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Abstract Background Computerised cognitive behaviour therapy (cCBT) involves standardised, automated, interactive self-help programmes delivered via a computer. Randomised controlled trials (RCTs) and observational studies have shown than cCBT reduces depressive symptoms as much as face-to-face therapy and more than waiting lists or treatment as usual. cCBT’s efficacy and acceptability may be influenced by the “human” support offered as an adjunct to it, which can vary in duration and can be offered by people with different levels of training and expertise. Methods/design This is a two-by-two factorial RCT investigating the effectiveness, cost-effectiveness and acceptability of cCBT supplemented with 12 weekly phone support sessions are either brief (5–10 min) or extended (20–30 min) and are offered by either an expert clinician or an assistant with no clinical training. Adults with non-suicidal depression in primary care can self-refer into the study by completing and posting to the research team a standardised questionnaire. Following an assessment interview, eligible referrals have access to an 8-session cCBT programme called Beating the Blues and are randomised to one of four types of support: brief-assistant, extended-assistant, brief-clinician or extended-clinician. A sample size of 35 per group (total 140) is sufficient to detect a moderate effect size with 90% power on our primary outcome measure (Work and Social Adjustment Scale); assuming a 30% attrition rate, 200 patients will be randomised. Secondary outcome measures include the Beck Depression and Anxiety Inventories and the PHQ-9 and GAD-7. Data on clinical outcomes, treatment usage and patient experiences are collected in three ways: by post via self-report questionnaires at week 0 (randomisation) and at weeks 12 and 24 post-randomisation; electronically by the cCBT system every time patients log-in; by phone during assessments, support sessions and exit interviews. Discussion The study’s factorial design increases its efficiency by allowing the concurrent investigation of two types of adjunct support for cCBT with a single sample of participants. Difficulties in recruitment, uptake and retention of participants are anticipated because of the nature of the targeted clinical problem (depression impairs motivation) and of the studied interventions (lack of face-to-face contact because referrals, assessments, interventions and data collection are completed by phone, computer or post). Trial registration Current Controlled Trials ISRCTN98677176

Processing of discourse seems to be far from uniform with much evidence indicating that it can be quite shallow. The question is then what modulates depth of processing? A range of discourse devices exist that we believe may lead to more detailed processing of language input (Attention Capturers), thus serving as modulators of processing enabling some parts of discourse to be processed more than others. We list some of these and describe two in detail. We introduce the text-change procedure in which texts are presented twice in succession with a possible change to a word on the second presentation. By analogy with visual change-blindness, text change provides a method of tracking attention capture and depth of processing in text. In Experiment 1, the effect of italicization in writing was investigated. Italicization led to an increase in change detection. In Experiment 2, we investigated focus-driven word stress in speaking. Once again, focus-driven stress led to increases in change detection. These examples show how word stress increases depth of processing. We discuss the findings in terms of the Granularity account of focus, in which deeper processing is characterized as a more detailed semantic specification.

Author(s): Karina Lovell 1,*, Peter Bower 2, Judith Gellatly 1, Sarah Byford 3, Penny Bee 1, Dean McMillan 4, Catherine Arundel 5, Simon Gilbody 4, Lina Gega 4, Gillian Hardy [...], Background Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. "High-intensity" cognitive-behaviour therapy (CBT) from a specialist therapist is current "best practice." However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for "low-intensity" interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. Methods and findings This study was approved by the National Research Ethics Service Committee North West-Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through "OCFighter" or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale-Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = -1.91, 95% CI -3.27 to -0.55). These effects did not reach a prespecified level of "clinically significant benefit." cCBT did not demonstrate significant benefit (adjusted mean difference = -0.71, 95% CI -2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment. Conclusions We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT. Trial registration International Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN73535163.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jml.2005.05.004 Byline: Alison J.S. Sanford (a), Anthony J. Sanford (b), Ruth Filik (b), Jo Molle (a) Keywords: Text-change paradigm; Referential load; Syntactic complexity; Lexical processing; Shallow processing Abstract: The text-change detection task has been used to show that changes are more readily detected for words that fall under narrow focus than broad focus (), and that narrow focus appears to lead to finer semantic distinctions being held in the representation of the word. The present experiments apply the same paradigm to investigate whether sentence processing load also influenced the detection of changes, and whether under a high load, semantic distinctions are held at a more crude (rougher grain) level than under low load. Load comparisons were made through subject- and object-extracted relative clauses (Experiment 1), and through referential load (Experiments 2 and 3). Higher loads resulted in poorer change detection, but the pattern of data differed from that obtained in focus manipulations. Experiment 4 explored the effects of referential load upon comprehension, confirming that comprehension did not break down under high-load conditions. In Experiment 5, the load effect was localized to the embedded verb. These results suggest that the effect of load differs from the effect of focus on lexical processing. Author Affiliation: (a) Department of Psychology, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK (b) University of Glasgow, UK Article History: Received 21 September 2004; Revised 4 May 2005