Background & Objectives: One of the most complex and chronic psychiatric disorders is systemic lupus erythematosus (SLE). It is a chronic inflammatory disease that affects the kidney, blood, heart, pulmonary, neurological, or immunological system. Individuals with SLE experience decreased mental health levels and present high anxiety, depression, and physical discomfort. Most neuropsychological manifestations are often critical and present significant adverse impacts on patients, including increased feelings of fatigue and alexithymia. Thus, the patients require early pharmacotherapy according to each patient's condition. Various pharmacological and non–pharmacological interventions are available for treating these patients; of which, metacognitive therapy (MCT) has a strong theoretical basis. Metacognitive therapy teaches individuals strategies to liberate themselves from thought patterns that cause information processing disorders, worry, health threats, and maladaptive self-control. In addition, by teaching flexible emotional processing methods, MCT helps individuals develop the cognitive patterns needed to guide their thinking and behavior in future encounters with harm or threat. Thus, this research aimed to investigate the effectiveness of metacognitive therapy on the feeling of fatigue and alexithymia of women with lupus.

Methods: This quasi-experimental study employed a pretest–posttest design with a 2-month follow-up and a control group. The statistical population of this research included all female patients with lupus who had been referred to the Lupus Association of Tehran City, Iran, in 2024 for lupus counseling and treatment. From the statistical population, 30 qualified volunteers were selected by simple random sampling and assigned to the experimental and control groups (each group included 15 people). The inclusion criteria included being at least 18 years old, having a history of lupus for more than 1 year, and having a higher-than-average score on research questionnaires. The exclusion criteria included a history of hospitalization in the Psychiatric Department and not attending two psychotherapy sessions. In this research, ethical standards, including obtaining informed consent and ensuring privacy and confidentiality, were observed. Also, participants were free to withdraw from the research at any time or to decline to provide personal information. They were assured that their information would remain confidential and fully respected. At the end of the research, communication skills training was implemented for the control group. Both groups completed the Multidimensional Fatigue Inventory (Smets et al., 1995) and Toronto Alexithymia Scale (Bagby et al., 1994). The metacognitive therapy training program included 8 60-minute sessions, one session every week, but the control group did not receive any treatment plan. Descriptive and inferential statistics were used to describe the data. Descriptive statistics included mean and standard deviation. Regarding inferential statistics, a repeated-measures analysis of variance and a Bonferroni post hoc test were used to compare means across the research stages. Data analysis was done using SPSS software version 27. The significance level of the tests was set at 0.05.

Results: The effects of time, group, and the interaction of time and group on the fatigue and alexithymia variables were significant (p < 0.001). In addition, for the variables of fatigue and alexithymia, there was a significant difference between the pretest and posttest (p < 0.001) and between the pretest and follow-up (p < 0.001) in the intervention group. In comparison, no significant difference was observed between the posttest and follow-up mean scores (p = 1.000).

Conclusion: This research showed that teaching the MCT program to women with lupus is effective in improving fatigue and alexithymia.