{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:07:20Z","timestamp":1789153640218,"version":"build-2803163510"},"reference-count":74,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Beijing Research Ward Excellence Program","award":["BRWEP2024W074110118"],"award-info":[{"award-number":["BRWEP2024W074110118"]}]},{"name":"Capital\u2019s Funds for Health Improvement and Research","award":["CFH: 2020-2-4112"],"award-info":[{"award-number":["CFH: 2020-2-4112"]}]},{"name":"Capital\u2019s Funds for Health Improvement and Research","award":["CFH: 2022-2-4114"],"award-info":[{"award-number":["CFH: 2022-2-4114"]}]},{"name":"Capital\u2019s Funds for Health Improvement and Research","award":["CFH: 2024-2-4114"],"award-info":[{"award-number":["CFH: 2024-2-4114"]}]},{"name":"Key Attending Psychiatrist Program of Peking University Sixth Hospital","award":["BDLYYLZL2023-03"],"award-info":[{"award-number":["BDLYYLZL2023-03"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Atten Disord"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Therapist-guided Internet-delivered Cognitive Behavioral Therapy (iCBT) offers a promising alternative to face-to-face CBT (FTF-CBT) for adults with attention-deficit\/hyperactivity disorder (ADHD), but evidence on its comparative efficacy and long-term maintenance mechanisms is limited. This study aimed to analyze the efficacy of group-format therapist-guided iCBT and FTF-CBT in medicated ADHD adults immediately post-treatment and at 1-year follow-up; and explored potential maintenance correlational pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Secondary analysis of data from two randomized controlled trials (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 184) comprised participants into three groups: group-format therapist-guided iCBT (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 43), group-format FTF-CBT (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 49), and treatment as usual (TAU;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 92). Outcomes included ADHD core symptoms, anxiety symptoms, dysfunctional attitudes, and psychological quality of life (QoL). Linear Mixed Models were utilized to assess treatment efficacy both at post-treatment and 1-year follow-up, and exploratory structural equation path modeling was used to investigate synchronous correlational patterns of long-term symptom changes between the two active intervention groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      At post-treatment, both group-format interventions demonstrated significant improvements over the TAU group in reducing ADHD core symptoms, alleviating anxiety, and enhancing psychological QoL (|\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      | = 0.230\u20130.828). At 1-year follow-up, FTF-CBT maintained benefits for all outcomes and was superior to iCBT across all four domains, while iCBT only retained significant advantages over TAU on ADHD core symptoms (\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = \u22120.483) and psychological QoL (\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = 0.217). The exploratory structural equation path model identified three significant correlational patterns: changes in dysfunctional attitudes were directly associated with psychological QoL changes (\u03b2 = .899), indirectly via anxiety changes (\u03b2 = .861), and through sequential changes in anxiety and ADHD symptoms (\u03b2 = .146).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>While both group-format therapist-guided iCBT and FTF-CBT were effective at post-treatment, only FTF-CBT maintained benefits across all outcomes at 1-year follow-up and showed larger effect sizes than iCBT in exploratory comparisons. Exploratory path analyses identified the role of changes in dysfunctional attitudes in synchronous long-term symptom covariation linked to sustained psychological QoL. These findings offer valuable insights into strategies for enhancing the real-world impact of therapist-guided iCBT, highlighting areas for future research and clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ChiCTR1900021705, ChiCTR2100044201 (Chinese Clinical Trial Registry,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\">www.chictr.org.cn<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  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