What is the sense of coherence (SOC) according to Antonovsky?

It began with an observation. In the early 1970s, the medical sociologist Aaron Antonovsky was analysing a study on Israeli women’s adaptation to menopause. Among the participants were two groups of women born in Germany in the 1920s. One group had arrived before the Second World War. The other had survived the Nazi concentration and extermination camps. That the survivors were on average less satisfied and rated their health lower came as no surprise. Antonovsky noticed something else: about 30 % of the survivors reported high life satisfaction. This is how his son, Dr. Avishai Antonovsky, tells it.

According to Dr. Avishai Antonovsky, this led to a new question: where does health come from? Medicine knew the word pathogenesis, the origin of disease. For the origin of health there was no word. Antonovsky coined it: salutogenesis, from salus, Latin for health, and genesis for origin. The salutogenic question is: what helps people move towards health? At any given moment, every person is somewhere on a continuum between total illness and total health.

Dr. Avishai Antonovsky describes the model with a river. Curative medicine tries to rescue people who have fallen in. Prevention tries to stop them from falling in. Salutogenesis assumes that all people are in the river all the time. Life is full of stressors, for example an argument, money worries, a sick child or losing one’s job. What matters is how well someone can swim.

Aaron Antonovsky published his answer to the salutogenic question in 1987 in the book “Unraveling the Mystery of Health”: the sense of coherence. Paraphrased, he describes it as a global orientation. It expresses the extent to which a person has a pervasive, enduring yet dynamic feeling of confidence that the stimuli arising from the inner and outer environment in the course of life are structured, predictable and explicable, that resources are available to meet the demands posed by these stimuli, and that these demands are challenges worthy of investment and engagement (Antonovsky, 1987, p. 19).

Three components follow from this. Dr. Avishai Antonovsky links each of them to a question. Comprehensibility answers the question “What is happening here?”. Manageability answers the question “How can I deal with it?”, for example with friends, family, money or physical fitness. Meaningfulness answers the question “Why is the effort worthwhile?”. The more people understand their challenges, the more resources they see and the more meaning they find in them, the more likely they are to cope successfully.

How does the sense of coherence work? According to Dr. Avishai Antonovsky, it is an orientation towards life, a way of looking at the world. It draws on resources that are not confined to the psychological domain, for example friends, family, money or physical fitness. This distinguishes it from resilience. Resilience mainly refers to the ability to recover after a crisis. The sense of coherence can help people cope with challenges without necessarily falling into crisis. He sees it as close to mental fitness, a learnable capacity that can be trained.

Why can it work? According to Dr. Avishai Antonovsky, it can help to reduce uncertainty about life’s challenges, to remember one’s coping resources and to emphasise the meaning in action. In the Journal of Epidemiology and Community Health (2005), Lindström and Eriksson explain the key concepts of salutogenic theory around the sense of coherence. According to them, the salutogenic approach could create a solid theoretical framework for health promotion. A study in Frontiers in Psychiatry (2021) describes the sense of coherence, following Antonovsky, as a generalised resistance resource against stress. Meaningfulness stands there for the desire to be motivated to cope.

According to Dr. Avishai Antonovsky, studies from many countries show that the sense of coherence can predict, for example, recovery after a heart attack, academic success and operational performance in the military. According to him, a strong sense of coherence acts as a protective factor against depression, post-traumatic stress disorder and occupational burnout. According to him, studies worldwide show a strong inverse relationship between employees’ sense of coherence and burnout.

According to the Handbook of Salutogenesis (2017), Antonovsky’s questionnaire has 29 items: 11 on comprehensibility, 10 on manageability and 8 on meaningfulness. A short version has 13 questions. The scales are considered reliable and valid. By the end of 2025, according to Dr. Avishai Antonovsky, the questionnaire had been translated into close to 70 languages and used in more than 50 countries. There are versions for families, communities, work teams and children.

The Handbook of Salutogenesis also names criticism: Antonovsky saw the sense of coherence, with its three components, as a single overall measure, meaning unidimensional. Recent research suggests that it is a multidimensional construct. Antonovsky’s assumption that it remains largely stable from the age of 30 until retirement finds no support in later research. According to Dr. Avishai Antonovsky, how stable the sense of coherence is across life remains a research question.

Aaron Antonovsky (1923–1994) was a medical sociologist and one of the founders of the Medical School at Ben-Gurion University of the Negev. The theory was born in the 1970s in a small home office near Beersheba. His wife, Dr. Helen Antonovsky (1925–2007), was his partner in developing salutogenic thinking and in writing the two seminal books. Their son, the psychologist Dr. Avishai Antonovsky, dedicates a page to the model: The Salutogenic Model of Health on antonovsky.com.

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