POCZUCIE KOHERENCJI W WYBRANYCH CHOROBACH ALERGICZNYCH
Karina Badura-Brzoza, Magdalena Piegza
DEPARTMENT OF PSYCHIATRY IN TARNOWSKIE GORY, SCHOOL OF MEDICINE WITH THE DIVISION OF DENTISTRY IN ZABRZE,
MEDICAL UNIVERSITY OF SILESIA, ZABRZE, POLSKA
According to “holistic” model of physician’s approach to the patient, physical, psychological and social aspects should be taken into account when we assess disease and effects of diagnostics and treatment. Those attributes form health related quality of life. Patient’s disposition to disease depends on many psychological factors, among them sense of coherence (SOC). Sense of coherence is a health-promoting life orientation, perceiving the world as comprehensible, manageable and meaningful. The prevalence of allergic diseases is dramatically increasing. This epidemy strongly influences comfort of patient’s life. In our paper we try to present the current knowledge on sense of coherence as a factor potentially influencing the course of allergic diseases.
Zgodnie z holistycznym modelem podejścia do pacjenta, gdy analizujemy chorobę i efekty diagnostyki oraz leczenia, powinny być brane pod uwagę fizyczne, psychologiczne i społeczne aspekty indywidualnego funkcjonowania. Te elementy składają się na jakość życia zależną od zdrowia. Stosunek pacjenta do choroby jest uwarunkowany wieloma czynnikami psychologicznymi m.in. poczuciem koherencji. Poczucie koherencji to prozdrowotna orientacja życiowa, pozwalająca postrzegać świat jako przewidywalny, zrozumiały i sterowalny. Rozpowszechnienie chorób alergicznych dramatycznie rośnie, znacznie wpływając na komfort życia. W naszym opracowaniu staramy się przedstawić obecny stan wiedzy na temat poczucia koherencji jako czynnika potencjalnie wpływającego na przebieg chorób alergicznych.
Wiad Lek 2018, 71, 9, 1774-1776
Before attempting to assess various models of a patient’s attitude to a disease, one should consider which variant will be the most favorable one to the patient and thus should be spread. Extreme attitudes toward a disease include: attempts to ignore the symptoms completely, selective abiding by the doctor’s recommendations concerning everyday life and applied treatment as well as attempts to lead a life identical to that of healthy persons. The latter model of behavior undoubtedly helps one maintain a high quality of life, but it may negatively affect disease progression and prognosis, leading to a number of adverse events. In the opposite situation, the patient completely gives in to the disease, viewing it as a state of an irreversible disaster which thwarts any dreams and aspirations as well as exempts one from the necessity to carry out the activities of everyday life. Even if the patient abides by the doctor’s recommendations and their condition improves as a result (the symptoms regress or are at least alleviated), such an approach completely restructures their personality and attitude toward themselves and the surroundings, with all the adverse consequences included.
There are many variants in between the abovementioned extreme attitudes to a disease. Therefore, what makes a patient choose a particular model of behavior in a given situation? Which personality elements, traits of character and resources available to the person influence behavior diversification? Why can patients with similar courses of a disease demonstrate totally different attitudes to everyday limitations and differently assess their possibilities in life? Is the way of coping with a difficult situation related to the patient’s personality parameters and ability to cope with such situation and accept its existence (referred to as the sense of coherence)?
SENSE OF COHERENCE ACCORDING
TO A. ANTONOVSKY
The sense of coherence (SOC) is a property characteristic of stress management mechanisms. It is defined as the way of viewing the world which allows one to perceive the surrounding phenomena in a comprehensible, manageable and meaningful manner [1, 2]. If a disease is viewed as a state of chronic stress, persons with a strong sense of coherence are more likely to develop adaptive behaviors, lead a healthy and hygienic lifestyle, notice disease symptoms and react accordingly as well as abide by the doctor’s recommendations.
Sense of coherence is a term coined by Antonovsky based on the assumptions of salutogenic orientation [3, 4]. Salutogenesis examines health-supporting factors and sources of health as well as attempts to establish why certain people remain healthy or recover quickly despite functioning in unfavorable conditions where they are exposed to numerous stressors and pathogenic factors. The essence of the answer to the fundamental questions of salutogenesis is the sense of coherence.
Contrary to researchers promoting the pathogenic theory, which focuses mainly on the mechanisms leading to a disease and on their avoidance, supporters of the salutogenic theory lay the emphasis first and foremost on defense mechanisms. A strong sense of coherence encompasses a belief that the surrounding world is predictable and assumes a significant role of one’s self-agency in modeling the events in accordance with one’s expectations .
The sense of coherence consists of three elements:
1. Comprehensibility — the cognitive aspect of a situation where the body faces a stimulus. It conditions the ability to order and structure the received information. It also facilitates anticipation of specific events or at least allows one to believe that if unexpected situations take place, it will be possible to understand and order them.
2. Manageability — an individual’s feeling that they possess means or resources allowing them to influence the situation actively. Those do not need to be material resources or means under the individual’s personal control. The resources may be possessed by the family, friends or organizations; they can also refer to religion. An important aspect here is the feeling that one can rely on somebody or something should the need arise.
3. Meaningfulness — the emotional aspect of the attitude toward a situation and the stimuli faced by a human being. Meaningfulness is a conviction that it is worth getting involved in a given situation, fighting and actively influencing one’s life. It makes one perceive a difficult situation as a challenge and not a threat [5, 4].
The power of the sense of coherence is the ability to understand a difficult situation (comprehensibility), the belief in the sense of taking action (meaningfulness) and the resources allowing one to tackle the problem (manageability). All those factors prevent transformation of tension into pathogenic distress, which may lead to psychosomatic diseases, psychic disturbances and psychoactive substance abuse [4, 6−8]. Their interactions have direct physiological consequences because they influence body immunity via hormonal mechanisms. Those elements favor health-supporting behaviors such as hygienic lifestyle, avoidance of harmful addictions and follow-up visits. In short, they promote health. The level of the sense of coherence is finally shaped when one is approximately thirty years old [4, 6, 8, 9]. The concept of the sense of coherence assumes that SOC may be much lower in persons with somatic diseases and psychic disturbances and may be treated as a significant variable in the treatment process [7, 9−11].
SENSE OF COHERENCE AND ITS RELATION TO SYMPTOMS OF DEPRESSION AND ANXIETY IN SOME ALLERGIC DISEASES
An assessment of the quality of life and the unfavorable phenomena leading to emotional disturbances becomes especially important in the case of chronic diseases, the frequency of which has been increasing. Such ailments include allergic diseases (especially asthma), atopic dermatitis, chronic urticaria and allergic rhinitis.
Allergic diseases are becoming increasingly common both in Europe and worldwide in recent years; this is confirmed, among other things, by the European White Book on Allergy — a report published already in 1997 . A dozen years ago, atopic features affected 10–15% of European population, while in 1997, relevant assessments mentioned 25%. Presently, in certain age groups, the assessed frequency of sporadic allergic rhinitis is 10–15% (the chronic form — 10%), bronchial asthma — 2–5% and atopic dermatitis — even 12%.
Struggling with a chronic somatic disease encompasses two types of activities. Some of them concern the therapeutic procedures undertaken by the patient and the treating team, while others are related to the necessity of coping with the stress caused by disease development, treatment and hospitalization. A disease causes a feeling of being threatened, helpless and insecure; it also hinders the accomplishment of one’s life’s goals and adversely affects one’s perception of oneself . An effective struggle with stress, a disease or disability depends, among other things, on choosing an adequate preventive activity, which is defined both by situational factors and personal qualities. In this context, the sense of coherence may be deemed such a personal variable .
A number of studies conducted thus far confirms the relationship between a lower sense of coherence and a higher intensity of depression and fear as well as the occurrence of certain somatic diseases [14, 15]. However, the number of studies concerning changes shown by the parameters of the sense of coherence in chronic allergic diseases is clearly limited. Zirke et al. conducted a study in which they demonstrated that patients with chronic asthma and atopic dermatitis had a lower sense of coherence accompanied by higher parameters of depression and fear than persons suffering from chronic tinnitus . Potoczek compared patients with aspirin-induced asthma to persons suffering from severe asthma (the latter demonstrated lower values of the general sense of coherence and its components), pointing at the differences in the intensity of depression and fear symptoms depending on the sex. The author ponders the possibility that a decreased SOC influences the development and severity of depression and fear symptoms, especially in women with severe asthma . Similar relationships, albeit in patients with atopic dermatitis, were noted by another team of researchers, who underline the presence of an elevated depression level and its connection with a lowered SOC in patients with atopic dermatitis compared to persons with remission and persons without allergic diseases . We have also found two studies concerning negative emotions and their relationship with the parameters of the sense of coherence in patients with chronic urticaria [18, 19]. The first study highlights the already known negative correlation between fear and depression and global SOC and its components as well as, interestingly, a negative correlation between the severity of disease symptoms and total SOC . The second study reports lower SOC levels, higher fear levels and a higher intensity of depression symptoms as well as lowered concentrations of dehydroepiandrosterone sulfate (DHEA-S) in persons with chronic urticaria in comparison with healthy persons .
The total SOC values in the abovementioned groups of allergic diseases were lower than in healthy persons. Thus, one can assume that the chronic disease itself is one of the factors decreasing the sense of coherence. Most study participants had struggled with an allergic disease for many years, which means that it had certainly taken place also in the years when the parameters of the sense of coherence are normally shaped. This may actually be a vicious circle: a chronic disease leads to shaping a lower sense of coherence, which in turn impairs the patient’s ability to cope with the disease. It should be noted that the parameters of the sense of coherence decreased similarly regardless of the allergic disease type. Therefore, one can conclude that in shaping the sense of coherence, the presence of a chronic disease is more important than the type of disease symptoms.
Another significant issue is how the influence exerted by the disease via the sense of coherence shapes the parameters of that disease (how it affects possible additional symptoms and consequences of the disease).
Most allergic diseases begin in childhood; therefore, the parameters of the sense of coherence in this patient group should be treated not only as elements responsible for the manners of coping with the disease, but also as elements shaped by that disease. It seems that any therapeutic interventions leading to strengthening of the sense of coherence may be important in coping with the stress which accompanies chronic allergic diseases.
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Conflict of interest:
The Authors declare no conflict of interest.
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