Kristin Martinsen

• Ytreland, Kristin; Bania, Elisabeth Valmyr; Lisøy, Carina; Lydersen, Stian; Neumer, Simon-Peter & Adolfsen, Frode [Show all 9 contributors for this article] (2025). Relationships between parental factors and child anxiety and depressive symptoms in an indicated preventive intervention. European Child and Adolescent Psychiatry. ISSN 1018-8827. p. 1–12. doi: 10.1007/s00787-025-02831-5. Full text in Research Archive
• Martinsen, Kristin; Aas, Eline; Ingul, Jo Magne; Lisøy, Carina; Adolfsen, Frode & Rasmussen, Lene-Mari Potulski [Show all 8 contributors for this article] (2025). Cost-effectiveness analysis of preventive strategies for child anxiety and depression: a health service perspective. Child and Adolescent Psychiatry and Mental Health (CAPMH). 19(1). doi: 10.1186/s13034-025-00962-w. Full text in Research Archive Show summary

  Background The rising prevalence of mental health problems presents economic and social challenges with youth anxiety and depression as major contributors. While strengthening preventive measures is essential to mitigate the impacts of these conditions, limited resources necessitate careful prioritization of interventions. This underscores the need for cost-effectiveness studies to inform resource allocation and decision-making. Methods This study utilized data from a trial employing the MOST framework to optimize a targeted group CBT intervention for youths exhibiting anxiety and depressive symptoms. Experimental strategies were evaluated for cost-effectiveness using real-world data examining intervention costs, child mental health outcomes: anxious and depressive symptoms and quality-adjusted life-years (QALYs). Three intervention factors were examined: delivery format (16 sessions vs. 8 sessions + 8 web-based sessions), parental involvement (five sessions vs. parental brochure), and measurement feedback system (MFS) (feedback vs. no feedback), producing eight intervention strategies. The study included 701 children aged 8 to 12, recruited from 52 public schools in 39 municipalities in Norway. Statistical analysis was conducted using R. Results For depressive symptoms and QALYs, cost-effective strategies included the long in-person version with low parental involvement and no feedback, and the hybrid format (in-person + web-based sessions) with low parental involvement and no feedback. For depressive symptoms, the hybrid format with parental involvement and no feedback was a feasible strategy. For anxiety symptoms, cost-effective strategies involved the long in-person version with low parental involvement and feedback, and the hybrid format with low parental involvement and feedback. Discussion In resource-constrained environments, the least resource-intensive strategies can ensure symptom reduction at minimal cost. Parental involvement is a viable alternative under conditions of intermediate resources, balancing costs, and clinical benefits. When symptom reduction is prioritized, and cost is secondary, the long in-person format with low parental involvement and no feedback may be preferable. Conclusion The study highlights trade-offs between cost containment, reach, and intervention effectiveness. Policymakers must weigh costs against desired levels of symptom reduction when making decisions.

• Ytreland, Kristin; Bania, Elisabeth Valmyr; Lydersen, Stian; Sund, Anne Mari; Neumer, Simon-Peter & Adolfsen, Frode [Show all 9 contributors for this article] (2025). Parental Involvement in Child Anxiety and Depression: Exploring the Impact of Delivery Format on Modifiable Parental Factors. Child Psychiatry and Human Development. ISSN 0009-398X. p. 1–13. doi: 10.1007/s10578-025-01814-6. Full text in Research Archive Show summary

  Prior research has linked parental factors such as parent psychopathology, family functioning, parenting style, and parental practices to child anxiety and depression. Parents are often involved in interventions for these disorders. However, previous research suggests that this does not always add to the effect of child treatment alone. Furthermore, little research report changes in known parental risk and protective factors. As part of the ECHO-trial, we examined two delivery formats of parental involvement in the Emotion intervention, an indicated school-based cognitive behavioral therapy (CBT) program to prevent child anxiety and depression. Parents received either five parent group sessions or a brochure, while their children attended group sessions. Parents (N=1028) completed our online survey at baseline, post-intervention, and/or 12-month follow-up. On average, parents showed small improvements in anxiety and depression symptoms and parental practices over time. There was no difference in parental factors between parents in the group sessions and the brochure condition. The trial was preregistered at https://www.clinicaltrials.gov/ (NCT04263558), in February 2020.

• Bania, Elisabeth Valmyr; Ytreland, Kristin; Sund, Anne Mari; Lydersen, Stian; Neumer, Simon-Peter & Adolfsen, Frode [Show all 9 contributors for this article] (2024). Does dose matter? Parental attendance in a preventive intervention for anxious and sad children. BMC Psychology. 12(740). doi: 10.1186/s40359-024-02234-2. Full text in Research Archive Show summary

  Background International studies show increasing prevalence of anxiety and depression among children. Parents are vital for children in all aspects of life, also in supporting their offspring in promoting better mental health, life skills and reducing emotional difficulties. Therefore, involving parents in interventions aimed at preventing development of anxiety and depression is natural. In treatment studies, targeted parental involvement has been difficult to prove effective. However, few existing studies investigate the effect of parental involvement in preventive interventions. Objective We aimed to explore whether attendance influenced the change in child’s emotional symptoms post intervention and one-year later reported by parents. Method Parents of children attending an indicated preventive intervention named EMOTION, who took part in a high parental involvement condition were included in this study (n = 385). High involvement entailed 5 parent group sessions. Using linear mixed models, we investigated whether attendance in the parent groups influenced the parent-reported levels of children’s emotional symptoms post-intervention and at one-year follow-up. Results Parents who did not attend parent sessions reported significantly larger reductions in child anxiety symptoms over time than attending parents. There was no such effect on child depression. However, parents who attended sessions reported significantly higher depression symptoms than non-attendees at baseline. Further, attending more parent sessions did not significantly impact either symptom measure. Discussion Given the non-significant differences of parental attendance in this study, future studies could examine less resource demanding interventions for children with emotional difficulties. When the child is struggling with anxiety and depression, the parent’s role in child’s life could be vital for symptom amelioration. The challenge is finding effective, evidence-based methods to involve parents, to reduce child emotional difficulties and improve their quality of life. Conclusions In this preventive study, attendance in parent sessions has limited effect on parent-reported symptoms of child emotional difficulties.

• Martinsen, Kristin; Lisøy, Carina; Wentzel-Larsen, Tore; Neumer, Simon-Peter; Rasmussen, Lene-Mari Potulski & Adolfsen, Frode [Show all 8 contributors for this article] (2024). School children’s mental health during the COVID-19 pandemic. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1290358. Full text in Research Archive Show summary

  Introduction: The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life. Methods: Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations. Results: Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness. Discussion: Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.

• Lisøy, Carina; Neumer, Simon-Peter; Adolfsen, Frode; Ingul, Jo Magne; Rasmussen, Lene-Mari Potulski & Wentzel-Larsen, Tore [Show all 15 contributors for this article] (2024). Optimizing indicated cognitive behavioral therapy to prevent child anxiety and depression: A cluster-randomized factorial trial. Behaviour Research and Therapy. ISSN 0005-7967. 176. doi: 10.1016/j.brat.2024.104520. Full text in Research Archive Show summary

  Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8–12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention.

• Martinsen, Kristin; Fredriksen, Annelise; Lunde-Hansen, Christian; Torbjørnsen, Kirsten & Fedøy, Barbro (2023). A study of self-perceived change in CBT competence among Norwegian therapists undertaking a 2-year CBT training for working with young people. The Cognitive Behaviour Therapist. 16(3). doi: 10.1017/S1754470X23000296. Full text in Research Archive Show summary

  The rising prevalence of mental illness among youth has underscored the critical need for proficient therapists trained in effective methods for treating prevalent mental disorders. As mental health services grapple with resource constraints, the demand for shorter training programs has increased. This study aimed to investigate whether therapist competence improves continuously over a two-year cognitive behavioural therapy (CBT) training course, whether specific CBT skills show greater improvement than generic skills, and whether self-perceived competence varies based on therapist characteristics. Data were gathered from seven different CBT training courses spanning the years 2013–2021 involving a total of 151 Norwegian therapists. Therapist self-assessed their CBT competence using the Cognitive Therapy and Adherence Scale (CTACS). The collected data were analysed using mixed effects models using the R program. The findings revealed a significant increase in self-reported competence throughout the two-year training period. Notably, skills related to case formulation and CBT techniques displayed the most substantial improvements, indicating a high level of competence attained by the conclusion of training. No significant interactions were identified between time and therapist characteristics. The outcomes of this study support the efficacy of in-depth training through an extended CBT course spanning multiple semesters. The observed progress in CBT skills suggests that investments in therapist training can yield high levels of competence. Furthermore, this investment appears warranted regardless of therapists’ individual characteristics.

• Lisøy, Carina & Martinsen, Kristin Dagmar (2023). Måleegenskaper ved den norske versjonen av Beck Anxiety Inventory for ungdom og unge voksne (BAI). PsykTestBarn. 12(1), p. 1–16. doi: 10.21337/0080. Full text in Research Archive
• Pedersen, Marit Løtveit; Holen, Solveig; Sund, Anne Mari; Adolfsen, Frode; Løvaas, Mona Elisabeth S & Martinsen, Kristin [Show all 10 contributors for this article] (2022). Targeting Internalizing Symptoms in Children: What is the Impact on School Functioning? Scandinavian Journal of Educational Research. ISSN 0031-3831. doi: 10.1080/00313831.2022.2042849. Full text in Research Archive Show summary

  ABSTRACT Internalizing problems may be associated with poor academic performance and school absenteeism among youth. This study investigated the impact of the EMOTION: “Coping Kids” Managing Anxiety and Depression Program on academic achievement and school adaptation in children. Data were collected in a national cluster-randomized controlled trial at three time points in Norway. Children (N = 688, 8–12 years), who had elevated levels of anxiety or depressive symptoms from 36 schools participated. There were no significant differences between the intervention and control groups post-intervention or at 12-month follow-up regarding academic achievement and school adaptation. Likewise, no significant intervention effects were identified for school-related variables in the anxiety-only, depression-only, or combined (anxiety and depression) groups. The intervention did not have an impact on school functioning. Thus, focusing on school-related challenges and enhanced collaboration with teachers, possibly through a tailored version of the EMOTION program, could be an interesting adaptation of the intervention.

• Lisøy, Carina; Neumer, Simon-Peter; Waaktaar, Trine; Ingul, Jo Magne; Holen, Solveig & Martinsen, Kristin Dagmar (2022). Making high-quality measures available in diverse contexts — The psychometric properties of the Revised Child Anxiety and Depression Scale in a Norwegian sample. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. 31(4), p. 1–13. doi: 10.1002/mpr.1935. Full text in Research Archive Show summary

  Objectives - Recent initiatives have recommended the Revised Child Anxiety and Depression Scale (RCADS) for use in research and as patient-reported outcome in health care globally. We aimed to investigate, for the first time, whether the psychometric properties of the anxiety and depression youth self-report measures, RCADS-47 and RCADS-25, generalize to a Norwegian setting.<p> <p>Methods - We examined gender and age differences in symptomatology among 592 children (mean age 10.7 years), and conducted a psychometric investigation of the internal reliability, structural validity, measurement invariance and convergent validity of the RCADS-47 and RCADS-25 youth versions.<p> <p>Results - Girls reported higher levels of anxious and depressive symptoms than boys, but no age differences were observed. Reliability coefficients for the RCADS-47 and RCADS-25 scales indicated good internal consistency. Structural validity for RCADS-47 and RCADS-25 was supported by confirmatory factor analyses results. For both measures, strong gender-based measurement invariance was present. Convergent validity of the RCADS-47 and RCADS-25 with other well-established self-report measures for anxiety (Multidimensional Anxiety Scale for Children) and depression (The Short Mood and Feelings Questionnaire) was supported.<p> <p>Conclusion - The RCADS-47 and RCADS-25 youth versions are valid and reliable instruments for measuring symptoms of anxiety and depression in a Norwegian setting. The results add to the evidence supporting RCADS's cross-cultural validity.

• Rasmussen, Lene-Mari Potulski; Patras, Joshua; Handegård, Bjørn Helge; Neumer, Simon-Peter; Martinsen, Kristin & Adolfsen, Frode [Show all 8 contributors for this article] (2021). Evaluating Delivery of a CBT-Based Group Intervention for Schoolchildren With Emotional Problems: Examining the Reliability and Applicability of a Video-Based Adherence and Competence Measure. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.702565. Full text in Research Archive Show summary

  Adherence and competence are essential parts of program fidelity and having adequate measures to assess these constructs is important. The Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS CBT) was developed to evaluate the delivery of cognitive therapies for children with clinical anxiety. The present study is an assessment of the slightly adapted version of the CAS CBT evaluating the delivery of a Cognitive Behavioral Therapy (CBT)-based preventive group intervention: EMOTION: Kids Coping with Anxiety and Depression. This study was part of a Norwegian cluster randomized controlled trial (cRCT) investigating the effectiveness of a transdiagnostic intervention, the EMOTION program—an indicated prevention program targeting anxious and depressive symptoms. The applicability and psychometric properties of the CAS CBT were explored. Results are based on six raters evaluating 239 video-recorded sessions of the EMOTION program being delivered by 68 trained group leaders from different municipal services. Interrater reliability (intraclass correlation coefficients, ICC [3, 1]) indicated fair to good agreement between raters. Internal consistency of the instrument's key domains was calculated using the Omega coefficient which ranged between 0.70 to 0.94. There was a strong association between the two scales Adherence and Competence, and inter-item correlations were high across the items, except for the items rating the adherence to the session goals. Competence and Adherence Scale for Cognitive Behavioral Therapy is a brief measure for use in first-line services, with some promising features for easily assessing program fidelity, but some of the results indicated that the instrument should be improved. Future attention should also be made to adapt the instrument to fit better within a group setting, especially regarding evaluation of session goals. More research on how to adequately evaluate fidelity measures are also warranted.

• Pedersen, Marit Løtveit; Jozefiak, Thomas; Sund, Anne Mari; Holen, Solveig; Neumer, Simon-Peter & Martinsen, Kristin D. [Show all 9 contributors for this article] (2021). Psychometric properties of the Brief Problem Monitor (BPM) in children with internalizing symptoms: examining baseline data from a national randomized controlled intervention study. BMC Psychology. 9(1), p. 1–12. doi: 10.1186/s40359-021-00689-1. Full text in Research Archive Show summary

  Background Prevention is essential to reduce the development of symptomology among children and adolescents into disorders, thereby improving public health and reducing costs. Therefore, easily administered screening and early assessment methods with good reliability and validity are necessary to effectively identify children’s functioning and how these develop. The Brief Problem Monitor (BPM) is an instrument designed for this purpose. This study examined the psychometric properties of the Norwegian version of the BPM parent (BPM-P) and teacher (BPM-T) versions, including internal reliability and construct validity at assessing children with internalizing problems. Methods Baseline data were collected from a national randomized controlled intervention study. Children aged 8–12 years with self-reported symptoms of anxiety and/or depression with one standard deviation above a chosen population’s mean were included in this study. Teachers (n = 750) and parents (n = 596) rated children using the BPM-T and BPM-P, respectively. Internal consistency was measured using Cronbach’s alpha, and multi-informant agreement between the BPM-P and BPM-T was measured using Spearman’s correlations. Construct validity was assessed via confirmatory factor analysis. Results Internal consistency was good throughout all domains for both the BPM-P and BPM-T, with a Cronbach’s alpha ranging from .763 to .878. Multi-informant agreement between the parents and the teacher was moderate on the externalizing, attention, and total scales and low on the internalizing scale. The model fit for the three-factor structure of the BPM was excellent for the BPM-P and good for the BPM-T. Conclusions Internal consistency was good, and the original three-factor solution of the BPM-P and BPM-T was confirmed based on our sample of school children at-risk for emotional problems. These promising results indicate that the BPM may be a valid short assessment tool for measuring attentional, behavioral, and internalizing problems in children.

• Martinsen, Kristin & Rognli, Erling W. (2021). Kunnskapsoppsummering og klassifisering av tiltaket: The Bergen 4-Day Treatment (B4DT). Ungsinn. Tidsskrift for virksomme tiltak for barn og unge. 1(3). Full text in Research Archive
• Martinsen, Kristin; Rasmussen, Lene-Mari Potulski; Wentzel-Larsen, Tore; Holen, Solveig; Sund, Anne Mari & Pedersen, Marit Løtveit [Show all 10 contributors for this article] (2021). Change in quality of life and self-esteem in a randomized controlled CBT study for anxious and sad children: can targeting anxious and depressive symptoms improve functional domains in schoolchildren? BMC Psychology. 9:8, p. 1–14. doi: 10.1186/s40359-021-00511-y. Full text in Research Archive Show summary

  Background: Quality of life and self-esteem are functional domains that may suffer when having mental problems. In this study, we examined the change in quality of life and self-esteem when targeting anxious and depressive symptoms in school children (8–12 years) using a CBT-based transdiagnostic intervention called EMOTION, Kids Coping with anxiety and depression. The aim of this study was to investigate quality of life and self-esteem in children with elevated levels of anxious and depressive symptoms, and further if the EMOTION intervention could influence these important functional domains. Methods: The study had a clustered randomized design (cRCT), where N = 795 children recruited from 36 schools participated. The children were included based on self-reports of anxious and depressive symptoms. Schools were the unit of randomization and were assigned to intervention or control condition. Children in the intervention condition received the 10-week EMOTION intervention. Mixed effects models were used to take account of the possible clustering of data. Separate models were estimated for the dependent variables. Results: Children with elevated levels of anxious and depressive symptoms reported lower levels of quality of life and self-esteem compared to normative samples, with girls and older children reporting the lowest levels. For both genders and older children, a large and significant increase in quality of life and self-esteem was found among the children who received the intervention compared to the children in the control condition. Children in the intervention group reporting both anxious and depressive symptoms showed a significantly larger increase in both quality of life and self-esteem compared to the controls. Reductions in quality of life and self-esteem were partially mediated by reductions in symptoms of anxiety and depression. Conclusions: Participating in an intervention targeting emotional symptoms may have a positive effect on quality of life and self-esteem in addition to reducing anxious and depressive symptoms. Improved quality of life may increase the child’s satisfaction and subjective perception of wellbeing. As low self-esteem may lead to anxious and depressive symptoms, improving this functional domain in children may make them more robust dealing with future emotional challenges. Trial registration NCT02340637, retrospectively registered

• Ingul, Jo Magne; Martinsen, Kristin; Adolfsen, Frode; Sund, Anne Mari; Ytreland, Kristin & Bania, Elisabeth Valmyr [Show all 13 contributors for this article] (2021). Inside the clockwork of the ECHO factorial trial: A conceptual model with proposed mediators for prevention of emotional problems in children. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.703224. Full text in Research Archive Show summary

  Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the totalinterventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8–12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.

• Løvaas, Mona Elisabeth S; Lydersen, Stian; Sund, Anne Mari; Neumer, Simon-Peter; Martinsen, Kristin Dagmar & Holen, Solveig [Show all 10 contributors for this article] (2020). A 12-month follow-up of a transdiagnostic indicated prevention of internalizing symptoms in school-aged children: The results from the EMOTION study. Child and Adolescent Psychiatry and Mental Health (CAPMH). 14. doi: 10.1186/s13034-020-00322-w. Full text in Research Archive Show summary

  Background Anxious and depressive symptoms in youth are highly prevalent, are often comorbid and have a high rate of relapse. Preventive interventions are promising, but follow-up results are lacking. The transdiagnostic EMOTION program is an indicated preventive cognitive behavioral therapy (CBT) intervention targeting children aged 8–12 years. Methods The present study investigates the 12 months follow-up effects of the EMOTION intervention in a cluster randomized controlled trial (RCT) with 795 children that included both child self-reports and parental reports. Results Mixed model analyses showed a larger decrease of symptoms in the intervention group than in the control group for child self-reported anxious symptoms (The Multidimensional Anxiety Scale for Children (MASC) difference 4.56, CI 1.83 to 7.29, p = .001). Parental reports for both anxious (MASC difference 2.50, CI .26 to 4.74, p = .029) and depressive (The Mood and Feelings Questionnaire-short form (SMFQ) difference 1.55, CI .83 to 2.26, p ≤ .001) symptoms in children also showed a reduction. No statistically significant difference was found for child self-reported depressive symptoms (SMFQ difference .69, CI − .22 to 1.60, p = .139). Conclusion The transdiagnostic EMOTION program has shown the potential for long-term reductions in symptoms of both anxiety and depression in school-aged children. However, results regarding depressive symptoms must be considered preliminary as only parental report indicated effect. Trial registration The regional ethics committee (REC) of Norway approved the study. Registration number: 2013/1909; Project title: Coping Kids: a randomized controlled study of a new indicated preventive intervention for children with symptoms of anxiety and depression. ClinicalTrials.gov Identifier; NCT02340637.

• Rasmussen, Lene-Mari Potulski; Patras, Joshua; Neumer, Simon-Peter; Adolfsen, Frode; Martinsen, Kristin Dagmar & Holen, Solveig [Show all 8 contributors for this article] (2019). Facilitators and Barriers to the Implementation of EMOTION: An Indicated Intervention for Young Schoolchildren. Scandinavian Journal of Educational Research. ISSN 0031-3831. p. 1–16. doi: 10.1080/00313831.2019.1596976. Full text in Research Archive Show summary

  Research on implementation of school-based transdiagnostic interventions, conducted by personnel from the municipal services is limited. We investigated facilitators and barriers regarding implementation of EMOTION, an intervention targeting symptoms of anxiety and depression in children 8–12 years. Trained health- and childcare professionals completed one questionnaire before (N = 63) and a separate questionnaire after running an EMOTION group (N = 66). Twelve of the group leaders were interviewed to provide additional information regarding implementation. Results indicated that factors such as a perceived need for the intervention and positive attitudes from the group leaders facilitated implementation. Hindering factors were related to time constraints, workload, unsupportive leaders, and lack of cooperation from the schools. Allocating resources to implementation specifically could promote future use of the program.

• Martinsen, Kristin Dagmar; Rasmussen, Lene-Mari Potulski; Wentzel-Larsen, Tore; Holen, Solveig; Sund, Anne Mari & Løvaas, Mona Elisabeth S [Show all 10 contributors for this article] (2019). Prevention of anxiety and depression in school children: Effectiveness of the transdiagnostic EMOTION program. Journal of Consulting and Clinical Psychology. ISSN 0022-006X. 87(2), p. 212–219. doi: 10.1037/ccp0000360. Full text in Research Archive Show summary

  Objective: The objective of the study was to examine the effectiveness of a transdiagnostic program (EMOTION, Coping Kids Managing Anxiety and Depression) targeting symptoms of anxiety and depression in schoolchildren by comparing the intervention condition (EC) to a control condition (CC). Method: A clustered randomized design was used with schools as the unit of randomization. Children (N = 1686) aged 8–12 years in 36 schools completed screening using the Multidimensional Anxiety Scale (MASC-Child) and The Mood and Feelings Questionnaire Short version (SMFQ-Child). Scoring 1 SD above a population-based mean on anxiety and/or depression, 873 children were invited to participate. Intent-to-treat analyses were performed, and mixed-effects models were used. Results: Analyses revealed significant reductions of anxious and depressive symptoms as reported by the children, in which children in the intervention condition EC had almost twice the reduction in symptoms compared with the control condition CC. For parent report of the child’s depressive symptoms, there was a significant decrease of symptoms in the intervention condition EC compared with CC. However, parents did not report a significant decrease in anxious symptoms in the intervention condition EC as compared with CC. Conclusion: A transdiagnostic prevention program, provided in schools, was successful in reducing youth-reported symptoms of anxiety and depression and parent-reported depression. The EMOTION program has the potential to reduce the incidence of anxious and depressive disorders in youth.

• Løvaas, Mona Elisabeth S; Sund, Anne Mari; Lydersen, Stian; Neumer, Simon-Peter; Martinsen, Kristin Dagmar & Holen, Solveig [Show all 9 contributors for this article] (2019). Does the transdiagnostic EMOTION intervention improve emotion regulation skills in children? Journal of Child and Family Studies. ISSN 1062-1024. 28(3), p. 805–813. doi: 10.1007/s10826-018-01324-1. Full text in Research Archive Show summary

  Objectives Emotion regulation is thought to be an important transdiagnostic process across internalizing disorders in youth, and the regulation of emotions is believed to play a central role in both adaptive and maladaptive development. Several preventive interventions focus on improving children’s emotion regulation skills, but research regarding the outcomes of emotion regulation skills are scarce. Methods We therefore investigated whether a new transdiagnostic indicated prevention intervention for anxiety and depressive symptoms, the EMOTION program, improves emotion regulation skills as reported by parents of children aged 8–12 years. Data from a large national cluster randomized control trial (RCT) study, Coping Kids, performed in Norway were used, including data from 601 children and their parents. Results Using mixed models, we found a decrease in dysregulation of emotions (Δ  =  .06, CI  =  (0.00 to .11), p =  .040) and an increase in emotion regulation (Δ  =  .11, CI  =  (0.05 to .17) p  <  .001) in the intervention group compared to the control group. Conclusions The EMOTION intervention has a potential positive effect on children’s emotional regulation skills. One opportunity in transdiagnostic interventions lies in targeting common underlying processes in internalizing disorders and thereby reaching a larger proportion of the youth population than is possible with single-disorder approaches.

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• Martinsen, Kristin & Fredriksen, Anne Lise (2024). Veiledning i kognitiv atferdsterapi. Innføring i teori og praksis for veiledere. Gyldendal Akademisk. ISBN 9788205591967. 133 p. Full text in Research Archive
• Fredriksen, Annelise & Martinsen, Kristin (2024). Veiledning i kognitiv atferdsterapi. Innføring i teori og praksis for veiledere. Gyldendal Norsk Forlag A/S. ISBN 9788205591967. 133 p. Full text in Research Archive
• Martinsen, Kristin & Hagen, Roger (2021). Håndbok i kognitiv atferdsterapi i behandling av barn og unge. Gyldendal Akademisk. ISBN 9788205545298. 484 p. Full text in Research Archive

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• Øverland, Klara; Martinsen, Kristin & Bell, Martyna (2026). Er høyere aldersgrense på sosiale medier til hjelp, eller er det som å fiske uten snøre og krok? doi: https:/www.utdanningsnytt.no/klara-overland-kristin-martinsen-martyna-bell/aldersgrenser-pa-sosiale-medier-og-forestillingen-om-direkte-pavirkning/468975. Full text in Research Archive Show summary

  Debatt: – Er høyere aldersgrense på sosiale medier til hjelp, eller er det som å fiske uten snøre og krok?

• Martinsen, Kristin; Lisøy, Carina; Wentzel-Larsen, Tore; Neumer, Simon-Peter; Rasmussen, Lene-Mari Potulski & Adolfsen, Frode [Show all 8 contributors for this article] (2024). Corrigendum: School children's mental health during the COVID-19 pandemic (Frontiers in Psychology, (2024), 14, (1290358), 10.3389/fpsyg.2023.1290358). Frontiers in Psychology. 15. doi: 10.3389/fpsyg.2024.1508141. Full text in Research Archive
• Adolfsen, Frode; Ingul, Jo Magne; Martinsen, Kristin; Lisøy, Carina; Rasmussen, Lene-Mari Potulski & Neumer, Simon-Peter (2024). How can we promote the implementation of evidence-based interventions (EBIs) for children and adolescents within municipal services? Full text in Research Archive
• Ytreland, Kristin; Ingul, Jo Magne; Bania, Elisabeth Valmyr; Lydersen, Stian; Neumer, Simon-Peter & Martinsen, Kristin [Show all 11 contributors for this article] (2024). What about the parents? Insights from the ECHO-trial. Full text in Research Archive
• Ingul, Jo Magne; Lisøy, Carina; Ytreland, Kristin; Adolfsen, Frode; Martinsen, Kristin & Bania, Elisabeth Valmyr [Show all 8 contributors for this article] (2024). One year effect of components in the cluster randomized factorial trial ECHO. Full text in Research Archive Show summary

  Introduction: Preventive interventions, like the transdiagnostic EMOTION intervention, can play an important role in mitigating the burden of internalizing symptoms at an early stage, reducing the risk for development of internalizing disorders. The indicated preventive programs for internalizing disorders show effectiveness, but there is still uncertainty surrounding the duration of these effects, and what part of the interventions that is producing these effects. Interventions are often developed and tested in RCT’S as packages optimized to produce effect not considering usability in services they are meant to be implemented in. Method: The ECHO study was a cluster randomized 2x2x2 factorial trial, trying to optimize delivery for services, while maintaining the effect, of the preventive transdiagnostic intervention EMOTION. In the study, 3 different components (original or blended delivery, original or low parental involvement, multi feedback system or no multi feedback system) and their long-term effects were investigated. Results: In this presentation the ECHO study will be presented, results focusing on the 12 months follow up will be presented. Discussion: Results will be discussed in terms of effectiveness and the different components contributions to the effect and how these results can contribute to increased usability in services while retaining effects.

• Lisøy, Carina; Askeland, Anne Liv; Martinsen, Kristin; Bania, Elisabeth Valmyr; Wentzel-Larsen, Tore & Adolfsen, Frode [Show all 15 contributors for this article] (2024). Less Is More? Viktige faktorer i et indikert gruppetiltak for barn med internaliserende vansker. Full text in Research Archive
• Ytreland, Kristin; Ingul, Jo Magne; Bania, Elisabeth Valmyr; Lydersen, Stian; Sund, Anne Mari & Askeland, Anne Liv [Show all 13 contributors for this article] (2024). Har grad av foreldreinvolvering effekt på barns angst og depresjon? Full text in Research Archive
• Haug, Ida Mari; Lisøy, Carina; Ytreland, Kristin; Adolfsen, Frode; Rasmussen, Lene-Mari Potulski & Martinsen, Kristin [Show all 11 contributors for this article] (2023). OPTIMIZING A GROUP-BASED SCHOOL INTERVENTION FOR CHILDREN WITH EMOTIONAL PROBLEMS: DOSE-RESPONSE EFFECTS OF MEASUREMENT FEEDBACK SYSTEM ON DEPRESSIVE OR ANXIOUS SYMPTOMS. Full text in Research Archive
• Ytreland, Kristin; Ingul, Jo Magne; Bania, Elisabeth Valmyr; Lydersen, Stian; Neumer, Simon-Peter & Martinsen, Kristin [Show all 10 contributors for this article] (2023). Parental assessment of the child´s development, the flip side of the coin? Full text in Research Archive
• Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Lisøy, Carina; Haug, Ida Mari; Ytreland, Kristin & Martinsen, Kristin [Show all 10 contributors for this article] (2023). How to support EBIs in municipal services? Full text in Research Archive
• Neumer, Simon-Peter; Martinsen, Kristin; Ingul, Jo Magne; Rasmussen, Lene-Mari Potulski; Lisøy, Carina & Patras, Joshua Steven [Show all 10 contributors for this article] (2023). THE ECHO STUDY: OPTIMIZING A GROUP-BASED SCHOOL INTERVENTION FOR CHILDREN WITH EMOTIONAL PROBLEMS. INTRODUCTION. Full text in Research Archive
• Lisøy, Carina; Martinsen, Kristin; Adolfsen, Frode; Haug, Ida Mari; Ytreland, Kristin & Rasmussen, Lene-Mari Potulski [Show all 10 contributors for this article] (2023). OPTIMIZING A GROUP-BASED SCHOOL INTERVENTION FOR CHILDREN WITH EMOTIONAL PROBLEMS: EVALUATION OF THE MAIN CHILD OUTCOMES FROM THE FACTORIAL STUDY. Full text in Research Archive
• Rasmussen, Lene-Mari Potulski; Adolfsen, Frode; Neumer, Simon-Peter; Martinsen, Kristin; Holen, Solveig & Ingul, Jo Magne [Show all 12 contributors for this article] (2023). ECHO-studien: Optimalisering av et skolebasert KAT-tiltak for barn i alderen 8-12 år med symptomer på angst og depresjon. Full text in Research Archive
• Haug, Ida Mari; Neumer, Simon-Peter; Rasmussen, Lene-Mari Potulski; Adolfsen, Frode; Bania, Elisabeth Valmyr & Lisøy, Carina [Show all 11 contributors for this article] (2023). Differential effects of the MFS condition: Is there a dose response? Full text in Research Archive
• Adolfsen, Frode; Lisøy, Carina; Haug, Ida Mari; Ytreland, Kristin; Martinsen, Kristin & Rasmussen, Lene-Mari Potulski [Show all 10 contributors for this article] (2023). Optimalisering av et skolebasert CBT gruppetiltak for barn i alderen 8-12 år med symptomer på angst og depresjon. Full text in Research Archive
• Adolfsen, Frode; Rye, Marte; Neumer, Simon-Peter; Ingul, Jo Magne; Martinsen, Kristin Dagmar & Lisøy, Carina [Show all 7 contributors for this article] (2022). Pandemien gjorde triste og enstelige barn mer bekymret. https://forskning.no/. Full text in Research Archive
• Neumer, Simon-Peter; Haug, Ida Mari; Patras, Joshua; Rasmussen, Lene-Mari Potulski; Martinsen, Kristin Dagmar & Adolfsen, Frode [Show all 12 contributors for this article] (2022). Faktor 1: Measurement Feedback System (MFS). Tilbakemeldingssytem. Full text in Research Archive
• Rasmussen, Lene-Mari Potulski; Ingul, Jo Magne; Martinsen, Kristin Dagmar; Neumer, Simon-Peter; Adolfsen, Frode & Sund, Anne Mari [Show all 11 contributors for this article] (2022). Virtual Reality (VR). Full text in Research Archive
• Martinsen, Kristin Dagmar; Lisøy, Carina; Neumer, Simon-Peter; Adolfsen, Frode; Ingul, Jo Magne & Sund, Anne Mari [Show all 11 contributors for this article] (2022). Delvis digital versjon av Mestrende barn. Full text in Research Archive
• Neumer, Simon-Peter; Haug, Ida Mari; Adolfsen, Frode; Patras, Joshua; Lisøy, Carina & Martinsen, Kristin Dagmar [Show all 12 contributors for this article] (2022). USE OF A NEW MEASUREMENT FEEDBACK SYSTEM (MFS) FOR CHILDREN WITH EMOTIONAL PROBLEMS – HOW CAN THE “myEcho” APP IMPROVE OUTCOMES IN A PREVENTIVE INTERVENTION? Full text in Research Archive
• Martinsen, Kristin; Neumer, Simon-Peter; Ingul, Jo Magne; Adolfsen, Frode; Lisøy, Carina & Ytreland, Kristin [Show all 8 contributors for this article] (2022). A transfer from traditional CBT group intervention to DIGGI, a partially web-based intervention. Full text in Research Archive
• Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Adolfsen, Frode; Lisøy, Carina & Ytreland, Kristin [Show all 10 contributors for this article] (2022). Optimizing an intervention using VR technology. Full text in Research Archive
• Haug, Ida Mari; Neumer, Simon-Peter; Saus, Merete; Rye, Marte; Rasmussen, Lene-Mari Potulski & Adolfsen, Frode [Show all 13 contributors for this article] (2022). A novel MFS for use in first line services and in preventative mental health interventions:Preliminary results of qualitative exploration of group leaders experiences implementing MFS in group sessions in a school-based mental health intervention. Full text in Research Archive
• Ytreland, Kristin; Ingul, Jo Magne; Bania, Elisabeth Valmyr; Martinsen, Kristin Dagmar; Adolfsen, Frode & Neumer, Simon-Peter [Show all 7 contributors for this article] (2022). NEW STRATEGIES FOR IMPROVING YOUTH MENTAL HEALTH AND FACILITATING DELIVERY OF A CBT PREVENTIVE INTERVENTION - DO PARENTS MATTER? - HIGH AND LOW PARENTAL INVOLVEMENT IN A PREVENTIVE INTERVENTION FOR ANXIOUS AND SAD CHILDREN. Full text in Research Archive
• Lisøy, Carina; Ingul, Jo Magne; Martinsen, Kristin Dagmar; Adolfsen, Frode; Holen, Solveig & Rasmussen, Lene-Mari Potulski [Show all 7 contributors for this article] (2022). Factorial Design in the ECHO Study, Initial Data & the Use of Technology in CBT for children. Full text in Research Archive
• Martinsen, Kristin; Neumer, Simon-Peter & Nygaard, Egil (2021). Forebygging av psykiske vansker hos barn og unge. In Martinsen, Kristin & Hagen, Roger (Ed.), Håndbok i kognitiv atferdsterapi i behandling av barn og unge. Gyldendal Akademisk. ISSN 9788205545298. p. 51–75. Full text in Research Archive
• Neumer, Simon-Peter; Martinsen, Kristin; Haug, Ida Mari; Lisøy, Carina; Ingul, Jo Magne & Ytreland, Kristin [Show all 11 contributors for this article] (2021). Moving from TIM to ECHO: optimizing a school-based intervention to prevent anxiety and depression in children. Full text in Research Archive
• Neumer, Simon-Peter; Patras, Joshua; Holen, Solveig; Lisøy, Carina; Askeland, Anne Liv & Haug, Ida Mari [Show all 15 contributors for this article] (2021). Study Protocol of a factorial trial ECHO: Optimizing a group-based school intervention for children with emotional problems. BMC Psychology. 9:97, p. 1–12. doi: 10.1186/s40359-021-00581-y. Full text in Research Archive Show summary

  Youth mental health problems are a major public health concern. Anxiety and depression are among the most common psychological difficulties. The aim of this study is to evaluate an optimized version of a promising indicated group intervention for emotional problems. The program (EMOTION Coping Kids Managing Anxiety and Depression) targets school children 8–12 years with anxious and depressive symptoms and examines three factors. Factor 1 compares the standard EMOTION intervention delivered in 16 group-based sessions (Group), versus a partially-digital EMOTION intervention (DIGGI) delivered as eight group sessions and eight digital sessions. Both versions use virtual reality technology (VR) to improve behavioral experiments. Factor 2 compares parent participation in a 5-session parent group (high involvement) versus sharing information with parents via a brochure (low involvement). Factor 3 compares the use of a measurement and feedback system (MFS) designed to help group leaders tailor the intervention using feedback from children with no MFS. Methods Using a cluster-randomized factorial design, 40 schools across Norway will be randomized to eight different experimental conditions based on three, two-level factors. To assess internalizing symptoms in children, children and their parents will be given self-report questionnaires pre-, post-, and one year after intervention. Parents also report on demographics, user satisfaction, personal symptoms and perception of family related factors. Teachers report on child symptoms and school functioning. Group leaders and the head of the municipal services report on implementation issues. The primary outcomes are changes in depressive and anxious symptoms. Some secondary outcomes are changes in self-esteem, quality of life, and user satisfaction. Questions regarding the consequences of the COVID-19 pandemic are included. Treatment fidelity is based on checklists from group leaders, and on user data from the participating children. Discussion This study is a collaboration between three regional centers for child and adolescent mental health in Norway. It will provide knowledge about: (1) the effect of school-based preventive interventions on anxiety and depression in children; (2) the effect of feedback informed health systems, (3) the effect and cost of digital health interventions for children, and (4) the effect of parental involvement.

• Martinsen, Kristin & Hagen, Roger (2021). Introduksjon til kognitiv atferdsterapi for barn og unge. In Martinsen, Kristin & Hagen, Roger (Ed.), Håndbok i kognitiv atferdsterapi i behandling av barn og unge. Gyldendal Akademisk. ISSN 9788205545298. p. 17–50. Full text in Research Archive
• Neumer, Simon-Peter; Haug, Ida Mari; Patras, Joshua; Lisøy, Carina; Askeland, Anne Liv & Adolfsen, Frode [Show all 14 contributors for this article] (2020). MittEcho - En brukerstemme til barn og unge i ECHO studien. Full text in Research Archive
• Martinsen, Kristin Dagmar; Lisøy, Carina; Askeland, Anne Liv; Adolfsen, Frode; Rasmussen, Lene-Mari Potulski & Andersson, Ola Goverud [Show all 13 contributors for this article] (2020). Digital betingelse - Diggi - Kan delvis digital gjennomføring gi god effekt for barna? Full text in Research Archive
• Martinsen, Kristin Dagmar; Neumer, Simon-Peter; Holen, Solveig; Ingul, Jo Magne; Sund, Anne Mari & Adolfsen, Frode [Show all 7 contributors for this article] (2020). Gi barn som strever hjelp til mestring på egne premisser. Full text in Research Archive
• Martinsen, Kristin Dagmar; Sund, Anne Mari; Rasmussen, Lene-Mari Potulski; Løvaas, Mona Elisabeth S; Neumer, Simon-Peter & Holen, Solveig (2020). Forebygging av angst og depresjon hos skolebarn - effekten av det transdiagnostiske tiltaket Mestrende barn. BestPractice nordic. Full text in Research Archive
• Martinsen, Kristin Dagmar; Holen, Solveig & Neumer, Simon-Peter (2020). Forebygging av vanlige psykiske lidelser hos barn og unge - Er gruppe- og internettbaserte tiltak vikrsomme og kostnadseffektive? Tidsskrift for kognitiv terapi. ISSN 1504-3142. Full text in Research Archive
• Ingul, Jo Magne; Rasmussen, Lene-Mari Potulski; Martinsen, Kristin Dagmar; Ytreland, Kristin; Bania, Elisabeth Valmyr & Sund, Anne Mari [Show all 14 contributors for this article] (2020). Virtual Reality for engstelige og triste barn; optimering av atferds-eksperimenter og aktivering. Full text in Research Archive Show summary

  Bakgrunn Ferdighetstrening, eksponering og øving er av de mest brukte, og best dokumenterte, teknikkene i arbeidet med barn og unge med angst og/eller depresjon.. Likevel opplever terapeuter ofte vansker med å legge til rette for gode øvingssituasjoner. Gjennom bruk av Virtual Reality (VR) kan barn og unge øve under standardiserte betingelser, gjentatte ganger, i trygge omgivelser. Basert på data- genererte scener eller 360°-filmer skapes et virtuelt miljø som sikrer innlevelse og opplevelse tilnærmet lik situasjoner den unge opplever i hverdagen. Dette kan potensielt gjøre det enklere å komme i gang med øving og føre til bedre effekt av øvingen. Tidligere studier som har sett på effekten av VR i behandling viser gode resultater, men er ofte gjennomført på spesifikke fobier (f.eks edderkoppfobi), med voksne som målgruppe. I ECHO studien blir VR brukt for engstelige og triste barn i grupper på skolene de går. Formål Hovedmålet med bruk av VR-teknologi er å hjelpe barn og gruppeledere til å komme i gang med øving, i tillegg ønsker vi svar på følgende problemstillinger: • Hvordan opplever barn og gruppeledere øving med bruk av VR? • Gjør det det lettere å legge til rette for øving? • Øker brukervennligheten i mestrende Barn ? Metode Bruk av VR-teknologi er en del av ECHO studien som er en RCT med multifaktorielt design. Det er laget 13 scener med 360°film basert på situasjoner engstelige og triste barn synes er vanskelige. Filmene er laget av Ravnfilm i samarbeid med ECHO og 7. klasse ved Halsan barneskole. I studien vil barn få tilgang til scenene gjennom bruk Oculus GO briller med headset. Barn rekruttert til ECHO studien skal bruke scenene som en del av øvingen i Mestrende barn grupper. Det er laget spesifikke prosedyrer for bruk av hver scene. Datainnsamling starter våren 2020 og er ferdig høsten 2022. Resultat Det foreligger ingen resultater fra ECHO studien enda. Rekruttering av første bølge er gjennomført med god deltagelse og NN grupper er pr dags dato i gang!

• Bania, Elisabeth Valmyr; Ytreland, Kristin; Ingul, Jo Magne; Sund, Anne Mari; Martinsen, Kristin Dagmar & Lisøy, Carina [Show all 14 contributors for this article] (2020). "Hvilken betydning har foreldreinvolvering i et gruppebasert tiltak for triste og engstlige barn?". Full text in Research Archive
• Lisøy, Carina; Martinsen, Kristin Dagmar; Askeland, Anne Liv; Adolfsen, Frode; Rasmussen, Lene-Mari Potulski & Ingul, Jo Magne [Show all 14 contributors for this article] (2020). ECHO: Optimalisering av et gruppebasert tiltak for engstelige og triste barn. Full text in Research Archive
• Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Patras, Joshua; Rasmussen, Lene-Mari Potulski; Holen, Solveig & Adolfsen, Frode [Show all 8 contributors for this article] (2019). Optimizing Evidence Based Interventions (EBI) for children and adolescents in Norway. Full text in Research Archive Show summary

  Norwegian municipalities are responsible for primary mental health care of children and adolescents, however, systematic procedures for systematic screening and providing Evidence Based Interventions (EBI) are lacking. Giving access to EBIs and improving these interventions through systematic feedback can address variations between municipalities and streamline referral to specialized services to ensure that all children have access to the best mental health care no matter where they live. The presentation will briefly describe the current situation in Norway with regards to mental health care and present online tools that have been launched to support the use of EBIs in mental health services and outpatient clinics for children and adolescents. This will be followed with a presentation of a new, integrated intervention that targets multiple but related emotional problems in a transdiagnostic approach, the EMOTION Coping Kids. This intervention is based on Phil Kendall’s “Coping Cat” program and runs in an intensive 10 weeks course in order internalize the coping skills necessary to produce lasting change. The presentation will close with a presentation of our latest project, the Echo study, where we will, among other things, develop and evaluate a Measurement and Feedback System (MFS) using a cluster randomized factorial design involving 40 schools across Norway. The aim of the Echo MFS is to support assessment and interventions related to emotional problems through feedback to service providers, thus optimizing the performance of services. The idea is that this MFS is free for use and can be combined with various interventions. In this way, Echo MFS could provide us with a platform for international research cooperation.

• Ingul, Jo Magne; Ytreland, Kristin; Sund, Anne Mari; Neumer, Simon-Peter; Martinsen, Kristin Dagmar & Adolfsen, Frode [Show all 8 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Adolfsen, Frode; Rasmussen, Lene-Mari Potulski & Patras, Joshua [Show all 7 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Bania, Elisabeth Valmyr; Ytreland, Kristin; Ingul, Jo Magne; Sund, Anne Mari; Neumer, Simon-Peter & Martinsen, Kristin Dagmar [Show all 9 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Bania, Elisabeth Valmyr; Ytreland, Kristin; Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar & Adolfsen, Frode [Show all 9 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Bania, Elisabeth Valmyr; Ytreland, Kristin; Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar & Adolfsen, Frode [Show all 9 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Bania, Elisabeth Valmyr; Ytreland, Kristin; Ingul, Jo Magne; Sund, Anne Mari; Neumer, Simon-Peter & Martinsen, Kristin Dagmar [Show all 9 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Ingul, Jo Magne; Ytreland, Kristin; Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Adolfsen, Frode & Patras, Joshua [Show all 8 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Adolfsen, Frode; Patras, Joshua & Rasmussen, Lene-Mari Potulski [Show all 7 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Holen, Solveig; Adolfsen, Frode; Patras, Joshua & Rasmussen, Lene-Mari Potulski [Show all 8 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Martinsen, Kristin Dagmar; Neumer, Simon-Peter; Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Patras, Joshua & Ingul, Jo Magne [Show all 7 contributors for this article] (2019). Fra TIM til Echo. Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Patras, Joshua; Holen, Solveig; Neumer, Simon-Peter & Martinsen, Kristin Dagmar [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Patras, Joshua; Neumer, Simon-Peter; Holen, Solveig & Martinsen, Kristin Dagmar [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Patras, Joshua; Ingul, Jo Magne; Sund, Anne Marie & Martinsen, Kristin Dagmar [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Holen, Solveig; Patras, Joshua; Adolfsen, Frode & Rasmussen, Lene-Mari Potulski [Show all 8 contributors for this article] (2019). Development of a new measurement feedback system for children with emotional problems. Full text in Research Archive Show summary

  Preliminary results in a Cochrane report currently undertaken at our institution (Kornør, et al., 2015) on the effect of client feedback, identified several MFS instruments that can be used with children and adolescents. The existing MFS systems suffer, however, from use of measures that are not well-validated, a rigid structure that is not adaptable, or a monetized approach to distribution that is not compatible with large-scale distribution. To develop a new MFS for the Echo study, our research group conducted a pilot study funded by the Norwegian Research Council establishing assessment protocols in close cooperation with first line services. One part of this assessment protocol is a new idiographic measure that has been developed and evaluated in a study with adolescents (Tollefsen et al.,2019; under review). The new Measurement Feedback System for use in the current study and later the services in the municipality is called “myEcho” and it will be developed in close collaboration with the University of Oslo. It will include an idiographic measure of personal aims and items measuring symptom levels, with everything displayed on a visual data dashboard to guide the interventionists in developing goals for the children. We will present the results from the studies mentioned above, address the limitations of established MFS systems, and give a picture of the MFS system that is currently under development for use in our study. Reference: Kornør, H., et al. (2015). Client feedback in psychological therapy for children and adolescents with mental health problems. Cochrane Database of Systematic Reviews, (6).

• Adolfsen, Frode; Patras, Joshua; Rasmussen, Lene-Mari Potulski; Martinsen, Kristin Dagmar; Holen, Solveig & Neumer, Simon-Peter [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Patras, Joshua; Sund, Anne Marie; Ingul, Jo Magne & Martinsen, Kristin Dagmar [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Adolfsen, Frode; Patras, Joshua; Rasmussen, Lene-Mari Potulski; Ingul, Jo Magne; Sund, Anne Marie & Neumer, Simon-Peter [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Patras, Joshua; Ingul, Jo Magne; Sund, Anne Marie & Martinsen, Kristin Dagmar [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Adolfsen, Frode; Rasmussen, Lene-Mari Potulski; Patras, Joshua; Ingul, Jo Magne; Martinsen, Kristin Dagmar & Neumer, Simon-Peter [Show all 8 contributors for this article] (2019). ECHO- Optimering av indikert forebyggende tiltak for barn og unge. Full text in Research Archive
• Martinsen, Kristin Dagmar (2019). Nettverksmøte for Mestrende barn gruppeledere. Full text in Research Archive
• Ingul, Jo Magne; Martinsen, Kristin Dagmar; Rasmussen, Lene-Mari Potulski; Neumer, Simon-Peter; Sund, Anne Mari & Holen, Solveig [Show all 8 contributors for this article] (2019). PARENTAL INVOLVEMENT; WILL IT MAKE A DIFFERENCE? Full text in Research Archive Show summary

  Research has shown that parental factors contribute to the maintenance as well as the development of childhood anxiety and depression. Therefore, involvement of parents in treatment of childhood anxiety and depression has been included in many manuals. Focusing on positive parenting, altering negativity and distorted cognitions in parents have been hypothesized to increase effect of treatment. Effects of parental involvement in treatment are, however, ambiguous (Breinholst, Esbjorn, Reinholdt-Dunne, & Stallard, 2012; Silverman, Pina, & Viswesvaran, 2008). One metanalysis study shows a possibly positive effect of involving parents in Cognitive Behaviour Therapy (CBT) interventions for depression and anxiety in children (Brendel & Maynard, 2014), while another meta-analysis indicate only a small non-significant effect in favor of treatments including only the child (Thulin, Svirsky, Serlachius, Andersson, & Ost, 2014). The reasons for these ambiguous results may partly stem from methodological issues and the relevance of included components (Breinholst et al., 2012), but also because change usually is measured through diagnostic or symptomatic change in children, rather than measuring the factor’s it is supposed to change; parental and family functioning. Also, most studies investigate this in relation to children with established anxiety or depressive disorders, therefore the effects of parental involvement in children with subclinical symptoms of anxiety and depression is largely unknown. In first line services resources are scarce, and in busy times parents may find it difficult to attend meetings. Including only components known to enhance effect seems important. The ECHO study is designed to investigate the effects of parental involvement on child symptoms, but also on parent and family functioning. Half the included children will receive a parental involvement component while for the other half parents will only receive a brochure describing anxiety, depression and parenting. The mechanisms and possible effects of this will be discussed at the symposium.

• Martinsen, Kristin Dagmar & Neumer, Simon-Peter (2019). Fra TIM til Echo, Optimalisering av et skolebasert tiltak for barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar & Neumer, Simon-Peter (2019). Fra TIM til Echo, Optimalisering av et skolebasert tiltak for barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar (2019). Fra TIM til Echo, Optimalisering av et skolebasert tiltak for barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar & Neumer, Simon-Peter (2019). Fra TIM til Echo, Optimalisering av et skolebasert tiltak for barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar (2019). Fra TIM til Echo, Optimalisering av et skolebasert tiltak for barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar (2019). Fra TIM til Echo, Optimalisering av et skolebasert tiltak for barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar (2019). Mestrende barn opplæring for ECHO, Trondheim. Full text in Research Archive
• Martinsen, Kristin Dagmar & Neumer, Simon-Peter (2019). Fra TIM til Echo, Optimalisering av et skolebasert tiltak for barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar (2019). Tidlige tiltak- Det transdiagnostiske tiltaket Mestrende barn skal forebygge både angst og depresjon hos barn. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 56(02), p. 99–101. Full text in Research Archive
• Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Holen, Solveig; Sund, Anne Mari; Ingul, Jo Magne & Rasmussen, Lene-Mari Potulski [Show all 8 contributors for this article] (2019). Forebyggende arbeid i kommunene: Erfaringer fra TIM-studien og videreføring i ECHO. Full text in Research Archive
• Martinsen, Kristin Dagmar; Neumer, Simon-Peter; Holen, Solveig; Ingul, Jo Magne; Sund, Anne Mari & Patras, Joshua [Show all 8 contributors for this article] (2019). Fra TIM til ECHO: optimalisering av et gruppebasert tiltak rettet mot barn med emosjonelle vansker. Full text in Research Archive
• Martinsen, Kristin Dagmar; Neumer, Simon-Peter; Holen, Solveig; Ingul, Jo Magne; Sund, Anne Mari & Patras, Joshua [Show all 8 contributors for this article] (2019). Fra TIM til ECHO: optimalisering av et gruppebasert tiltak rettet mot barn med emosjonelle vansker. Full text in Research Archive
• Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Holen, Solveig; Sund, Anne Mari; Tore, Wentzel-Larsen & Ingul, Jo Magne [Show all 9 contributors for this article] (2019). Forebyggende arbeid i kommunene: Erfaringer fra TIM-studien og videreføring i ECHO. Full text in Research Archive
• Martinsen, Kristin Dagmar; Neumer, Simon-Peter; Holen, Solveig; Sund, Anne Mari; Løvaas, Mona Elisabeth S & Ingul, Jo Magne [Show all 9 contributors for this article] (2019). TRANSFER FROM A TRADITIONAL CBT GROUP INTERVENTION TO A PARTIAL WEB-BASED SOLUTION. Full text in Research Archive Show summary

  Youth with subclinical but elevated levels of anxious and depressive symptoms experience significant impairment, and the symptoms predict later disorders. From 2015, the responsibility for treating mild depression and anxiety in Norway shifted from specialized mental health clinics to first line services, and there is a gap between the number of children in need and those few receiving care. It is therefore a great need for evidence-based interventions that can reach more children in schools. Developing and evaluating integrated evidence-based interventions (EBI) that target multiple but related emotional problems (i.e., a transdiagnostic approach), has been an important task for research groups involved in the Echo study. The research group recently conducted an RCT study of the transdiagnostic indicated prevention program EMOTION (Kendall, Stark, Martinsen, O'Neil, & Arora, 2013). The original EMOTION-intervention aims to reduce symptoms of anxiety and/or depression in children aged 9 to 12 years in 20, group-based sessions. Outcome results for EMOTION were positive and indicate that the intervention can reduce symptoms of anxiety and depression and that the services would benefit from optimized intervention methods (Martinsen et al., 2019).The same study suggested that further investigation is needed to facilitate implementation when the intervention is transferred into routine practice. One way to improve widespread adoption of the program is to provide a shorter version where some of the sessions are completed online. We therefore developed a new standard version (16 group sessions) and a shorter version with 8 sessions in groups plus 8 sessions online. Based on results from previous evaluations, the development of a partially digital intervention will be presented and challenges when using new technology will be discussed. References Kendall, P. C., Stark, K. D., Martinsen, K., O'Neil, K. A., & Arora, P. (2013). EMOTION: "Coping kids" managing anxiety and depression; groupleaders manual. Ardmore, PA: Workbook Publishing. Martinsen, K. D., Rasmussen, L. M. P., Wentzel-Larsen, T., Holen, S., Sund, A. M., Lovaas, M. E. S., . . . Neumer, S. P. (2019). Prevention of anxiety and depression in school children: Effectiveness of the transdiagnostic EMOTION program. Journal of Consulting and Clinical Psychology, 2(87), 212-219. doi:10.1037/ccp0000360

• Rasmussen, Lene-Mari Potulski; Neumer, Simon-Peter; Patras, Joshua; Martinsen, Kristin Dagmar; Adolfsen, Frode & Ingul, Jo Magne [Show all 8 contributors for this article] (2019). HOW CAN USE OF VIRTUAL REALITY TECHNOLOGY HELP IMPROVE AN INTERVENTION FOR CHILDREN WITH EMOTIONAL PROBLEMS? Full text in Research Archive Show summary

  <p>Exposure training and behavioral experiments are common and well-supported mechanisms in cognitive behavioral therapy (CBT) for anxiety and depression in children. Virtual reality (VR) technology applies computer-generated, three-dimensional virtual environments, which have the potential to create realistic situations that can be repeated and rehearsed several times. Virtual environments, therefore, provide an opportunity to enhance exposure training and behavioral experiments by introducing training in situations, which are not easily reproduced in real life settings (in vivo training). Thus, employing VR potentially optimizes the exposure and behavioral portion of these targeted interventions. <p>Using VR as part of the treatment, particularly related to anxiety, have shown promising results. Overall, multiple meta-analyses have indicated that VR is a promising tool, providing larger mean effect sizes in the VR conditions compared to the control conditions, and yielding equal results compared to regular in vivo exposure training. Research on the use of VR technology in CBT is limited however, and some of the studies show reduced methodological quality (e.g., small sample sizes, lack of control group). Much of the work is conducted on specific phobias (e.g., arachnophobia, fear of heights). Studies on other anxiety disorders or depression, especially with children, and in the prevention field are even sparser. <p>VR-technology for behavioral experiments and exposure training will be used to provide control over stimuli presented in groups during the EMOTION intervention in the ECHO study. The VR-situations will be created using 3D-videos with head-mounted display (HMD), using professional filmmakers to make the situations as realistic as possible. The emphasis will be on creating VR-videos that mimic situations that are difficult to produce in a group setting, with the goal of rehearsing challenging situations in safe surroundings. The development and use of VR technology in an indicated preventive transdiagnostic intervention for children will be discussed at the symposium.

• Bania, Elisabeth Valmyr; Sandvik, Kristin; Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar & Holen, Solveig [Show all 10 contributors for this article] (2019). Presentasjon av ECHO for Stjørdal Kommune. Full text in Research Archive
• Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Holen, Solveig; Adolfsen, Frode & Patras, Joshua [Show all 8 contributors for this article] (2019). Presentasjon av ECHO for Levanger Kommune. Full text in Research Archive
• Ingul, Jo Magne; Sund, Anne Mari; Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Holen, Solveig & Adolfsen, Frode [Show all 8 contributors for this article] (2019). Presentasjon av ECHO for Trondheim Kommune. Full text in Research Archive
• Ingul, Jo Magne; Neumer, Simon-Peter; Martinsen, Kristin Dagmar; Holen, Solveig; Adolfsen, Frode & Patras, Joshua [Show all 8 contributors for this article] (2019). Presentasjon av ECHO for Melhus Kommune. Full text in Research Archive

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