Date of Award

2026

Document Type

Dissertation

Degree Name

Psychology (Ph.D.)

Department

Psychology

First Advisor

Mark Terjesen

Second Advisor

Imad Zaheer

Third Advisor

Melissa Peckins

Abstract

Adolescent depression is prevalent, recurrent, and associated with substantial functional impairment, yet variability in treatment response suggests that existing interventions may differ in how therapeutic processes are emphasized. The present study examined the extent to which positive psychology–consistent components, operationalized using the PERMA framework (positive emotion, engagement, relationships, meaning, and accomplishment), are embedded within empirically supported cognitive-behavioral therapy (CBT) manuals for adolescent depression and whether variation in this content corresponds to differences in treatment outcomes. Rather than analyzing individual participants, the unit of analysis was the treatment manual. Seven manualized CBT protocols for adolescents aged approximately 12–17 years were identified using American Psychological Association criteria for empirically supported treatments. Posttreatment depression effect sizes were drawn from a published multilevel meta-analysis of youth psychotherapy outcomes. A systematic content analysis was conducted in which therapeutic components within each manual were coded dichotomously for the presence of PERMA-related elements. PERMA density per session scores were calculated by standardizing total PERMA codes by the number of sessions in each protocol. Manual-level PERMA density scores were then examined in relation to manual-level depression effect sizes using descriptive correlational and sensitivity analyses. Substantial variability in PERMA density was observed across protocols. Greater overall PERMA density per session demonstrated a positive, though non-significant, association with posttreatment depression effect sizes. Domain-level analyses indicated that Positive Emotion and Accomplishment content showed the strongest descriptive associations with outcomes. Findings are exploratory and should be interpreted cautiously given the small number of manuals contributing effect size estimates. This study contributes a novel manual-level approach to examining treatment composition and heterogeneity within CBT for adolescent depression. By applying PERMA as a content-analytic framework, the findings highlight variability in strengths-oriented emphasis across established protocols and provide a foundation for future research designed to directly test positive psychological processes as potential mechanisms of change in youth depression treatment.

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