Motivation and emotion/Book/2020/Sense of coherence

Sense of coherence:
What is SOC, what are the effects, and how can it be developed?

Overview

Sense of coherence is a theory that was originally put forward by Aaron Antonovosky, an Israeli American sociologist. A majority of Antonovsky's work was involved with the relationships between stress, health and well-being. After completing his PhD at Yale University, he then emigrated to Israel in 1960, where he worked in the department of medical sociology at the Hebrew university of Jerusalem, where his work heavily focused on social class differences in mortality and morbidity. Later, in 1979, Antonovsky developed his theory of health and illness, which he called salutogenesis, and the model was described in his book, Health, Stress and Coping. A crucial concept in Antonovsky's theory focuses on how specific personal dispositions make individuals more resilient to stressors they encounter during everyday life. Antonovsky identified these traits, which he claimed helped individuals better cope and remain healthy, by providing that they have a sense of coherence about life, and the challenges faced throughout.

Focus questions:

What is sense of coherence?
What is the salutogenic model of health?
What are the physical and mental effects of SOC?
How is SOC developed?
How does SOC effect personality?

Sense of coherence

Figure 1: Sense of coherence reflects an individual's coping capacity to deal with everyday life stressors.

Sense of coherence is a core construct of the salutogenic model, created by Aaron Antonovsky, which is a medical approach that mainly focuses on factors that support well-being and health. It is specifically concentrated on the relationship between stress, coping and health. A sense of coherence reflects a person's view of life and their capacity to respond to stressful situations. It is considered a global orientation to view one's life as a manageable, structured and worthwhile process, all while being considered as a personal way of thinking, acting and behaving. It also says a lot about a person's ability to identify one's external and internal resources and utilise them in a way that promotes health and well-being, which can loop back to the salutogenic model of health. ^[1] Antonvosky defined a sense of coherence as:

"a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.^[2]"

Above all, a sense of coherence is a coping mechanism that allows people to deal with everyday stressors in life and can help explain the role of stress in human functioning. Before moving onto the next section, it is crucial that we go over the three components that form the sense of coherence theory so we can understand how they factor into stress and human behaviour.

In sense of coherence, there are three components:

Comprehensibility: the belief that things happen in a predictable or well-ordered manner, and a sense that you can understand events in your life with reason or a logical basis.
Manageability: the belief you have the ability, knowledge, skills, support or resources necessary to take care of things that are within your control.
Meaningfulness: the extent to which you believe things in your life are interesting and worthwhile, and that there is reason and purpose to care about what you do, or what happens in your life.

The salutogenic model of health

Figure 2: Antonovsky's sense of coherence model. This chart depicts the 3 stages, as well as a state of well-being on a scale of life and death.

As aforementioned, the salutogenic model of health is a medical-based approach model that focuses on factors that support health and well-being, rather than factors that cause disease, which is also known as pathogenesis. It is beyond a more traditional, pathogenic focus on risks and health problems. The three key concepts: comprehensibility, manageability and meaningfulness are all concepts to help shift focus from disease and ill-being to health and well-being. ^[3]

Salutogenesis

Salutogenesis is a medical approach which focuses on factors that support human health and well-being. Rather than focusing on factors that cause disease, salutogenesis refers to the theory of why and how certain people remain healthy. Salutogenesis is almost equivalent to sense of coherence, in that it seeks to gain a better understanding of positive aspects of human behaviour. ^[4]

Pathogenesis

Pathogenesis is the biological mechanisms that develop into a diseased state. The term also describes the origin and course of a disease, including the state it is in, such as acute or chronic. Essentially, it describes how a disease begins and develops.

Antonovsky's Development of Salutogenesis

Antonovsky initiated a study amongst different ethnic groups of women in Israel with the intention of discovering their menopausal symptoms. He interviewed the women about perceived health, and on different life events that affected them, such as losing a spouse, losing a limb, losing eyesight or suffering from a serious condition. After analyzing the interviews[spelling?] , Antonovsky found that 29% of the women reported good health, although they survived the Holocaust. Even though the intention of the interviews was to gain an understanding of menopausal symptoms, it still demonstrated a relationship between coping mechanisms and perceived health. This was the beginning of Antonovsky's shift from pathogenesis to salutogenesis. [spelling?] which lead to the emergence of the sense of coherence theory (Eriksson, 2016).

Development of sense of coherence

Life cycle

A sense of coherence is assumed to develop over the entire life cycle and increases with age and remain stable. According to Antonovsky, a sense of coherence generally develops until the age of 30 years old. From then on, a sense of coherence is estimated to remain comparatively stable until retirement age, where a decrease is expected to occur. However, this assumption has not been backed by empirical research. ^[5] A sense of coherence seems to be relatively stable overtime, although it is not as stable as Antonovsky assumed.

Psychologically

A sense of coherence is developed psychologically when a person encounters a stressor in their lives. For example, if somebody with a strong sense of coherence was to do a long or stressful assignment at university, they would be able to see the task as manageable, meaningful and understandable. They would be able to reflect on their coping capacity and use this to their advantage in order to complete the task efficiently.

The effects of sense of coherence

Figure 3: Big Five traits, also known as "OCEAN" or the "five-factor model" are a grouping of personality traits that represent domains of behaviour and are responsible for differences in personality.

Mental health

A sense of coherence can affect an individual's mental health in various ways. Having a strong sense of coherence may serve as protection against depression. It can help improve life satisfaction, and is also linked with reduced loneliness, anxiety and exhaustion. It can also affect stress as a sense of coherence, in its whole, is how people cope with stressful situations. Stress has a major impact on not only mental health, but the immune system, so being able to effectively cope with stressful stimuli, will allow a person to maintain good mental and physical health.

Physical health

In terms of physical health, having a strong sense of coherence also contributes to a strong sense of perceived health, at least for those who initially had a high sense of coherence. Sense of coherence seems to have a moderating role in the explanation of health, in that it can predict health and can contribute to the development and understanding of someone's health. As stated in the salutogenic model of health section, Antonovsky's study on Israeli women and perceived health showed that 30% of the women interviewed were still able to report good health, despite having experienced unfortunate health circumstances. This was likely due to a strong sense of coherence.

Personality

Sense of coherence appears to have a positive correlation with personality traits including extraversion, openness and agreeableness, which are all components of the Big Five traits. A study on the relationship between sense of coherence and the Big Five traits was conducted amongst Japanese youths to confirm the overlap of both theories. It was discovered that extraversion strongly correlated with the three concepts of SOC and that openness, agreeableness and conscientiousness may possibly help us further understand the components of sense of coherence. However, neuroticism negatively correlated with the three components, therefore further studies may be needed to better distinguish the aspects of SOC and the Big Five so that the characteristics of both theories are better understood. ^[6]

Test your knowledge

Test your knowledge in this section with a quick quiz!

Quiz time!

Please read the question and select your answer by clicking the circle and then clicking "submit".

Conclusion

In essence, a sense of coherence is a multidimensional concept that demonstrates how people deal with stressors in their lives and their capacity to reflect and understand those stressors. The sense of coherence model ties in with salutogenesis, which is a medical-based approach that focuses on factors that relate to human health and well-being. It's counterpart, pathogenesis, focuses on the origin and development of disease, and the biological mechanisms that lead to a diseased state. Both theories are rooted into sense of coherence and play a key role in the understanding of how people deal with stressors, and their perceived sense of health. A high sense of coherence generally leads to good health and may serve as a barrier or protection for depression and other symptoms of poor mental health such as fatigue, anxiety and isolation. People who hold a high sense of coherence are generally able to deal with stressors in a healthy manner, which in turn may be able to maintain their mental and physical health.

The three constructs; comprehensibility, manageability and meaningfulness all have their own meanings. They allow individuals to reflect on their capacity to deal with stressors in a logical and rational manner, as well as understanding how to utilise resources and whether challenges faced in life are meaningful and worthwhile. These constructs also have their ties in other psychological theories, such as the Big Five traits. As seen in Figure 3; the Big Five traits are a grouping of personality traits that each represent different aspects of behaviour. Also known as "OCEAN", these traits positively correlate to the three components of sense of coherence, which can further help with the understanding of how the three components impact personality.

Furthermore, additional research could be conducted in order to fully understand the origins, development and course of sense of coherence, specifically over the lifespan. As mentioned above, it may also be beneficial to understand the relationship between personality and a sense of coherence, as well as how it affects mental and physical health.

Take-home messages

1. Sense of coherence is a concept that can explain stress within the role of human functioning.

2. Having a strong sense of coherence may serve as a barrier of protection against depression, anxiety and other mental health issues.

3. Sense of coherence comes from the medical-based concept of salutogenesis, which focuses on how and why people stay healthy.

4. A strong sense of coherence can contribute to the understanding and development of health issues.

5. A sense of coherence is generally experienced when you encounter a stressor in your life.

6. The three key concepts (comprehensibility, manageability and meaningfulness) all have their own individual meanings and play a crucial role in coping with stressors and other life events.

References

Antonovsky, A. Unraveling The Mystery of Health - How People Manage Stress and Stay Well, San Francisco: Jossey-Bass Publishers, 1987

Eriksson M. The Sense of Coherence in the Salutogenic Model of Health. 2016 Sep 3. In: Mittelmark MB, Sagy S, Eriksson M, et al., editors. The Handbook of Salutogenesis [Internet]. Cham (CH): Springer; 2017. Chapter 11. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435812/ doi: 10.1007/978-3-319-04600-6_11

Eriksson M, Lindström Bantonovsky’s sense of coherence scale and the relation with health: a systematic review journal of Epidemiology & Community Health 2006;60:376-381.

Eriksson M, Mittelmark MB. The Sense of Coherence and Its Measurement. 2016 Sep 3. In: Mittelmark MB, Sagy S, Eriksson M, et al., editors. The Handbook of Salutogenesis [Internet]. Cham (CH): Springer; 2017. Chapter 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435830/ doi: 10.1007/978-3-319-04600-6_12

Kase, T., Ueno, Y., & Oishi, K. (2018). The overlap of sense of coherence and the Big Five personality traits: A confirmatory study. Health Psycology Open. Available from: http://doi.org/10.1177/2055102918810654

Vinje HF, Langeland E, Bull T. Aaron Antonovsky’s Development of Salutogenesis, 1979 to 1994. 2016 Sep 3. In: Mittelmark MB, Sagy S, Eriksson M, et al., editors. The Handbook of Salutogenesis [Internet]. Cham (CH): Springer; 2017. Chapter 4. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435860/ doi: 10.1007/978-3-319-04600-6_4

S. Super, M. A. E. Wagemakers, H. S. J. Picavet, K. T. Verkooijen, M. A. Koelen, Strengthening sense of coherence: opportunities for theory building in health promotion, Health Promotion International, Volume 31, Issue 4, December 2016, Pages 869–878, https://doi.org/10.1093/heapro/dav071