Why Some People Stay Well: The Science of Stress, Coping, and Meaning

Stress is an inevitable part of human life. Yet not everyone exposed to adversity becomes ill or overwhelmed. This article explores Aaron Antonovsky’s salutogenic model (1979), which focuses on the origins of health rather than disease. Central to this model is the concept of sense of coherence, a global orientation that helps individuals perceive life as comprehensible, manageable, and meaningful. By integrating insights from Cognitive Behavioural Therapy (CBT), solution-focused brief therapy (SFBT), and systemic approaches, this article outlines how psychological flexibility, adaptive coping, and meaning-making enhance resilience and well-being.

In modern society, stress has become a universal experience that affects mental and physical health. However, the presence of stressors does not automatically result in illness. The central question, as posed by Aaron Antonovsky (1979), is not “Why do people fall ill?” but rather “Why do people stay well despite stress?” His salutogenic model offers a paradigm shift within health psychology and psychotherapy, moving from a pathogenic to a health-promoting perspective.

Antonovsky (1979) proposed that life inherently involves tension and that well-being depends on one’s ability to manage this tension effectively. Rather than eliminating stress, the focus lies on how individuals mobilise internal and external resources; what he called generalised resistance resources (GRRs); to restore balance and maintain health. These resources may include social support, financial stability, education, cultural identity, and personal competence.

Research has consistently shown that a salutogenic orientation predicts greater psychological and physical well-being, improved recovery from illness, and lower burnout rates ³.

Stress, Stressors, and Life Events

Stress is a response to internal or external demands that challenge one’s capacity for equilibrium. A stressor may be a single life event, such as bereavement or migration, or an accumulation of “daily hassles” that gradually erode resilience ⁶. Importantly, it is not the event itself but the interpretation and perceived controllability that determine its impact.

Studies demonstrate that chronic exposure to stressors without adequate coping resources increases vulnerability to anxiety, depression, and somatic symptoms ⁷. Conversely, individuals who appraise stress as meaningful or manageable often experience growth and learning, even after adversity ¹².

Stress is a response to internal or external demands that challenge one’s capacity for equilibrium. A stressor may be a single life event, such as bereavement or migration, or an accumulation of “daily hassles” that gradually erode resilience ⁶. Importantly, it is not the event itself but the interpretation and perceived controllability that determine its impact.

Coping and Psychological Flexibility

Antonovsky (1979) defined coping as a dynamic process through which people confront and regulate stress. Effective coping requires three interrelated capacities: rational assessment of the situation, flexibility in strategy, and foresight regarding consequences.

Modern psychological science has expanded this view through the concept of psychological flexibility; the ability to stay in contact with the present moment while adjusting behaviour in accordance with values and contextual demands ⁴. Research shows that greater flexibility predicts lower distress and higher life satisfaction across clinical and non-clinical populations.

Sense of Coherence

The cornerstone of Antonovsky’s model is the sense of coherence (SOC), defined as a global life orientation that reflects a person’s enduring yet dynamic confidence that:

Comprehensibility: life is structured and predictable;

Manageability: adequate resources are available to meet demands;

Meaningfulness: Challenges are worth investment and engagement.

Empirical studies have demonstrated that a strong SOC correlates with higher resilience, lower perceived stress, and improved mental health outcomes ³. Meaning, in particular, appears to act as a protective mechanism, transforming stress from threat into challenge.

Studies demonstrate that chronic exposure to stressors without adequate coping resources increases vulnerability to anxiety, depression, and somatic symptoms ⁷. Conversely, individuals who appraise stress as meaningful or manageable often experience growth and learning, even after adversity ¹².

Integration with Evidence-Based Therapies

Cognitive Behavioural Therapy (CBT)

CBT provides structured methods for identifying and modifying maladaptive thoughts and behaviours. Meta-analyses confirm its effectiveness in stress reduction and emotional regulation ⁹. The CBT emphasis on cognitive appraisal and behavioural mastery mirrors Antonovsky’s principles of comprehensibility and manageability. Through reframing unhelpful beliefs, clients cultivate a more coherent and balanced worldview.

Solution-Focused Brief Therapy (SFBT)

SFBT aligns closely with the salutogenic focus on strengths and resources. Instead of analysing the problem’s origins, SFBT explores exceptions, successes, and future-oriented possibilities ⁵. This enhances clients’ sense of manageability and meaningfulness; key components of the SOC. Recent meta-analyses confirm that SFBT produces moderate-to-large improvements in well-being and functioning across diverse populations ¹¹.

Systemic Approaches

Systemic therapy highlights that stress and coping are not solely individual processes but embedded in relational and social contexts. Family dynamics, cultural patterns, and collective meaning-making all contribute to resilience ². Systemic interventions often amplify GRRs by strengthening communication, role flexibility, and support networks; core to salutogenic health promotion.

Conclusion

Health is not defined by the absence of stress but by the capacity to face life’s challenges with flexibility, understanding, and purpose. The salutogenic model invites both clients and therapists to shift focus from pathology to potential, from what is wrong to what sustains well-being. Integrating Antonovsky’s theory with evidence-based therapies such as CBT, SFBT, and systemic approaches provides a comprehensive and hopeful framework for psychotherapy: one that views stress as a teacher, coping as a skill, and meaning as medicine.

References

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