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

作为回复，我们感谢 Ebert 和 Baumeister 的富有洞察力的回应。我们同意我们的研究结果应谨慎考虑，正如我们在文章中也指出的那样。¹

首先，作者强调，如果对我们研究结果的临床意义的解释进行更详细的讨论，尤其是关于小影响，他们将不胜感激。虽然我们承认在解释临床相关性时需要谨慎，但我们认为需要治疗 8 次的自我指导干预措施可能对不愿意寻求专业帮助的人群有所帮助，以便在观察等待期间使用在初级保健，或在没有或只有有限的精神卫生服务基础设施的中低收入国家。¹我们在此注意到，正如 Muñoz 及其同事所报告的，²“大规模的开放式在线干预有可能增加心理干预的范围、可扩展性和可负担性。” 当它应用于大量人群时，即使是很小的影响也会产生巨大的影响。因此，基于互联网的自我引导认知行为疗法可以对心理健康产生很大影响，尽管效果很小。我们还指出，g  = 0.27 (95% CI, 0.17-0.37) 的影响大小可能很小，但与其他治疗没有太大区别。例如，抗抑郁药物与安慰剂的效果大小也只有g  = 0.31（95% CI，0.27-0.35）。³