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Objectives: A recent report from the US Institute of Medicine indicated that identifying core elements of psychosocial interventions is a key step in successfully bringing evidence-based psychosocial interventions into clinical practice. Component studies have the best design to examine these core elements. Earlier reviews resulted in heterogeneous sets of studies and probably missed many studies., Methods: We conducted a comprehensive search of component studies on psychotherapies for adult depression and included 16 studies with 22 comparisons., Results: Fifteen components were examined of which four were examined in more than one comparison. The pooled difference between the full treatments and treatments with one component removed was g = 0.21 (95% CI: 0.03∼0.39). One study had sufficient statistical power to detect a small effect size and found that adding emotion regulation skills increased the effects of CBT. None of the other studies had enough power to detect an effect size smaller than g = 0.55. Only one study had low risk of bias., Conclusions: The currently available component studies do not have the statistical power nor the quality to draw any meaningful conclusion about key ingredients of psychotherapies for adult depression.

Recent studies have questioned the idea of rumination as a unitary dysfunctional process and identified an adaptive subcomponent: reflective pondering. We tested whether reflective pondering could represent an adaptive strategy of regulating emotions, and contrasted it with reappraisal and acceptance, strategies linked to major psychotherapeutic approaches. Participants (103 students) received training in one of these and were exposed to a negative mood induction consisting of social scenarios, both in the presence and in the absence of the specific emotion regulation instruction. Acceptance was more useful than reflective pondering in impacting negative emotions and anxiety. Reappraisal was more efficient than pondering for anxiety. However, moderation analysis showed that social anxiety (SA) levels influenced the comparative efficiency of reappraisal and acceptance as contrasted to reflective pondering for negative emotions and anxiety. Participants low in SA made equal use of all strategies, while for those high in SA reappraisal and acceptance were more efficient than pondering. Our results provide preliminary evidence that reflective pondering can, in some circumstances, be an adaptive regulation strategy.