Motivation and emotion/Book/2020/Sense of coherence

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

Overview[edit | edit source]

Focus questions:

  • What is sense of coherence?
  • What is the salutogenic model of health?
  • What are the effects of sense of coherence?
  • How is a sense of coherence developed?
  • How is a sense of coherence measured?

Sense of Coherence[edit | edit source]

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

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 on, in 1979, Antonovsky developed his theory of health and illness, which he called salutogensis[spelling?], and the model was described in his book, Health, Stress and Coping.[1] 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 you face.[2]

Sense of coherence is a core consruct[spelling?] of the salutogenic model, 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. The three core elements of sense of coherence are; Comprehensibility, Manageability and Meaningfulness. These three elements are all comrpised[spelling?] within the salutogenic model of health, however the model of salutogenesis stems into sense of coherence. The sense of coherence reflects a person's view of life and their capacity to respond to stressful situations. It's considered a global orientation to view one's life as a managable[spelling?] , 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 interal[spelling?] resources and utilise them in a way that promotes health and well-being, which can loop back to the salutogenic model of health. [3]

Fundamentally, a sense of coherence is a coping mechanism that allows people to deal with everyday stressors in life.[4] A sense of coherence also proposes that in order for people to deal with life stressors, it is essential that an individual is able to reflect on their understanding of a stressful situation, and that they also understand that helpful resources are available to them.

The Salutogenic Model of Health[edit | edit source]

Salutogenesis

Salutogenesis is a medical approach which focuses on factors that support human health and well-being, rather than on factors that cause disease, which is what pathogenesis focuses on. The theory essentially refers to a theory of how and why certain people remain healthy.

Pathogenesis

Pathogenesis is the biological mechanisms that lead[grammar?] to a diseased state. The term also describes the origin and development of a disease, and the state it is in, such as, acute, reccurent[spelling?] or chronic. Essentially, it describes how a disease begins and develops.

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 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. [5]

The three key concepts are; Comprehensibility, Manageability and Meaningfulness. These concepts are all important and all have their own meanings. Firstly, comprehensibility is the extent to which an individual perceieves[spelling?] events making logical sense, and how someone may perceieve[spelling?] external and internal stimuli and comprehend it in a rational manner. Secondly, manageability is the extent to which an individual feels they can cope, and what resources someone may have access too in order to manage stressful stimuli and lastly, meaningfulness is how much an individual feels that their life makes sense and that challenges are worthwhile and fulfilling . [6] This concept may also come into play when we face an challenge or problem in our lives.

Development of Sense of Coherence[edit | edit source]

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.

A sense of coherence is developed 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.

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 interveiws[spelling?] , Antonovsky found that 29% of the women reported good health, although they survived the Holocaust. This led him to focus on smaller numbers of respondents and began a search for their health resources. This was the beginning of Antonovsky's shift from pathogenesis to salutogensis[spelling?] which lead to the emergence of the sense of coherence theory (Eriksson, 2016).

The Effects of Sense of Coherence[edit | edit source]

A sense of coherence can effect an individual's mental health in various ways. Having a strong sense of coherence may serve as protection against depression, [grammar?] for this reason, it can help improve life satisfaction, and is also linked with reduced lonelines[spelling?], anxiety and exhaustion [7]. It can also effect[grammar?] stress as a sense of coherence, in it's[grammar?] 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.

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. [8] As stated in the development section, Antonovsky's study on Israeli women and perceieved[spelling?] health, regardless of having suffered from unfortunate health circumstances, almost 30% of the women were still able to report good health, and this was likely due to them having a high sense of coherence.

Biopsychosocial Factors

The biopsychosocial model views health and illness as products of biological, behavioural and social factors. This includes lifestyle, genetics, cultural influences and relationships. The model examines how these aspects play a role in the development of health and disease. In terms of sense of coherence, it may be helpful to understand the biopsychosocial factors for stress or pathogenesis, as biopsychosocial factors may influence health and the development and basis of disease.

Quiz[edit | edit source]

What are the 3 concepts from the salutogenic health model?

Comprehensibility, Meaningfulness, Controllability
Meaningfulness, Manageability, Controllability
Comprehensibility, Manageability, Meaningfulness


Measuring Sense of Coherence[edit | edit source]

Antonovsky developed the 29 item orientation to life questionnaire to measure sense of coherence. It has 11 items that measure comprehensibility, 10 items measuring manageability and 8 items to measure meaningfulness. The questionnaire's yielded scores are [grammar?] ranged from 29 to 203. Antonovsky also developed a shorter questionnaire with 13 questions with a score range of 13 and 91. Research has shown that a sense of coherence is a multidimensional construct rather than unidimensional, which was what Antonovsky believed. [9] Due to all 3 of the constructs constantly interacting to form a common factor, the construct validity of the sense of coherence model is complex.

Examples of items which measure the comprehensibility construct are:

  1. When you talk to people, do you have a feeling that they don't understand you?
  2. Do you have a feeling that you're in a familiar situation and you don't know what to do?

Examples of items that measure the manageability construct are:

  1. When something unpleasant happens in the past, your tendency was ___ ?[explain?]
  2. When you do something that gives you a good feeling ___[explain?]

Lastly, examples of the meaningfulness construct are:

  1. Doing the things you do everyday is ___[explain?]
  2. When you think about your life, you very often ___ [explain?]

The sense of coherence scales have been empirically tested in different cultures, both in Africa, Asia and Western society[factual?]. The scale had also been tested on different population, people in different professions, persons with disabilities, different patient groups such as adults, elderly and young children[factual?]. In short, the SOC questionnaire has been used in studies all over the world, with samples of various different ages, cultures and practices[factual?].

Conclusion[edit | edit source]

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 of these 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 constructsts[spelling?] ; comprehensibility, manageability and meaningfulness all have their own meanings and reflect an individuals[grammar?] understanding on how to deal with stressors in a logical and rational manner, how to utilise resources available and how much an individual feels their life and the obstacles and challenges faced are worthwhile and meaningful. These constructs are measured in detail in the 29-item orientation life questionnaire, which has been empirically tested in many cultures, countries and within different populations.

See also[edit | edit source]

References[edit | edit source]

Collingwood, J. (2020). Your Sense of Coherence. Psych Central. Retrieved on October 15, 2020, from https://psychcentral.com/lib/your-sense-of-coherence/’s Salutogenic approach. (2014, September 20). DTA. https://dta.com.au/dta-salutogenic-approach/

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[spelling?] sense of coherence scale and the relation with health: a systematic reviewJournal[spelling?] 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

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

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

Wikipedia contributors. (2020, October 13). Aaron Antonovsky. Wikipedia. https://en.wikipedia.org/wiki/Aaron_Antonovsky

External links[edit | edit source]

  1. https://en.wikipedia.org/wiki/Aaron_Antonovsky
  2. https://www.ncbi.nlm.nih.gov/books/NBK435812/
  3. https://www.ncbi.nlm.nih.gov/books/NBK435812/
  4. Super, S.; Wagemakers, M. a. E.; Picavet, H. S. J.; Verkooijen, K. T.; Koelen, M. A. (2016-12-01). "Strengthening sense of coherence: opportunities for theory building in health promotion". Health Promotion International 31 (4): 869–878. doi:10.1093/heapro/dav071. ISSN 0957-4824. https://academic.oup.com/heapro/article/31/4/869/2593454. 
  5. https://dta.com.au/dta-salutogenic-approach/
  6. https://psychcentral.com/lib/your-sense-of-coherence/#:~:text=It%20has%20three%20components%20%E2%80%93%20comprehensibility,person%20feels%20they%20can%20cope.
  7. read, Jane Collingwood Last updated: 14 Jan 2020 ~ 4 min (2016-05-17). "Your Sense of Coherence". psychcentral.com. Retrieved 2020-10-14.
  8. Eriksson, Monica; Lindström, Bengt (2006-05-01). "Antonovsky’s sense of coherence scale and the relation with health: a systematic review". Journal of Epidemiology & Community Health 60 (5): 376–381. doi:10.1136/jech.2005.041616. ISSN 0143-005X. PMID 16614325. https://jech.bmj.com/content/60/5/376. 
  9. Eriksson, Monica; Mittelmark, Maurice B. (2017). Mittelmark, Maurice B.; Sagy, Shifra; Eriksson, Monica; Bauer, Georg F.; Pelikan, Jürgen M.; Lindström, Bengt; Espnes, Geir Arild (eds.). The Handbook of Salutogenesis. Cham: Springer International Publishing. pp. 97–106. doi:10.1007/978-3-319-04600-6_12. ISBN 978-3-319-04600-6.