Salutogenic Approach Based Interview With People With Schizophrenia

Schizophrenia is a chronic and serious disease that affecting 20 million people in the world. Because of the problems these individuals face in cognitive, emotional, and behavioral domains, they have frequently difficulty in adapting to their environment, have to struggle against stigmatization, have an increased risk of committing suicide due to ever decreasing functioning and hopelessness they experience, and they need a long-term care and support due to their difficulty in compliance to treatment.

The sense of coherence and resilience are important components for individuals diagnosed with schizophrenia to cope with problems in cognitive, emotional, and behavioral domains. Sense of coherence reflects the capacity of a person to respond stressful situations. It is associated with a person's emotional responses and resources, making sense of the world, use of required resources, and respond to demands. Powerful sense of coherence helps a person to protect own health, to cope with the stress factors, to manage the strain, and to activate their resources.

Resilience is described as the capacity of individuals to recover or adapt after problems, difficult periods, and stressful life crises that they face during their life. This term can also be understood as the ability to ensure and/or maintain a state of coherence.

The model addressing the concepts of sense of coherence and resilience is salutogenic model. Salutogenic model (1996) which was developed by Aaron Antonovsky (1923-1994) is an alternative model to pathogenesis approach. While pathogenesis focuses on how the disease has occurred, salutogenesis focuses on how wellbeing is formed. Salutogenic approach attempts to explain why some people better cope with the strain, stressful life events and difficulties they face and how they maintain their health and wellbeing better compared to others. The most significant factor in personal evaluation of an external stimulus and in coping with the strain is explained with sense of coherence which is specified in the model. Sense of coherence is the fundamental concept of salutogenic theory and consists of three components. These are comprehensibility, manageability, and meaningfulness. Comprehensibility expresses that internal and external stressors experienced by a person are "expected" and "explainable" in the life. Manageability is the sense about that individual has the internal and external resources to cope with the situation caused by stressor. Meaningfulness states a person's perception on how they struggle against negative life events.

Lindström and Eriksson (2010) describe salutogenesis as an "umbrella". Under this umbrella, there are also concepts of "empowerment", "self-efficacy", "quality of life", "resilience", "welfare", and "competence" as well as the sense of coherence. It is accepted that all of these concepts are associated with salutogenic dimensions and provide significant contributions to describe, explain, analyze, and promote health.

There are studies applying intervention programs based on salutogenic model in people with mental disorder or groups at risk in terms of mental disorder. The first intervention program based on salutogenic model is talk therapy. The major goal of this application is to increase awareness and confidence of the participants and to promote their sense of coherence, coping skills, mental health, and welfare level by allowing them to recognize internal/external resources and potentials. With the talk therapy application, it is provided to manage stressful situations effectively by bringing out personal and collective resistance resources.

The intervention based on salutogenic model has five fundamental components. (1) Sustainability of health, (2) Story of the person, (3) Factors to promote health, (4) Understanding the health promotion power of tension and strain, (5) Active adaptation.

Traditional therapy which is recommended for recovery focuses on negative life events, diagnosis, and medication. In the talk therapy based on salutogenic approach, resources and coping potential of a person are addressed and three recovery factors are focused for the recovery process. These factors are (1) participants' perception about themselves as more than only a diagnosis and disease, (2) getting respected about discovering themselves and getting discovered by other people, (3) having control of their own lives. Psychiatric nurses take part as group leaders in the intervention. Focus of the talk therapies is their speech.

It is stated that it could be possible for a person diagnosed with schizophrenia to gradually regain the ability of functioning independently, to rebuild family relationships, and to fulfil professional roles and functions with the practices to be made by the help of salutogenic model. Therefore, these people should be empowered to decide about their lives. By this means, it is possible to lead a satisfying life for them against the restrictions caused by the disease. A study evaluating sense of coherence and quality of life for people diagnosed with schizophrenia revealed that sense of coherence was an indicator for the quality of life. Bengtsson-Tops and Hansson (2001) concluded in their literature review on sense of coherence that the studies using methods regarding care, support and recovery of people diagnosed with schizophrenia or schizoaffective disorder could be useful in terms of recovery. In the light of these findings, Bengtsson-Tops and Hansson concluded that actions to improve cognitive abilities of people in order to facilitate the recovery could be increased by the concepts of sense of coherence. Menzies (2000) providing detailed information about how salutogenic approach should be applied for a person diagnosed with schizophrenia highlighted that psychiatric nurse would develop a person's hopes allowing them to cope with symptoms and problems, would enhance their self-esteem supporting their abilities and skills, would contribute development of their personal identity, and would increase the sense of coherence.

It is stated in the literature that practices based on salutogenic model and talk therapy based on this model could be used for people diagnosed with schizophrenia. In the international literature, there is no study in which salutogenic-based talk therapy program is applied to only people diagnosed with schizophrenia. In Turkey, there has been no study examining the efficacy of any intervention program based on this model.