Effects of problem-focused versus emotion-focused behavioral interventions on peptic ulcer recurrence: a 4-year...

Peptic ulcer disease (PUD) exhibits high recurrence rates, and behavioral interventions targeting coping strategies may influence long-term outcomes. However, the differential associations of problem-focused versus emotion-focused structured interventions with ulcer recurrence remain unclear.

To evaluate the association between problem-focused versus emotion-focused behavioral interventions delivered during hospitalization and subsequent 4-year ulcer recurrence in patients with PUD.

This single-center retrospective cohort study included 167 patients hospitalized with PUD between January 2021 and March 2025. Based on documented structured interventions received during the index hospitalization, patients were classified into a problem-focused intervention group (n = 84; 6 monthly 90-min group sessions emphasizing problem identification, solution generation, goal-setting, and action planning) or an emotion-focused intervention group (n = 83; 6 monthly 90-min group sessions focusing on emotional awareness, relaxation training, mindfulness, and cognitive restructuring). Clinical outcomes and endoscopic findings were ascertained retrospectively from the electronic medical record over a 4-year period (January 2021 to March 2025). Baseline demographic and clinical characteristics were comparable between groups. Outcome assessors (endoscopists) were blinded to group assignment; patient blinding was not feasible given the behavioral intervention context.

Over the 4-year observation period, cumulative ulcer recurrence was significantly lower in the problem-focused group (19.05% vs. 37.35%; χ² = 7.243, P = 0.007). After multivariable adjustment for prespecified confounders (baseline ulcer diameter, NSAID use history, smoking status, H. pylori positivity, age, and gender), problem-focused intervention remained independently associated with reduced odds of recurrence (adjusted OR = 0.41, 95% CI: 0.22-0.76, P = 0.004). The problem-focused group also demonstrated higher intervention adherence (92.86% vs. 81.93%, P = 0.038), greater patient satisfaction (22.41 ± 2.30 vs. 19.75 ± 2.98, P < 0.001), and shorter median healing time (6.0 vs. 7.0 weeks, P = 0.022). No significant differences were observed in H. pylori reinfection rates or adverse events.

In this retrospective cohort, receipt of a structured problem-focused behavioral intervention during hospitalization was associated with lower ulcer recurrence and improved clinical outcomes over the 4-year observation period compared to an emotion-focused intervention. However, given the observational design, single-center setting, lack of participant blinding, and potential residual confounding, these findings should be interpreted as hypothesis-generating. Prospective randomized controlled trials are warranted to establish causality and evaluate generalizability before integration into routine clinical practice.