Objective <p>This study evaluated the effects of intensive lifestyle modification (ILM) incorporating calorie-carbohydrate restriction (CCR) with or without time-restricted feeding (IFCCR) on psychological health in adults with type 2 diabetes (T2D).</p> Research design and methods <p>In a 24-week randomized controlled trial, 120 adults with T2D were allocated to CCR (<i>n</i> = 40), IFCCR (<i>n</i> = 40), or a control group (<i>n</i> = 40). Both intervention arms followed an energy-restricted diet (1000–1200&#xa0;kcal/day), received behavioral support, and performed ≥ 150&#xa0;min/week of physical activity. The IFCCR group additionally restricted eating to an 8-hour daily window. Primary and secondary outcomes were eating disorder psychopathology (EDE-Q scale) and diabetes-related distress (PAID scale), respectively.</p> Results <p>Both CCR and IFCCR significantly reduced diabetes-related distress compared to the control (CCR: β = -1.80, <i>p</i> = 0.007; IFCCR: β = -1.78, <i>p</i> = 0.01). EDE-Q scores also improved significantly. Improvements were observed across EDE-Q subscales, particularly in weight and shape concern. After adjustment for changes in weight and HbA1c, reductions in PAID became non-significant, while improvements in several EDE-Q domains, particularly in the IFCCR group, remained significant. IFCCR showed numerically greater reductions than CCR, though differences were not statistically significant. The control group demonstrated minimal changes.</p> Conclusions <p>Intensive lifestyle modification incorporating CCR or IFCCR improved eating disorder psychopathology, whereas reductions in diabetes-related distress appear largely related to metabolic changes. These findings support the integration of structured dietary and behavioral interventions into diabetes care.</p> Trial registration <p>This trial was registered in Iranian Registry of Clinical Trials (IRCT), IRCT20230917059447N1 (<a href="https://irct.behdasht.gov.ir/trial/72666">https//irct.behdasht.gov.ir/trial/72666</a>).</p>