In Reply Dr Lorenzo-Luaces and Dr van Emmerik and colleagues take issue with our discussion of the evidence base for CBT and other psychotherapies. We acknowledge that CBT, an umbrella concept for different interventions, is an effective treatment for many patients with more studies than for other approaches.
Nevertheless, quantity does not imply quality. If study quality is considered, the evidence base for CBT shrinks to a modest number of studies; for example, in anxiety or depressive disorders, it goes down to only 17% of 144 studies.1 If publication bias, study quality, comparisons with waiting list, and researcher allegiance are additionally taken into account, the effect sizes of CBT also decrease.1 Cuijpers et al1 concluded that the effects of CBT are 鈥渦ncertain and should be considered with caution.鈥� Thus, this description was not an 鈥渙verly negative interpretation鈥� by us as suggested by van Emmerik and colleagues.