Revisión sistemática: Intervenciones basadas en mentalización para población general y como complemento clínico

Abstract

Las intervenciones psicoterapéuticas de mayor alcance, de menor intensidad -como tratamientos modulares y transdiagnósticos, que incluyen la información y la psicoeducación, permitirían ampliar la atención primaria de la salud (APS). El objetivo general del presente trabajo fue realizar una revisión sistemática de las intervenciones basadas en la mentalización, destinadas a complementar tratamientos clínicos (IPBM-C) y para la prevención en la población general, no clínica (IPBM-P), considerando las directrices de la Declaración Prisma y aplicando la escala PEDro. Se registraron seis intervenciones complementarias a un tratamiento psicoterapéutico (IPBM-C) y 12 intervenciones para población no clínica (IPBM-P). Se describen las características de las intervenciones, quiénes son los destinatarios y los agentes que las implementan. Se destaca el valor potencial de este tipo de intervenciones para mejorar la salud mental en la población general. Además, se reconoce la importancia de abordar otras temáticas y proporcionar apoyo psicológico frente a nuevos desafíos.

Mental health gained greater importance today due to the COVID -19 pandemic (Cullen et al., 2020; Liu et al., 2020) and the climate change crisis (Botzen et al., 2021; Hornsey y Fielding, 2020). Previously, Kazdin (2018) had warned about the task of delivering psychological therapies and/or psychologically informed interventions on this scale. Barkham et al. (2021) proposes that psychological therapies should seek to be more relevant, inclusive, and impactful at a larger scale, given that most people in need do not have access to these services. Considering the need to expand knowledge about mentalization based interventions through methodologically rigorous research, the present study aims to conduct a literature review of mentalization-based interventions that complement clinical treatments and interventions aimed at the general population. There is a growing interest in the concept of mentalization and its operationalization as reflective functioning. Psychoeducation in mentalization includes a component linked to the understanding of psychiatric disorders that makes it possible to make explicit the vicious cycle that can be generated with these disorders, thus complementing therapeutic interventions. It is also noted that mentalization-based interventions may be useful for the general population, as they have the potential to reduce attachment problems. Some interventions have been designed specifically for this purpose by providing educational elements pertaining to parenting, mental health, child behavior, or attachment (Adkins et al., 2018; Allen et al., 2012). Most of these addresses the subject theoretically or are focused on their application in patients with severe pathologies and to a lesser extent the results of psychoeducational program interventions and complementary treatments are studied (Lüdemann et al., 2021; Santelices et al., 2016). This article presents the results of a systematic review, considering the guidelines of the Prisma Declaration (Preferred Reporting Items for Systematic reviews and Meta-Analyses, Page et al., 2021) and applying the PEDro scale, on specific interventions to develop mentalisation aimed at interventions complementary to psychotherapeutic treatments (IPBM-CTP) and the non-clinical population (IPBM-PG). The results indicate that from 191 initial citations registered in the searches of different databases, 18 articles were included in the quantitative systematic review. These correspond to 5 interventions complementary to psychotherapeutic treatment and 13 interventions for a non-clinical population. The following databases were used: Scientific Electronic Library Online (Scielo), PsycARTICLES of the American Psychological Association (APA), PubMed, Cochrane, the Regional Portal of the VHL of the Pan American Health Organization (VHL) and Google Scholar. The selection criteria for the databases considered the frequency of subjects related to the topic of interest. The last bibliographic search was performed in September 2021. Specifically described are the characteristics of the interventions, who are the recipients and who are the agents implementing them. They were addressed to parents and only one to relatives of people suffering from personality disorders. The target groups of the interventions in the non-clinical population were parents, educators, and professionals. The interventions were divided in the following classifications: a) Mentalization-based interventions as an adjunct to clinical treatment (IBM-C) b) Mentalization-based interventions for general population (IBM-P) In agreement with previous reviews on the subject (Santelices et al., 2016), the results obtained here corroborate that in Latin America, research on these interventions is very scarce. In this sense, it is considered important to replicate in Latin America research on these programs in different settings (clinical and general population/community) considering what contextual adaptations are necessary according to the target population of the intervention, such as socioeconomic level and educational level, among others.