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To test the efficacy of cognitive-behavioural therapy (CBT) for lifestyle modification in patients with metabolic syndrome (MetS).76 MetS patients completed this clinical trial, with 18 months follow-up. 45 participants from the experimental group (EG - CBT) and 31 to the control group (CG - usual care). The CBT programme was performed by a psychologist in a face-to-face group format, during 12 weekly sessions lasting 90 minutes. The intervention for the CG consisted of workshops with basic information about MetS and it's associated cardiovascular risk.Efficacy of (CBT) in (MetS) patients.Results showed reduction in weight (mean difference - MD -2.633, 95%CI [-4.322, -0.943]; p.003), waist circumference (MD -2.944, 95%CI [-5.090, -0.798]; p.008), body mass index (MD -0.915, 95%CI [-1.494, -0.335]; p.003), systolic (MD -0.046, 95%CI [-0.685, -0.023]; p.0002) diastolic blood pressure (MD -4.777, 95%CI [-7.750, -1.804]; p.002), and cardiovascular risk score after 18 months. An increase in adherence to the Mediterranean diet and assertiveness and a reduction in anger were observed in EG. The CG did not show any significant differences.The CBT focused on changes in lifestyle seems to be effective in the reduction of MetS and cardiovascular risk factors.Registered at clinicaltrials.gov (NCT02949622) - PROMETS (Multimodal Intervention Program for Patients with Metabolic Syndrome).