Targeting Resilience & Sense of Coherence
Resilience has been defined by the American Psychological Association as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat” (Southwick and Charney, 2012). However, is it unclear what is meant by ‘adapting well’. A paper that examined the definitions of resilience claimed that no operationalised definition truly exists, but the central question surrounding resilience concerns how some people are able to withstand adversity without developing adverse physical or mental health outcomes (Herman et al, 2011). Factors that influence resiliency fall under three categories; individual, context and life events (Lindstrom & Eriksson, 2010). Examples of individual factors include genetics, age and life experience. The context refers to social class, support and culture. Whereas life events concern the quantity and quality of such events, examples surrounding the controllability, desirability, magnitude etc. Some researchers have adopted a salutogenic approach, meaning that they focus on the factors that assist in one’s individual level of resilience. One key factor within this approach is a ‘sense of coherence’, which refers to the capability to organise the resources and social context of one’s life and manage themselves, and that the demands that one faces are meaningful and comprehensible (Allardt et al., 1980; Antonovsky, 1987). It has been argued that people with a strong sense of coherence are cognitively and emotionally more capable of managing problems and stressors and are thus more resilient to negative physical and mental health outcomes (Pallant and Lae, 2002). Low SOC has been found to be a significant predictor of depression (Sairenchi et al, 2011) and anxiety traits (Hart, Hittner and Paras, 1991). Successful interventions to increase SOC surround a focus on the individual, such as person-centred therapy (von Humboldt and Leal, 2013) or a pycho-drama intervention (using role play, imagination, writing, music, drawing etc. to investigate something of importance to an individual) (Kähönen et al, 2012).  
There is an abundance of research highlighting the relationship between resilience and health, with resilience moderating the relationship between stress with trait anxiety and depressive symptoms (Gloria & Steinhardt, 2014). Higher levels of resilience have also been associated with reduced symptoms of depression subsequently influencing both mental and physical health, along with reduced chronic pain (Mehta et al., 2008; Schure, Odden & Goins, 2013). It is argued that people with greater resilience view life stressors as challenges and employ strategies to actively cope with them (Bonanno et al., 2015).
Comprehensive training programmes have been developed to specifically target building resilience, including stress inoculation training (Meichenbaum & Deffenbacher, 1988), hardiness training (Maddi, 2008), the Psychoeducational Resilience Training Programme (Steinhardt & Dolbier, 2008), and the military’s Comprehensive Solider Fitness Programme (Cornum, Matthews & Seligman, 2011). There is a clear interest in resilience building, however many of these programmes lack supporting evidence regarding their efficacy (Southwick et a., 2015). Researchers have also argued that resilience training does not differ substantially from other forms of psychological training, and the impact of such training depends on the chosen outcome measures and training setting (Forbes & Fikretoglu, 2018).
Resilience-focused research in the 1980s predominantly concerned the ability to bounce back from adversity, known as recovery as resilience (Garmezy, 1991). Whereas resilience-building techniques based off the principles of positive psychology are now being recognised as a viable strategy to prevent ill-health (Davydov et al., 2010). An example of which focuses on optimism (Seligman, 2007), proving to be effective in improving wellbeing and coping styles (Khosla & Hangal, 2004; Scheier & Carver, 1992). The Penn Resilience Programme (PRP) and PERMA workshops have been developed to build resilience, wellbeing and optimism. These programmes have been applied to children, proving beneficial in reducing mental health symptoms among 11- to 12-year-olds (Gillham et a., 2006), as well as preventing symptoms of depression in adolescents (Cutuli et al., 2007), and increasing resilience and positive emotion among medical students (Peng et al., 2014).