Effects of cognitive behavioral therapy on psychological and physical outcomes in adults with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials
Abstract
BackgroundPain 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.MethodsPubMed, 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).ResultsTwelve 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.ConclusionThe 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.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261470674, CRD420261470674.
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BibTeX
@article{zhang2026effects,
title = {{Effects of cognitive behavioral therapy on psychological and physical outcomes in adults with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials}},
author = {Yize Zhang and Fangzhen Wu and Lihong Huang and Liying Lin and Shumin Huang and Yushan Zhao and Siyi Chen and Xiaoling Yang and Zhongwen Zhao},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1981494},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1981494},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effects of cognitive behavioral therapy on psychological and physical outcomes in adults with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials
AU - Yize Zhang
AU - Fangzhen Wu
AU - Lihong Huang
AU - Liying Lin
AU - Shumin Huang
AU - Yushan Zhao
AU - Siyi Chen
AU - Xiaoling Yang
AU - Zhongwen Zhao
PY - 2026
DA - 2026/11/04
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1981494
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1981494
AB - BackgroundPain 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.MethodsPubMed, 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).ResultsTwelve 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.ConclusionThe 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.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261470674, CRD420261470674.
SN - 2296-2565
ER -