. Psychologists working in healthcare provided support and led many initiatives, both regionally and nationally. However, it is unknown how this has d...

Science may be failing to convince a significant number of people about COVID-19 scientific facts and needed public health measures. Individual and social factors are behind believing conspiracy theories. Adults (N = 1001) were asked to rate their beliefs in various conspiracy theories circulating in social media, rate their psychological distress...

Vaccine hesitancy is a complex health problem, with various factors involved including the influence of an individual’s network. According to the Social Contagion Theory, attitudes and behaviours of an individual can be contagious to others in their social networks. This scoping review aims to collate evidence on how attitudes and vaccination uptak...

BACKGROUND Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. OBJECTIVE To address these challenges as well as their preferences for sexual and gender minority–targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, a...

This chapter focuses on how acceptance and commitment therapy (ACT) can be applied for dealing with the psychological parameters and particularly depression associated with cancer. Depression is one of the most common problems cancer patients present with. This chapter discusses reasons for employing ACT for depression among cancer patients and ill...

Introduction While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks. Objective This study investigates the uptake of online consultations provided by mental he...

This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological...

Background The negative impact of COVID-19 pandemic on public mental health can be persistent and substantial over a long period of time, but little is known regarding what psychological factors or processes can buffer such impact. The present study aimed to examine the mediating roles of coping, psychological flexibility and prosociality in the im...

Executive Summary Throughout its history the strategy and tactics of contextual behavioral science (CBS) research have had distinctive features as compared to traditional behavioral science approaches. Continued progress in CBS research can be facilitated by greater clarity about how its strategy and tactics can be brought to bear on current challe...

Objective: Illness perceptions (IP) are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors (within demographics and contact with COVID-19) and examine the impac...

Background Movement is a basic component of health. Little is known about the spatiotemporal movement of patients with mental disorders. The aim of this study was to determine how spatiotemporal movement of patients related to their symptoms and wellbeing. Method A total of 106 patients (inpatients ( n = 69) and outpatients ( n = 37)) treated for...

The COVID-19 pandemic has brought unprecedented situations (government lockdowns, quarantines, etc.) and stressors (a seemingly “phantom” virus that can be lurking anywhere) causing uncertainty for the future, uncontrollable and unpredictable situations. It appears that especially during times of uncertainty and high stress, conspiracy theories flo...

The Cognitive Fusion Questionnaire (CFQ) is a measure of cognitive fusion, a fundamental component of the psychological flexibility model, underlying Acceptance and Commitment Therapy (ACT). Numerous studies present cognitive fusion as a core pathological process contributing to psychological suffering, but none to date have examined phenomenologic...

Adaptability is purported to be a key mental resource and refers to an individual's cognitive, behavioral, and emotional regulation (or adjustment) in situations of change, novelty, and uncertainty. Psychological flexibility refers to a person's capacity to allow experience and acceptance of negative thoughts and feelings with mindful awareness gui...

Background The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affec...

In 2017, the European Federation of Psychologists Associations made a statement on psychotherapy. It recognizes that psychotherapy is a “special competence” practiced by psychologists, and that psychologists practicing psychotherapy receive specific education, including supervision. The statement also stresses that they have demonstrated competenci...

Introduction: Stress and social isolation are potent predictors of negative health outcomes and are impacted in mood and anxiety disorders. Difficulties in social interactions have been particularly noted in people diagnosed with major depression disorder (MDD) and social phobia (SP). It remains poorly understood, however, how these variables inte...

BACKGROUND While the general uptake of e-mental health interventions remained low over the past years, physical distancing and quarantine measures relating to the COVID-19 pandemic created a need and demand for online consultations and telepsychology in only a matter of weeks. OBJECTIVE This study investigates the uptake of online consultations pr...

This paper is now published in Internet Interventions: https://doi.org/10.1016/j.invent.2021.100405

Medication non-adherence (MNA) constitutes a complex health problem contributing to increased economic burden and poor health outcomes. The Medication Adherence Model (MAM) supports that numerous processes are involved in medication adherence (MA). Based on the MAM and guidelines of the World Health Organization (WHO), this scoping review aimed to...