TABLE 1.

Applying salutogenic principles in managing psychological distress in the context of COVID-19, in five steps.

Step	Brief description	Techniques and interventions used	Salutogenic principle(s) being applied
I	Triage	1. Screening for (a) acute risk of harm to self or others (b) diagnosable psychiatric disorder requiring formal treatment 2. Referral of individuals identified as (a) or (b) to “conventional” psychiatric care 3. Ensuring that such referred individuals return to the “salutogenic” intervention after acute management under (2)	Use of general resistance resources available within a conventional framework
II	History	Semi-structured interview assessing the following 1. Individual’s understanding or “explanatory model” of their current situation or predicament 2. Responses to adverse circumstances earlier in life 3. Sense of mastery over the current situation 4. Brief biographical sketch	Constructing a “story of the person” beyond symptoms or distress
III	Assessment	1. Enumeration of methods used to handle adversity in the past and present, especially those perceived as helpful 2. Enumeration of the individual’s perceived strengths and weaknesses 3. Enumeration of available general resistance resources–social, cultural or religious, material 4. If appropriate, structured assessment of the sense of coherence (SOC)	Identifying and preparing to mobilize existing general resistance resources (GRRs); baseline estimation of SOC
IV	Shared understanding	1. Explanation of the salutogenic model in common-sense or easily understandable terms 2. Reassurance that distress does not equate to mental disorder or illness and may be a “normal” response to an abnormal situation 3. Reframing the current situation, not just in terms of adversity, but in terms of an opportunity for growth and future positive mental health	Framing tension or stress as an opportunity for adaptation; preparing the individual for active adaptation rather than passive reception of medication or therapy
V	Salutogenic interventions	1. Select dimension(s) of the SOC which require specific attention for the individual–comprehensibility, manageability of meaningfulness. (a) Comprehensibility–develop a model of the current situation as a “challenge” and not just a “disaster” or “crisis”; Such a model must be open to revision and not “rigid.” Avoid either false hope or excessive pessimism (“realism”). Provide accurate information if the individual lacks access to this, or is misinformed. (b) Manageability–mobilize and optimize existing GRRs; develop and test potentially unexplored GRRs in collaboration with the individual; accept setbacks and non-linear improvement; focus on adaptation and not on specific symptoms. (c) Meaningfulness–focus the individual’s attention on the future “beyond” COVID-19, or at least “beyond” the immediate situation; develop short-term and long-term practical goals in terms of functioning and relationships. Call upon individually held “meanings” as well as shared wisdom from the prevailing culture or religious tradition.	Strengthening the SOC in a manner specific to the needs of the individual; optimal use of GRRs; construction of a “life story” that is not centered exclusively on COVID-19; active adaptation