Motivation and emotion/Book/2019/Sense of coherence

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

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Overview

This book chapter will focus in-depth on sense of cohesion by answering the following questions:

Focus questions: What is sense of coherence? How does it fit in with the salutogenic approach? How does it fit in with motivation and emotion? What are the effects? What is the course of development? What is the sense of coherence scale?

What is sense of coherence?

According to Antonovsky (1987), the definition of sense of coherence (SOC) is '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 meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement'.

Figure 1. Antonovsky's salutogenic aproach

The salutogenic approach

Sense of coherence is a key concept of the salutogenic theory which describes a state of health on a continuum rather than either ease or disease as shown in figure 1. Antonovsky was curious as to why some people stay well even when in the midst of adversity and extremely situations and why some do not (Eriksson & Lindstrom, 2007). He explored this question and was able to come up with the sense of coherence, a stable trait that influences how a person sees the world. Using a systems theory of thinking, Antonovsky (1987) made two major observations in the way he saw the world the first being that he noticed people interacting with their environment and secondly that phenomena like chaos and change are very normal parts of life. These observations formed the basis for much of this theory.

Three components of sense of coherence

The sense of coherence theory is made up of three components which relate to one another and form an individual's sense of coherence.  

Meaningfulness relates to motivation and includes how much an individual feels that their life has meaning emotionally and that challenges are worthy of attention not just burden's to deal with. It's motivational aspect comes from the individual needing to have the drive to cope with stressful events (Eriksson & Mittelmark, 2017) Meaningfulness can also be related to the result of a low sense of coherence, if one does not feel as though their goals and lives are worth commitment then problems like depression or anxiety may occur (Dezutter, Wiesmann, Apers & Luyckx, 2013).  

Comprehensibility refers to the extent that individuals feel as though events in their lives make sense logically and are structured. Antonovsky believed that to be able to cope with stressful situations one needs to be able, to a degree, understand them and make sense of the chaos they bring (Dezutter, Wiesmann, Apers & Luyckx, 2013). Due to the mental processes at play, this is also known as the cognitive dimension of this concept. This aspect can also affect mental health negatively as it may not make sense to that individual why certain things happen to them and that they are 'out of control' (Nielsen & Matthiesen, 2008).  

Finally, manageability is the degree that one feels they have the resources required to cope with stressful situations. These resources are referred to as generalised resistance resources (GRRs) and can be internal or externally in the environment (Super et al., 2016).

This approach sees health as a continuum between health-ease and dis-ease and prefers to target positive health than ill-health (Super et al., 2016).

How does sense of coherence fit within motivation and emotion?

• Motivation to deal with adverse events in life
• Emotion - coping with stress in a constructive way

Effects of the sense of coherence

Sense of coherence is a concept that can affect both mental and physical health as discussed below;

Figure 2. Life is filled with many stressors

Mental health

Sense of coherence is a massive factor in mental health as it involves coping effectively with stressful situations. Effective generalised resistance resources are crucial in maintaining a healthy mind and dealing with adversities that life comes with. A strong sense of coherence can be protective against mental health issues such as depression, anxiety and stress (Kövi et al., 2017). The three components of sense of coherence are also all equally relevant to mental health. Comprehensibility is important because information is able to be perceived in a structured way so as to understand it. Manageability is needed in the self-perception that one has of themselves and their ability to use GRRs to their advantage. Finally meaningfulness is useful in terms of confidence that individual's goals and beliefs are important and worthy enough of investment (Kövi et al., 2017).

Case study by Nielsen, Matthiesen & Einarsen (2008) on whether SOC could be a protective factor against workplace bullying: Results showed that a strong SOC was protective only when bullying was mild however when it was severe the benefits were less so. Bullying had a detrimental effect on participants meaningfulness, manageability and comprehensibility. The bullying could also cause cognitive dissonance between the attitudes associated with having a strong SOC and the experience of bullying. Participants had a diminished sense of manageability and felt as though they had no resources (GRRs) to use when faced with the bullying which caused a lowered SOC.

Physical health

How strong of a sense of coherence has been found to be important in physical health of some patients. Individuals with a strong SOC and musculoskeletal pain who were receiving care in a clinic were found to be much less susceptible to major depression and had limited co-morbid medical conditions (Chumber et al., 2013). Results of a trial to evaluate levels of SOC in these patients found that having a strong SOC was linked to better health, social functioning and pain efficacy (Chumber et al., 2013).

What is the course of development?

The sense of coherence is developed throughout childhood to adulthood before diminishing and can be improved through certain interventions.

How is it developed?

Antonovsky believe that sense of coherence was developed throughout childhood and adolescence until the age of 30 where it remained stable until retirement where it starts to diminish (Super et al., 2016). This however has not been found to be supported by research, instead it seems as though it stays fairly stable over time, even increasing as we age (Super et al., 2016).  

Can it be improved?

Sense of coherence can be influenced with certain interventions with the intent of building health promotion activities to improve it. Kähönen, Näätänen, Tolvanen & Salmela-Aro (2012) conducted a study in which two groups of employees who displayed symptoms of burnout were given different interventions aimed at improving aspects of their beliefs and patterns of behaviour. After 9 months both of these groups showed meaningful improvements when compared to the control group. In another study a 12 month intervention program was introduced to a group of people who were diagnosed with psychiatric illnesses. In comparison with the control group, the group who received the intervention were found to have a much higher SOC after participating in structured activities with an appropriate level of challenge (Forsberg, Björkman, Sandman & Sandlund, 2010).

Generalised resistance resources also have a huge influence on a person's sense of coherence, the type and how they apply them can be used to prevent affects of stressors in the long term (Super et al., 2016).  GRRs can aide in the form of avoiding stressors, redefining them as non-threatening and by managing them in a healthy way. Good health may also allow for further GRRs to be obtained throughout life (Super et al., 2016). Super et al (2016) identified two possible ways of strengthening the SOC, the first being if people are supported in finding suitable GRRs for the situation this can positively affect the SOC. The second is using GRRs to create positive life experiences that can be used as lessons to see stressful situations as stable and valuable, which in turn increases SOC (Super et al., 2016).  According to a study conducted by Amirkhan & Greaves (2003) who aimed to examine the processes underlying SOC, many aspects were found that can be utilised. The most important aspect found was empowerment, specifically the empowerment to be confident enough to use their GRRs appropriately (Amirkhan & Greaves, 2003). Therefore working on improving the meaningfulness, manageability and comprehensibility aspects of the sense of coherence by using and attaining added GRRs can aid in preventing stressors.

Mindfulness based stress reduction programs have been shown to engage all these areas while also allowing users to focus on the present which in turn allows an improvement in making sense of a situation, being aware of one's resources and feeling as though something is worthy of one's time (Super et al., 2016).

What is the sense of coherence scale?

The sense of coherence scale aims to assess how individuals see their world and how they use the resources they have to cope with stressful situations in their lives (Eriksson & Mittelmark, 2017).

Three main components of the sense of coherence:

• Comprehensibility, with 11 items on the scale - how much events are seen as making sense logically, as well as individuals being able to create structure within their life, even with turmoil. In other words, individuals must be able to understand the situations in their life in order to cope with them. This section is predominately focused on cognitive aspects.
• Manageability, with 10 items - A person's belief that they are able to cope, and that there are multiple resources or services that they are able to turn too. This section has behavioural aspects to it.
• Meaningfulness, with 8 items - how much one feels that challenges are worth it and that they make sense. This component focuses on the motivation factor.

The user of this SOC measurement receives a score from 29 to 203 in the original scale built by Antonovsky, but other versions have been constructed since then and for different specific areas such as for families (Eriksson & Mittelmark, 2017).

Conclusion

Should go here.

References

Amirkhan, J., & Greaves, H. (2003). Sense of Coherence and Stress: The Mechanics of a Healthy Disposition. Psychology & Health, 18(1), 31-62. doi: 10.1080/0887044021000044233

Antonovsky, A. (1987). The Jossey-Bass social and behavioral science series and the Jossey-Bass health series. Unraveling the mystery of health: How people manage stress and stay well. San Francisco, CA, US: Jossey-Bass.

Chumbler, N., Kroenke, K., Outcalt, S., Bair, M., Krebs, E., Wu, J. and Yu, Z. (2013). Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain. Health and Quality of Life Outcomes, 11(1), p.216.

Dezutter, K., Weismann, U., Apers, S. & Luyckx, K. (2013) Sense of coherence, depressive feelings and life satisfaction in older persons: a closer look at the role of integrity and despair, Aging & Mental Health, 17:7, 839-843,

Eriksson, M., & Lindstrom, B. (2007). Antonovsky's sense of coherence scale and its relation with quality of life: a systematic review. Journal Of Epidemiology & Community Health, 61(11), 938-944. doi: 10.1136/jech.2006.056028

Eriksson M., Mittelmark M.B. (2017) The Sense of Coherence and Its Measurement. In: Mittelmark M. et al. (eds) The Handbook of Salutogenesis. Springer, Cham Forsberg, K., Björkman, T., Sandman, P., & Sandlund, M. (2010). Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence. Journal Of Clinical Nursing, 19(11-12), 1519-1528. doi: 10.1111/j.1365-2702.2009.03010.x

Kähönen, K., Näätänen, P., Tolvanen, A. & Salmela‐Aro, K. (2012). Development of sense of coherence during two group interventions. Scandinavian Journal of Psychology 53, 523–527

Kövi, Z., Odler, V., Gacsályi, S., Hittner, J., Hevesi, K., Hübner, A., & Aluja, A. (2017). Sense of coherence as a mediator between personality and depression. Personality And Individual Differences, 114, 119-124. doi: 10.1016/j.paid.2017.03.064

Nielsen, M., Matthiesen, S. and Einarsen, S. (2008). Sense of coherence as a protective mechanism among targets of workplace bullying. Journal of Occupational Health Psychology, 13(2), pp.128-136.

Super, S., Wagemakers, M., Picavet, H., Verkooijen, K., Koelen, M., Strengthening sense of coherence: opportunities for theory building in health promotion, Health Promotion International, Volume 31, Issue 4, December 2016, Pages 869–878,