Cognitive behavioral therapy is associated with lower fatigue, anxiety, and depression in rheumatoid arthritisCognitive behavioral therapy may lower fatigue and anxiety in RA

Pain and functional limitations associated with rheumatoid arthritis (RA) can substantially impair patients’ psychological and physical well-being. Cognitive behavioral therapy (CBT) may alleviate psychological and physical symptoms in patients with RA by modifying maladaptive cognitions and behaviors and promoting adaptive coping with the disease. However, the effect of CBT in RA patients has not been systematically established. PubMed, the Cochrane Library, Embase, and Web of Science were systematically searched from database inception to July 9, 2026, for relevant studies. Study selection, data extraction, and risk-of-bias assessment were independently performed by two reviewers. Any discrepancies were resolved through discussion or adjudicated by a third reviewer. Meta-analyses were primarily implemented through random-effects models. Effect estimates were presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Twelve RCTs involving 1,538 participants with RA were incorporated. CBT was associated with lower levels of depression (SMD = −0.35, 95% CI: −0.55 to −0.14, low-certainty evidence), anxiety (SMD = −0.20, 95% CI: −0.32 to −0.08, moderate-certainty evidence), and fatigue (SMD = −0.44, 95% CI: −0.66 to −0.22, low-certainty evidence). At the 6-month follow-up, the pooled SMDs were −0.42 (95% CI, −0.63 to −0.20) for depression and −0.22 (95% CI, −0.43 to −0.01) for anxiety, based on six RCTs with available follow-up data. For sleep, the pooled estimate favored CBT, although this finding was based on only two studies and was supported by very-low-certainty evidence. No statistically significant between-group differences were noted for pain, physical function, or quality-of-life (QoL). Substantial heterogeneity was observed for depression and fatigue, and the 95% prediction intervals crossed the line of no effect for both outcomes. Exploratory subgroup analyses by CBT delivery format revealed no significant differences between subgroups. The pooled estimates suggested that CBT may be associated with lower levels of fatigue, anxiety, and depression in patients with RA. However, substantial heterogeneity, prediction intervals crossing the line of no effect, and low certainty of evidence limit the reliability of these outcomes. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261470674, CRD420261470674.