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OBM Neurobiology

(ISSN 2573-4407)

OBM Neurobiology is an international peer-reviewed Open Access journal published quarterly online by LIDSEN Publishing Inc. By design, the scope of OBM Neurobiology is broad, so as to reflect the multidisciplinary nature of the field of Neurobiology that interfaces biology with the fundamental and clinical neurosciences. As such, OBM Neurobiology embraces rigorous multidisciplinary investigations into the form and function of neurons and glia that make up the nervous system, either individually or in ensemble, in health or disease. OBM Neurobiology welcomes original contributions that employ a combination of molecular, cellular, systems and behavioral approaches to report novel neuroanatomical, neuropharmacological, neurophysiological and neurobehavioral findings related to the following aspects of the nervous system: Signal Transduction and Neurotransmission; Neural Circuits and Systems Neurobiology; Nervous System Development and Aging; Neurobiology of Nervous System Diseases (e.g., Developmental Brain Disorders; Neurodegenerative Disorders).

OBM Neurobiology publishes a variety of article types (Original Research, Review, Communication, Opinion, Comment, Conference Report, Technical Note, Book Review, etc.). Although the OBM Neurobiology Editorial Board encourages authors to be succinct, there is no restriction on the length of the papers. Authors should present their results in as much detail as possible, as reviewers are encouraged to emphasize scientific rigor and reproducibility.

Publication Speed (median values for papers published in 2024): Submission to First Decision: 7.6 weeks; Submission to Acceptance: 13.6 weeks; Acceptance to Publication: 6 days (1-2 days of FREE language polishing included)

Current Issue: 2026  Archive: 2025 2024 2023 2022 2021 2020 2019 2018 2017
Open Access Original Research

Evidence for an Impact of Super Skills for Life on Emotional and Behavioral Difficulties in Greek Anxious Children

Ioannis Syros 1,2,* ORCID logo, Anna Tsourdini 2, Blossom Fernandes 3,4, Xenia Anastassiou-Hadjicharalambous 2

  1. Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece

  2. Psychology Program, University of Nicosia, 46 Makedonitissas Avenue, P.O. Box 24005, 1700 Nicosia, Cyprus

  3. Department of Psychology, University of Roehampton, Whitelands College, Holybourne Avenue, London SW15 4JD, UK

  4. Department of Clinical, Education & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK

* Correspondence: Ioannis Syros ORCID logo

Academic Editor: Fabrizio Stasolla

Special Issue: Assessment and Treatment of Psychiatric Disorders in Children and Adolescents

Received: September 23, 2025 | Accepted: January 13, 2026 | Published: January 22, 2026

OBM Neurobiology 2026, Volume 10, Issue 1, doi:10.21926/obm.neurobiol.2601319

Recommended citation: Syros I, Tsourdini A, Fernandes B, Anastassiou-Hadjicharalambous X. Evidence for an Impact of Super Skills for Life on Emotional and Behavioral Difficulties in Greek Anxious Children. OBM Neurobiology 2026; 10(1): 319; doi:10.21926/obm.neurobiol.2601319.

© 2026 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Abstract

Super Skills for Life (SSL) is a transdiagnostic psychoeducational program designed for children with anxiety and depressive symptoms based on cognitive-behavioral therapy. Empirically documented studies to date have demonstrated its immediate and long-term effectiveness in different contexts. The aim of this study was to assess the efficacy of the SSL program to reduce emotional and behavioral difficulties in a clinical sample of Greek-speaking primary school children aged 6 to 12. The program was implemented over 2 years in a community child mental health unit of the NHS. The sample consisted of 23 children attending elementary school who had been diagnosed with at least one anxiety disorder (AD). Small groups of 4 to 6 children with a similar age range were formed, and each session was held once a week for 1 hour. Assessments were conducted before and after the 8-week intervention by using the Strengths and Difficulties Questionnaire parent form. After the intervention, a reduction was observed in children's hyperactivity (Z = -2.83, p = 0.01), peer problems (Z = -2.69, p = 0.01), as well as total scores of SDQ parent form (Z = -2.31, p = 0.02). A statistically significant increase in children's prosocial skills was also observed (Z = -2.470, p = 0.01). The findings of this study imply an immediate effect of the Greek adaptation of SSL, suggesting that it could be a valuable resource for early reduction, not only of emotional but also of comorbid symptoms in young Greek-speaking children. Finally, these results suggest that the intervention could be delivered by a non-mental health specialist since the program coordinator was a special educator. Clinical implications of these findings are discussed further in this report.

Keywords

Intervention; cognitive behavioral therapy; children; pathological anxiety; hyperactivity; social skills

1. Introduction

Childhood Anxiety Disorders (ADs) are a significant public health concern, impacting roughly 10% of children up to the age of 16 [1,2]. These disorders are not merely of a transient nature; they can severely impair a child's ability to participate in everyday activities and often develop into chronic conditions, substantially increasing the likelihood of subsequent mental health challenges during adolescence and young adulthood. Elevated anxiety levels in children are also associated with difficulties in social interactions, weaker friendships, as well as burdened resilience [3,4,5,6]. On the other hand, children with anxiety often exhibit restlessness, psychomotor agitation, difficulty concentrating, and irritability, shaping a clinical image that resembles ADHD syndrome [7,8]. Research consistently demonstrates the long-term consequences, as well as the diversity of phenomenology arising from untreated childhood anxiety [9].

While the exact prevalence of ADs among Greek children aged 6-12 varies across studies due to differing methodologies and assessment tools [10,11], a comprehensive review of mental health research in Greece has revealed a concerningly high rate of anxiety symptoms, exceeding 40% in this age group [12]. The challenges faced by Greek children, including the country's recent economic crisis, the COVID-19 pandemic, and the intense pressure from both school and parents, have all placed a heavy emotional burden on them [13,14]. Apart from the perceived anxiety, the most common symptoms in childhood AD also include excessive worry, separation anxiety, social withdrawal, irritability, fearful preoccupations, and somatic complaints. The aforementioned alarming statistics underscore the urgent need for effective interventions [9,15].

Fortunately, well-established and effective psychological treatments, particularly group-based cognitive-behavioral therapy (CBT), are available for children struggling with ADs [16]. CBT is considered the most effective treatment for anxiety in children, showing positive results in 50-70% of cases [17,18,19,20,21,22,23]. It has proven efficacy in equipping children with coping mechanisms and strategies to manage their anxiety. However, a critical gap exists between the availability of these treatments and their accessibility. Furthermore, a significant number of children with ADs remain unidentified and do not receive timely referrals for appropriate care [24,25]. At the same time, the outcome of CBT-based interventions for comorbid conditions with ADs requires further evaluation in this context [26]. The lack of early detection of children with ADs, as well as the lack of availability of non-disorder-specific interventions, has sparked a special focus by the scientific community on developing and implementing transdiagnostic and sustained treatment programs, aiming to address ADs and comorbid situations before they escalate into more severe and enduring psychopathology.

Internationally, mental health programs, particularly those using CBT, are often delivered in accessible community settings, such as schools or mental health centers [27,28]. While systematic reviews suggest the potential effectiveness of CBT prevention and treatment programs, further research with improved methodologies is needed. The question of who leads these programs, mental health professionals or trained teachers, remains unanswered mainly, with existing research offering inconclusive results and limited direct investigation [9,29].

CBT offers a structured approach to elucidating the interrelationship between a child's cognitions, affect, and behavior. Operationally, CBT facilitates the identification, empirical testing, and revision of maladaptive beliefs, promoting the adoption of more helpful cognitive frameworks. This therapeutic modality incorporates a range of behavioral interventions, notably positive reinforcement, contingency management, self-monitoring of negative cognitions, and graduated exposure [30,31,32]. The anticipated outcomes of CBT encompass: (a) cognitive restructuring, leading to a diminution of negative ideation; (b) improved emotional response, resulting in a reduction of anxiety and depressive affect; and (c) behavioral modification, fostering enhanced self-efficacy as children acquire the capacity to successfully navigate and confront challenges [24,33,34].

Combining effective cognitive-behavioral techniques with innovative components such as social skills training, behavioral activation, and video feedback with cognitive preparation, Essau and Ollendick developed Super Skills for Life (SSL) [35]. This is a transdiagnostic prevention protocol for children with emotional and comorbid problems (e.g., low self-esteem, aggression, peer problems, psychomotor difficulties, and lack of social skills). The importance of a transdiagnostic approach in the treatment of children with pathological anxiety and various comorbidities is demonstrated by the fact that intervention in these cases through diagnostic-specific CBT protocols, although considered the treatment of choice for emotional problems in childhood, appears to show modest success rates ranging from 50% to 70% [35,36]. SSL can be implemented in different formats and contexts, and comprises skills that help children become more resilient [35,37,38]. Several studies have reported its immediate and long-term effects internationally, in the UK [19,20], Spain [37,39,40,41,42,43,44,45,46,47,48,49], Mauritius [36], and Malaysia [38,50]. Additionally, promising initial results have been found in Greece [51]. The descriptions of these studies are shown in more detail in Table 1.

Table 1 Description of SSL efficacy studies.

Despite the promising results of SSL, evaluating its effectiveness in improving not only emotional difficulties but also other comorbid clinical situations, such as behavioral problems or social skills, still requires further investigation within a clinical sample drawn from the central suburbs of Athens, Greece. As mentioned earlier, disorder-specific interventions have positive effects on the disorder for which they are designed, but their effects on other comorbid symptoms are limited [52]. Additional research is also required to establish the effectiveness of adapted SSL among Greek-speaking elementary school students. Adapting SSL requires careful consideration of language, culture, and context specific to Greek-speaking children to ensure that effective interventions address symptoms whilst considering the cultural norms and values of those receiving the intervention [53]. Based on previous promising results [19,20,36,37,38,39,40,41,42,43,44,45,46], it is hypothesized that children with anxiety are likely to report reduced scores of emotional and behavioral comorbid symptoms after treatment. Secondly, we expect immediate and significant improvements in emotional problems, hyperactivity, conduct problems, peer problems, and prosocial behaviors following participation in this intervention.

2. Materials and Methods

2.1 Study Design and Participants

This study focused on the outcomes of the SSL intervention in a clinical group. The intervention was delivered over the period of two years, between 3/2018-2/2020, and took place at the Mental Health Center of Athens General Hospital for Chest Diseases "Sotiria", targeting children diagnosed with ADs. The sample comprised 23 children, aged 6 to 12 years (Mage = 9.35, SD = 1.15; 61% male). Participants were recruited from central Athens. All participants were Greek-born or/and/or Greek-speaking. The participating children were not receiving concurrent psychological treatment or had not initiated psychopharmacological treatment before the intervention. In this study, the children diagnosed with Intellectual Disability or Pervasive Developmental Disorder were excluded because the program is not designed to address the specific and complex needs associated with these conditions [43]. The inclusion and exclusion criteria for the participants are presented in Table 2.

Table 2 Inclusion and exclusion criteria of the participants.

The comorbidity in the sample was high: 30.4% of the children met the criteria for two disorders, mainly an AD accompanied by another emotional disorder, and 26.1% for three disorders. The list of all diagnoses, ages, and genders of our participants is presented in Table 3.

Table 3 List of diagnoses, age, and gender of our participants.

Participants were divided into groups of 4 to 6 children of a similar age range, grouped by school grade (i.e., 1st, 2nd, and 3rd grades together, and 4th, 5th, and 6th grades together). Each session was held once a week for one hour. The sample was evaluated at baseline (Session 1) and immediately after the intervention (Session 8). Only children with complete pre- and post-test data were included in the analyses. Neither parents nor children received any additional compensation for their participation in this study. The coordinator who carried out the intervention was a special educator who recruited the children following the child psychiatrist’s evaluation. She had undergone intensive training before intervention as well as supervision during the process by the adaptors of the Greek version of the SSL programme. The coordinator was given a leader's manual, which included a detailed outline of each session of the SSL. The appropriate questionnaires were administered to the children and their parents by the same person, namely the group coordinator. However, the investigator who assessed, analyzed, and evaluated the data was blind to the participants' replies.

2.2 Ethics Approval

This study adhered to the ethical guidelines of the World Medical Association's Declaration of Helsinki [54]. The Ethics Committee of Clinical Research at Athens' "Sotiria" General Hospital for Thoracic Diseases approved the study's protocol. Before the intervention began, parents completed a consent form. Participation of children and their parents in the survey was voluntary, and data collection was conducted on an anonymous and confidential basis.

2.3 Clinical Assessment

The evaluation and diagnosis of AD and other comorbid psychiatric disorders were conducted by the same child psychiatrist, using the Greek version of the semi-structured psychiatric interview K-SADS-PL (PL-DSM-5) [55,56]. Diagnosis of clinical anxiety and exclusion of other disorders was made according to DSM-5 criteria [57]. The study was designed and initiated in 2018, five years after the publication of DSM-5. The inclusion criteria were the diagnosis of at least one of the following ADs: Separation Anxiety Disorder F93.0, Selective Mutism F94.0, Specific Phobia, Social Anxiety Disorder (Social Phobia) F40.10, Panic Disorder F41.0, Agoraphobia F40.0, Generalized Anxiety Disorder F41.1, Anxiety Disorder Other Specified F41.8, and Anxiety Disorder Unspecified F41.9.

2.4 Super Skills for Life (SSL) Programme

As mentioned before, SSL is a transdiagnostic CBT-based programme aimed at treating emotional problems and their comorbid symptoms [19]. It was translated and adapted into the Greek language by Hatzicharalampous & Syros (2019), following the WHO 4-step translation and adaptation guidelines [58].

Through the programme, children learn to identify and manage their own and others’ emotions, develop cognitive restructuring skills, engage in behavioural activation, practice relaxation techniques, enhance social and communication skills, and employ problem-solving strategies. The SSL intervention consisted of eight weekly 1-hour sessions in small groups comprising 4-6 children. The content of the 8 sessions of the SSL program is presented in Table 4.

Table 4 Objectives and Activities of Super Skills for Life.

2.5 Procedures

Before the beginning of the intervention, parents completed the participant information which contained the personal demographic information of each child (name, age, gender, school year, number of siblings, contact telephone number, place of residence and birthplace etc.), information about the SSL program (its objectives, the procedure etc.), a statement on the children's voluntary participation and their free withdrawal from the program if they decided to do so. In the first evaluation, children and their parents completed a large battery of questionnaires via an electronic link, including the Strengths and Difficulties Questionnaire (SDQ-P) parent form. During the completion, the team coordinator was present near the participants to resolve any questions they had.

2.6 Strengths and Difficulties Questionnaire - Parent Version

The SDQ-P measures positive and negative traits [59]. It contains 25 items that provide scores on five subscales, including emotional symptoms (e.g., “He worries a lot”), conduct problems (e.g., “He gets angry and often lose his temper”), hyperactivity (e.g., “He is restless, He can’t sit still for long”), peer problems (e.g., “He is usually alone. He generally plays alone or withdraws into himself”), and prosocial behavior (e.g., “He has one or more good friends”). Each of the above subscales has 5 items. These items are rated on a 3-point Likert scale (0 = not true, 1 = somewhat true, and 2 = definitely true), with subscale scores ranging from 0-10. Additional questions measure the impact of behavioral outcomes (e.g., “Do the difficulties upset or bother him?”). A total score is calculated by adding all subscales except prosocial behavior. Higher scores on the prosocial behavior subscale indicate resilience (“strengths”), while higher scores on the other four subscales reflect difficulties. The SDQ-P was adapted and validated for a Greek population by Giannakopoulos et al. in 2013 [60]. The Greek version showed good test-retest stability and acceptable internal consistency, with Cronbach's α values above 0.70 for all SDQ scales except for conduct and peer problems.

2.7 Statistical Analysis

The data were identified as nonparametric because they were not normally distributed. The Wilcoxon signed-rank test was then used to assess whether the difference between the variables was significant; a p-value less than 0.05 was considered significant.

3. Results

Table 5 shows the findings from the Wilcoxon signed-rank test. This analysis demonstrated that following SSL, various comorbid difficulties were reduced following participation in this intervention. Outcomes for subscales of SDQ-P, including hyperactivity and peer problems, were significantly reduced following intervention. On the other hand, prosocial behavior increased significantly, while conduct problems decreased marginally. Finally, the total score of the SDQ-P form, representing the sum of all difficulty scales, except prosocial skills, was also significantly reduced.

Table 5 Results from the Wilcoxon signed rank test (Statistically significant correlations are marked with bold and italic writing).

4. Discussion

To our knowledge, this is the first study to show evidence concerning the short-term positive impact of the SSL program on various aspects of psychological well-being in Greek-speaking primary school children with clinical anxiety. The results showed that hyperactive behaviors were significantly reduced after the intervention. This finding is in line with the results of the Essau et al. [19] study, where SSL was effective in children in the UK recruited from 14 schools, aged 8-10 years, and withimilar psychopathology. However, unlike our study, which showed an immediate reduction following treatment, this particular study took somewhat longer for the children to experience the programme's positive impact on hyperactivity (i.e., at follow-up). Additionally, in two randomized controlled trials [40,61], similar positive results were also observed in children aged 6 to 8 years recruited from 10 schools in Spain. A further randomized controlled trial involving 100 children and adolescents aged 9 to 14 years living in residential care facilities in Mauritius also reported a significant reduction in hyperactive behaviors. SSL was also found to be effective in reducing hyperactivity in its individual form, as reported by parents [38,42].

Group treatment programs are generally considered beneficial for alleviating disruptive symptoms, such as hyperactivity [62]. In this particular case, the majority of our sample involved children with diagnoses not including ADHD. The reduction among hyperactivity in children participating in the SSL intervention may be due to various factors; the intervention may help children develop better self-regulation skills, i.e., the ability to control their impulses and manage their emotions [36,63]. Additionally, the intervention may include activities that enhance children's attention and concentration, such as problem-solving techniques or relaxation exercises. As their attention improves, children may be less likely to exhibit hyperactive behavior [64]. Furthermore, the intervention focuses on broad social skills development, such as communication, cooperation, sharing of experiences, as well as enhanced social exposure competence. As children learn to interact more effectively with others, their need to engage in hyperactive behavior to express themselves or seek attention may decrease [65]. As hyperactivity may be linked to anxiety [8], SSL may help children manage their anxiety through techniques such as effective self-assessment of emotions, as well as relaxation techniques, which can lead to a reduction in hyperactivity. Finally, SSL provides a structured and predictable environment, which can be particularly beneficial for children with increased mobility. Structure and routine can help children feel safer and reduce their need for constant movement [66].

In this study, we also observed a significant effect of SSL on prosocial behaviors and peer relationships. These findings highlight the positive impact of SSL, as research shows that a lack of social skills predicts anxiety disorders [67]. In line with our measures, the majority of studies have also demonstrated that SSL can help improve children's prosocial skills and reduce peer problems in primary school children with various clinical characteristics [14,19,39,40,41,47,48]. On the other hand, a very recent study where Spanish-speaking primary education pupils were randomly assigned to two groups (SSL vs. Controls) failed to detect a positive impact in this domain [49]. This discrepancy may be attributed to the fact that the study used a community sample likely with adequate levels of social competence at baseline, in contrast to our sample, which included, to a significant extent, children with increased levels of social anxiety baseline.

It is important to pinpoint that the beneficial effect of the intervention on hyperactivity and prosocial skills is indicative of the cascade effect that can be observed in cognitive behavioral-oriented therapies, that is, the phenomenon where an intervention that targets children with high anxiety also has a therapeutic effect on other areas not directly targeted, such as hyperactivity and prosocial skills. This is a significant observation, as it suggests the interconnectedness of these domains [9,68,69].

Concerning conduct problems, our study led to a marginal reduction in them, a finding which is also consistent with the aforementioned studies [19,36,40,41]. Furthermore, no significant positive effects were found for children's emotional problems following the intervention. Nonetheless, prosocial behavior was improved. Recent studies like that of Huber et al. [70] and Orgiles et al. [44] showed that social competence plays an important role in the earliest manifestations of internalizing symptoms, such as anxiety at early ages, and they considered it a relevant protective factor. In contrast to our study, earlier studies have reported a positive impact on children’s emotions [19,39,40]. However, the absence of this effect in our research could be attributed to the small sample size, resulting in low statistical power, the possible limited diversity of our sample, and increased random variation in our data. In addition, uncontrollable factors, such as family or school stressors, could affect children's emotional well-being and mask the effect of the SSL program.

It's important to note that while these studies suggest a positive impact on anxious children’s various comorbid problems, more research is needed to understand the long-term effects of SSL on these variables fully. However, the available evidence indicates that SSL is a promising psychoeducational intervention in elementary school children with clinical anxiety.

The current study has a few limitations. Notably, the Wilcoxon signed-rank test used in our analysis can only detect statistical differences at two time points, pre- and post-intervention. This finding cannot prove that the SSL program directly caused changes in the tested emotional/behavioral variables. Moreover, the study sample was selected without randomisation, and its size of only 23 pediatric participants, drawn by a single community unit, may limit the generalisability of these results beyond this context. Additionally, the absence of a control group represents a further limitation; researchers cannot definitively attribute the improvement in the aforementioned psychosocial difficulties to the SSL intervention without using controls. At the same time, evidence regarding the long-term sustainability of the program's beneficial effects, after the intervention's completion, is currently lacking. This is also a major limitation of our study, since there was no funding for the researchers to cover the long-term maintenance of treatment benefits, while the sample was largely drawn from the central, low-income suburbs of Athens and involved economic migrants, i.e. a population that is typically mobile and difficult to re-approach [71]. Furthermore, our reported findings were based exclusively on parent reports of the SDQ, and not additionally on children or teachers reports. Although the above constitute significant limitations, it is important to note that the majority of available studies assessing the efficacy of SSL are generally characterized by small sample sizes [20,27]. Furthermore, as previously mentioned, this is the first study to examine the impact of the SSL program on various aspects of psychological well-being in Greek-speaking primary school children. Additionally, the final clinical anxiety case sample was established through clinical evaluations performed by a specialized child and adolescent psychiatrist who utilized the semi-structured K-SADS-PL interview, rather than depending solely on self-reported questionnaires. The children who participated in the study had a strict entry criteria: they could not be receiving any concurrent psychosocial treatment. Moreover, social behaviors, peer problems, or hyperactivity do not remit spontaneously or evolve, so the improvement observed in the study should not be attributed to the passage of time. Thus, these speculations reduce the likelihood that the observed improvement could be attributed to confounding factors, such as the passage of time or external therapy. Finally, the present study used a field trial design in a clinical and not an experimental research-based setting. Therefore, the results were closer to the realistic conditions of clinical routine in a mental health center of the National Health System [9,20,44].

In the last two decades, there has been a tremendous expansion of the knowledge regarding the treatment of AD through evidence-based group interventions in children and adolescents. However, many key issues remain to be assessed. Nevertheless, we are currently at a point where children with anxiety are increasingly being acknowledged and can be well-evaluated.

The main advantages of the SSL program could be summarized as follows: Firstly, SSL includes various techniques and skills that are considered transdiagnostic, meaning they appear to have a favorable effect across various emotional and externalized clinical situations. For example, problem-solving skills are essential for children with anxiety, but also for individuals with hyperactivity, peer problems, etc. Additionally, the possibility of SSL being offered by trained teachers allows SSL to be conducted cost-effectively in diverse and often remote community contexts. Lastly, SSL, a group intervention, has the advantage of providing a protective environment in which children can practice a variety of skills [9,72].

Consequently, the SSL intervention demonstrates considerable potential for mitigating psychopathology in children with anxiety only, as well as those with anxiety and comorbid conditions, which often exacerbate clinical complexity. Observed positive outcomes encompass both immediate and sustained effects [61]. To enhance the statistical robustness of these findings, future investigations should incorporate larger sample sizes in randomized control trials. Furthermore, the observed gender disparity, with a higher representation of male participants, may reflect differential referral patterns, wherein parental concern for anxiety in male children may lead to a higher likelihood of seeking specialist consultation [73].

The inclusion of a control group, utilising either a waiting-list design or an active comparative intervention employing established therapeutic modalities, would significantly strengthen the inferential validity of the present study's results.

We can consider future challenges and suggestions for SSL research and implementation. More specifically, it will be essential to investigate the applicability and effectiveness of SSL for psychopathology in specific pediatric populations, including refugees, children in welfare facilities, and those with co-occurring chronic physical illnesses. Additionally, ensuring the sustainability of therapeutic gains over time is crucial. As Sandler [74] suggested, the long-term impact of treatment programs should be evaluated based on how well they maintain targeted outcomes, rather than just immediate effects. Another key area involves conducting detailed (dismantling) studies to pinpoint which components of the overall intervention offer the most significant therapeutic value. Finally, promoting innovative methods for delivering SSL, such as leveraging technology through internet-based and remote programs (telehealth), will be essential [47,48].

5. Conclusion

Despite its limitations, this study offers several notable strengths. It is the first research to examine the SSL program with young Greek-speaking children (ages 6-12) and provides initial support for the program's direct effectiveness in reducing internalizing and externalizing symptoms. These findings suggest that SSL could be a valuable tool for researchers and clinicians.

The study also extends the evidence that the program remains effective even when the group coordinator is not a mental health specialist. Finally, a key asset was the high reliability of the diagnoses, which were confirmed by a child psychiatrist's assessment.

Abbreviations

Acknowledgments

The authors would like to thank the staff of the Mental Health Center of Athens General Hospital for Chest Diseases "Sotiria" for their cooperation in taking the participants' initial histories and providing their workspaces to the research team.

Author Contributions

Anna Tsourdini was the basic researcher of the project. Ioannis Syros, Xenia Anastassiou-Hadjicharalambous, and Anna Tsourdini wrote the manuscript. Ioannis Syros and Xenia Anastassiou-Hadjicharalambous supervised the project, provided critical feedback, and helped shape the research, analysis, and manuscript. Blossom Fernandes contributed to the statistical analysis.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Competing Interests

The authors state that there are no conflicts of interest regarding the publication of this paper.

AI-Assisted Technologies Statement

Authors declare that while working on this manuscript, they employed the assistance of AI tools at various stages to help with fundamental grammar, language enhancement, and English translation of the text. Authors assert that all scientific content, data analysis, and conclusions were created independently by them. The authors have meticulously examined and revised the text produced with AI assistance to guarantee its precision and take complete responsibility for the manuscript's content.

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