The study assessed the effects of cognitive behavioral therapy (CBT) combined with enteral nutrition in 50 patients with severe acute pancreatitis (SAP) in the ICU. From May 2022 to August 2023, patients were randomly assigned to a control group with routine nursing and a study group with additional CBT. Both groups received enteral nutrition. After 14 days, the study group had higher levels of albumin, total protein and globulin in the blood and lower inflammatory markers such as procalcitonin, C-reactive protein and interleukin-6. The study group showed shorter ICU and hospital stays, faster resumption of oral feeding, lower pain scores, and higher quality of life scores. No significant differences in gastrointestinal adverse reactions and infections were observed between groups. CBT with enteral feeding improved nutritional status, reduced inflammation, reduced pain, and increased quality of life in ICU patients with SAP.