In Reply We thank Ebert and Baumeister for their insightful response. We agree that the results of our study should be considered with caution, as we also indicated in our article.1
First, the authors highlight that they would have appreciated a more detailed discussion about the interpretation of the clinical significance of our findings, especially regarding the small effect. While we acknowledge that we need to be cautious when interpreting the clinical relevance, we consider self-guided interventions that have a number needed to treat of 8 to be potentially helpful for populations that are not willing to seek professional help, for use during watchful waiting in primary care, or in low- and middle-income countries with no or only a limited infrastructure for mental health services.1 We note here that as reported by Muñoz and colleagues,2 “Massive open online interventions have the potential to increase the reach, scalability, and affordability of psychological interventions.” Even a small effect can have a huge impact when it is applied in large populations. Therefore, self-guided internet-based cognitive behavioral therapy can have a large impact on mental health, despite the small effect sizes. We also point to the fact that an effect size of g = 0.27 (95% CI, 0.17-0.37) may be small, but not very different from other treatments. For example, the effect size of antidepressant medication vs placebo is also only g = 0.31 (95% CI, 0.27-0.35).3
Karyotaki E, Riper H, Cuijpers P. Internet-Based Self-Help Interventions for Depression in Routine Care—Reply. JAMA Psychiatry. 2017;74(8):853. doi:10.1001/jamapsychiatry.2017.1406
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