Kristin Espenes

• Espenes, Kristin; Keles, Serap; Waaler, Pamela Marie; Kjøbli, John & Tørmoen, Anita Johanna (2025). Improving adolescent outcomes in residential care: preliminary outcomes of a dialectical behavior therapy-informed treatment model. Children and Youth Services Review. ISSN 0190-7409. 180. doi: 10.1016/j.childyouth.2025.108703. Full text in Research Archive Show summary

  Background Adolescents in residential youth care (RYC) often present with complex mental health needs, including trauma symptoms, emotion dysregulation, and self-harm. Dialectical Behavior Therapy (DBT) has shown promise in addressing these challenges, yet evidence for its implementation in RYC remains limited. Objective This pre-post pilot study examined preliminary outcomes of the Care and Development Model (CDM), a DBT-informed intervention adapted for RYC. Method Forty-two adolescents (Mage = 15.13, SDage = 1.41; 47.6 % female), along with caregivers and milieu staff, participated. CDM included skills-training group, individual sessions, milieu-based coaching, and staff consultation team meetings. Assessment included pre-intervention trauma symptoms, and pre- and post-intervention assessments of emotion regulation, DBT skill use, suicidality/self-harm, and internalizing/externalizing problems. Post-hoc analyses included reliable change indices and shifts in clinical range. Results At admission, adolescents reported elevated PTSD symptoms, with significantly higher scores among females (d = –1.48). Improvements varied across domains. Caregiver reports showed clinically significant reductions in Total Problems (d = –0.98) and Externalizing problems (d = –1.11). Adolescents reported modest improvements in DBT-WCCL Blaming Others (d = –0.54) and reduced suicidal ideation. Nearly half (48 %) reported using DBT distress tolerance skills. Therapists rated 81.6 % of adolescents as “very much” or “much” improved, though correlations with adolescent-reported outcomes were modest. Conclusion Findings suggest that DBT-informed care in RYC holds promise, particularly for addressing externalizing behavior and suicidality. However, variability across outcomes and informants highlights the complexity of implementation and the need for ongoing refinement of DBT adaptations in residential settings.

• Espenes, Kristin; Tørmoen, Anita Johanna; Rognstad, Kristian; Nilsen, Karianne Hammerstrøm; Waaler, Pamela Marie & Wentzel-Larsen, Tore [Show all 7 contributors for this article] (2024). Effect of Psychosocial Interventions on Children and Youth Emotion Regulation: A Meta-Analysis. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-024-01373-3. Full text in Research Archive Show summary

  To investigate the effect of psychosocial interventions on emotion regulation outcomes in children and youth (0–23 years). We conducted a meta-analysis using a three-level modeling approach extracting multiple effect-sizes from experimental and quasi-experimental studies. We included 40 interventions from 35 publications involving 3,891 participants and extracted 258 posttreatment effect sizes. Analyses were performed to assess intervention effects on emotion regulation, moderating effects of inclusion of acceptance focus and other potential moderators. Additionally, we examined intervention effects on mental health outcomes. Interventions showed a significant small-to-medium effect on emotion regulation (d = 0.37, 95% CI [0.22, 0.51], p < .001). Similar effects on were found regardless of acceptance-focus. Interventions significantly associated with a higher level of effect (p ≤ 0.045) included ACT, DBT, CBT and behavior parent training interventions. Significant small-to-medium effects were found for mental health outcomes (d = 0.39, 95% CI [0.25, 0.53], p < .001), with a correlation of .56 between overall outcomes across domains. Meta-regression results indicated that psychosocial interventions are moderately effective in improving emotion regulation, with no significant difference in inclusion of acceptance-focus. Findings suggest that emotion regulation is a transdiagnostic process that may inform the development of more beneficial interventions.

• Waaler, Pamela Marie; Bergseth, Josefine; Vaskinn, Linda; Espenes, Kristin; Holtan, Thale & Kjøbli, John [Show all 7 contributors for this article] (2024). Identification of treatment elements for adolescents with callous unemotional traits: a systematic narrative review. Child and Adolescent Psychiatry and Mental Health (CAPMH). 18(1). doi: 10.1186/s13034-024-00792-2. Full text in Research Archive Show summary

  Adolescents with callous unemotional (CU) traits are at risk for poor quality-of-life outcomes such as incarceration, suicide, and psychopathy. It is currently unknown which treatments are implemented with CU adolescents specifically and which elements make up these interventions. A narrative systematic review was used to identify the treatments and common elements used with CU adolescents (12–18 years). Eligible studies were randomized controlled trials and quasi-experimental studies evaluating psychosocial interventions, delivered within a clinical context, and directed towards the adolescent or their family. Eight studies with 1291 participants were included. Significant decreases in CU traits were demonstrated only in a minority of studies. The most utilized practice elements were set goals for treatment, practice interpersonal/communication skills, prepare for termination, and teach parents skills and strategies; the most utilized process elements were formal therapy, practice exercises, important others, and flexible/adaptive. A majority of the studies did not report an implementation element. While theoretical frameworks for CU children are employed with CU adolescents, there is still uncertainty regarding their suitability for this age group. Given the limited empirical evidence, there is a critical need for further exploration.

• Helland, Siri Saugestad; Mellblom, Anneli; Kjøbli, John; Wentzel-Larsen, Tore; Espenes, Kristin & Engell, Thomas [Show all 7 contributors for this article] (2022). Elements in Mental Health Interventions Associated with Effects on Emotion Regulation in Adolescents: A Meta-Analysis. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 49, p. 1004–1018. doi: 10.1007/s10488-022-01213-2. Full text in Research Archive
• Espenes, Kristin; Waaler, Pamela Marie; Keles, Serap; Helland, Siri Saugestad; III, Henry Schmidt & Kjøbli, John [Show all 7 contributors for this article] (2022). Implementing a Residential Dialectical Behavior Therapy Informed Treatment Model to Improve Adolescent Mental Health: Feasibility, Fidelity, and Acceptability. Residential Treatment for Children & Youth. ISSN 0886-571X. doi: 10.1080/0886571X.2022.2090481. Full text in Research Archive Show summary

  Dialectical Behavior Therapy (DBT) is an outpatient treatment that addresses severe emotional and relational difficulties and is successfully applied across diagnoses, populations, and settings. In this feasibility study, we examined a residential DBT-informed treatment model in Norway, the Care and Development Model (CDM), aimed to improve adolescent mental health outcomes. Study participants included 42 adolescents (22 males and 20 females) with a mean age of 15.13 years (SD = 1.41, range 13–17 years), as well as the adolescents’ caregivers and residential staff. Data collection lasted from May 2018 until May 2021 and combined standardized self-report measures of program feasibility and acceptability, including treatment satisfaction and alliance, as well as customized program fidelity measures combining on-site observation and interviews with adolescents and staff, protocol data on treatment characteristics, and self-report checklists for treatment adherence. Results indicate that residential staff consider the implementation of CDM appropriate, but also distinct challenges were mentioned regarding the population and setting. Moderate to high satisfaction and alliance levels were reported by both adolescents and therapists. The CDM program shows promise and may be feasible and acceptable, although considerable effort to implement it is required. Implications for practice and research are discussed.

View all works in NVA

• Espenes, Kristin (2026). Fra kaos til kunnskap – Nye måter å forske på tiltak i komplekse miljøer. Full text in Research Archive Show summary

  Plenarsesjon på DBT-seminaret 2026 som omhandlet hvordan benytte rammeverk til å bedre tilpasse forskning til døgninstitusjoner.

• Espenes, Kristin & Tørmoen, Anita Johanna (2023). Gjennomførbarhet og aksept av en DBT-informert behandlingstilnærming for ungdom i barnevernsinstitusjoner. Suicidologi. ISSN 1501-6994. Full text in Research Archive
• Espenes, Kristin; Tørmoen, Anita Johanna; Keles, Serap; Kjøbli, John; Helland, Siri Saugestad & Waaler, Pamela Marie (2023). Omsorgs – og Endringsmodellen (OEM): En DBT-informert miljøterapeutisk tilnærming i barnevernsinstitusjoner Teori og forskning. Full text in Research Archive Show summary

  Undervisning for Mastergradsstudenter.

• Bekkevold-Jernberg, Ina & Espenes, Kristin (2022). Erfaringer fra implementering av DBT-OEM i barnevernsinstitusjoner. Full text in Research Archive
• Espenes, Kristin; Waaler, Pamela Marie; Keles, Serap; Helland, Siri Saugestad; Schmidt, Henry & Kjøbli, John [Show all 7 contributors for this article] (2022). Emosjonsregulering blant ungdom i barnevernet – funn fra en metaanalyse og en implementeringsstudie av en institusjonstilpasset DBT-informert modell i barnevernsinstitusjoner. Full text in Research Archive
• Espenes, Kristin; Waaler, Pamela Marie; Keles, Serap; Helland, Siri Saugestad; Schmidt, Henry & Kjøbli, John [Show all 7 contributors for this article] (2022). Implementing a Residential Dialectical Behavior Therapy Informed Treatment Model to Improve Adolescent Mental Health: Feasibility, Fidelity, and Acceptability. Full text in Research Archive
• Espenes, Kristin; Kjøbli, John & Rognstad, Kristian (2018). Improving outcomes for vulnerable children: Identifying the core components of intervention. Full text in Research Archive
• Espenes, Kristin; Schmidt, Henry & Johansen, Håvard (2018). DBT i barnevernsinstitusjoner: Omsorgs- og endringsmodellen Bufetat region Nord og RBUP Øst og Sør. Full text in Research Archive
• Espenes, Kristin (2026). Targeting Emotion Regulation in Adolescents: Implementation and Preliminary Outcomes of a Dialectical Behavior Therapy-Informed Model in Residential Youth Care. Universitetet i Oslo. Full text in Research Archive Show summary

  Adolescents in residential youth care face complex and persistent challenges, including high rates of trauma exposure, mental health comorbidities, and poor long-term outcomes. Despite these needs, access to effective, evidence-based interventions remains limited. This thesis explores the implementation and preliminary outcomes of the Care and Development Model (CDM), an emotion regulation focused and skills-based milieu-therapeutic intervention informed by Dialectical Behavior Therapy (DBT) adapted to a residential care setting. Paper I presents a systematic review and meta-analysis showing small-to-moderate effects of psychosocial interventions on emotion regulation in children and youth. Papers II and III report findings from a naturalistic, mixed-methods study of the CDM across Norwegian residential units. The findings highlight satisfactory feasibility, acceptability, and therapeutic alliance outcomes, alongside modest improvements in adolescent emotion regulation and mental health outcomes. However, variability in implementation fidelity and several methodological limitations temper the conclusions. Collectively, the findings support the potential of transdiagnostic, emotion regulation–focused interventions in residential care, while emphasizing the need for additional tailoring to enhance contextual fit, improved methodological rigor, and sustainable implementation that fosters the successful integration of key intervention elements into practice.

View all works in NVA