Objective To explore the effects of illness perception intervention based on self-regulation theory on self-perceived burden, psychological resilience, and quality of life in lung cancer patients. Methods This study employed a prospective randomized controlled design, a total of 120 lung cancer patients attending the Oncology Outpatient Department at Zhengzhou Third People’s Hospital between January 2022 and October 2024 were enrolled and randomly and equally allocated to the intervention or control group . While the control group underwent conventional lung cancer treatment and standard care, the intervention group additionally participated in an 8-week program based on self-regulation theory focused on restructuring illness perceptions, including illness perception assessment, individualized illness perception reconstruction, self-regulation skills training, self-management practice and reinforcement, and family support system construction. The self-perceived burden questionnaire (SPBQ), connor-davidson resilience scale (CDRISC), and functional assessment of cancer therapy-lung (FACT-L) were used to assess patients’ self-perceived burden, psychological resilience, and quality of life before and after intervention. Results Before intervention, there were no statistically significant differences in self-perceived burden, psychological resilience, and quality of life scores between the two groups (all P>0.05). After intervention, the total score and dimensions (physical burden, psychological burden, social burden, economic burden) of self-perceived burden in the intervention group were significantly lower than those before intervention and those in the control group (all P<0.001); the total score and dimensions (tenacity, self-reliance, optimism) of psychological resilience were significantly higher than those before intervention and those in the control group (all P<0.001); the total score and dimensions (physical status, social/family status, emotional status, functional status, and lung cancer additional concerns) of quality of life were significantly higher than those before intervention and those in the control group (all P<0.001). There were no statistically significant differences in each indicator before and after intervention in the control group (all P>0.05). Conclusion Illness perception intervention based on self-regulation theory can effectively reduce self-perceived burden, improve psychological resilience and quality of life in lung cancer patients, providing new intervention strategies and theoretical basis for psychological care of lung cancer patients.