Running head: DOUBLE ABCX MODEL | 1

DOUBLE ABCX MODEL | 35

A Review of the Double ABCX Model and its ApplicationsHitha SrivatsanConverse College

AbstractThe Double ABCX Model of Family Adjustment and Adaptation was derived as an extension of Hills (1949) ABCX model about families in crisis. The Double ABCX model is presented in this paper as a simple, dynamic and easily applicable model to explain the factors associated with families adjustment to chronic stressors. It has considerable research supporting its applicability in a variety of contexts. This paper presents a review of the literature on the Double ABCX model and its various applications. A discussion of the limitations of the research on the model is offered, and suggestions for future research are made.Keywords: Double ABCX model, family crisis, adjustment, adaptation

A Review of the Double ABCX Model and its ApplicationsResearch on how families respond as a unit to stress and crises has been researched extensively over the last few decades. Reuben Hill, who is acknowledged to be the father of family stress theory (Boss, 2002), was the one of the first to propose a systematic model to explain what might be anticipated when a family goes through a period of stress, and what factors mitigate their response to it. His seminal research during the World War II was based on families separated by war and their reunion. He saw response to crisis (Factor X) as a roller coaster ride, made more or less intense by three factors he later denoted by the letters A, B and C to create the ABCX Formula in 1958 (Weber, 2011). This 70 year-old model has inspired a profusion of research, but has remained more or less relevant even today. The ABCX Formula, more commonly known as the ABCX model, is simple and captured in the figure (Figure 1) below. Factor A stands for the crisis-precipitating event or the stressor, Factor B for the crisis-meeting resources and Factor C for the subjective definition of the event (Weber, 2011).

Figure 1. The ABCX Formula (Source: McCubbin, Olson & Patterson, 1983) Hills model has been criticized for falling short of explaining adaptation to stress (Boss, 2002; Weber, 2011). To account for the familys ability to bounce back from crises, several other researchers have adapted the original ABCX model. For instance, Burr (1973) turned Hills formula into a formal model by incorporating the then recent research by Hill and Hansen, by adding the concepts of amount of change, vulnerability, and regenerative power as contributors to family adaptability (VanBreda, 2001).Building on Hills and Burrs research, as well as amalgamating longitudinal research on families that have lost a husband or father to war, either by capture or pronounced missing in action, McCubbin and Patterson extended the ABCX model into the Double ABCX model, to account for changes in the familys responses over time (McCubbin, Olson & Patterson, 1983).The Double ABCX model is far from recenthaving been developed in 1983and has undergone several revisions since its inception. Long after researchers have tagged on more details to this model and introduced the Family Adjustment and Adaptation Response (FAAR) Model (McCubbin & Patterson, 1983) and then later the T-Double ABCX Model (McCubbin & McCubbin, 1993), the original Double ABCX Model is still relevant and in use. It remains broad enough to allow it to be adapted to a variety of situations, while remaining specific enough to predict the general trend of adjustment and adaptation responses in families. The scope of this review is, therefore, to sum up the literature on this model, while examining its advantages and limitations in light of its applications.For the purpose of this paper, the articles reviewed were collected from databases including PsychArticles, PsychInfo, SocINDEX and ERIC, using the search words Double ABCX Model. In order to fully display the array of applications that the model has seen, I have not limited the search to recent years, instead accommodating any available article since the model was proposed. The following sections will first sum up the literature on the Double ABCX model and its properties. I will then proceed to review the articles that have employed this model in various contexts. Finally, there follows a discussion of the merits and demerits of the model, which leads to the limitations in the research conducted so far, as well as suggestions for future research.The Double ABCX ModelMcCubbin, Olson and Patterson (1983), in one of the first papers that introduced the double ABCX model, use research on war-affected families to extend the ABCX model into a model that not only stops with explanations of the pre-crisis and crisis phases, but also goes further and explains the familys resilient response, as well. In the figure below (Figure 2), post-crisis elements depicted are aA, bB and cC, denoting respectively the pile-up of demands, adaptive resources and perception of the crisis, of the pile-up and of the resources.

Figure 2. The Double ABCX Model (Source: McCubbin & Patterson, 1983)McCubbin and colleagues note that families that have lost a father or husband to war must now adapt to their loss and the changes that follow it (McCubbins, Olson & Patterson, 1983). This paper focuses largely on the wifes hardships and the process of how the women lead families to close ranks to overcome the stress and ambiguity that the family has been put through. Thus, there are changes in roles, boundary ambiguity, in processes of decision making, normal life events, and other problems which pile up over time (McCubbin, Olson & Patterson, 1983). In Figure 2, this pile-up is denoted by Factor aA in the post-crisis period, and Table 1 lists the factors associated with each dimension of the model.Factor bB, or the familys adaptive resources, can be examined in the way a family closes ranks, and employs various coping strategies to maintain stability. McCubbin and colleagues point out three main patterns of coping they found crucial from previous research: maintaining family integrity, establishing independence through self development, and seeking resolution and expression of feelings. Social support, social resources (laws, programmes, benefits, etc) and the familys own social action are more resources the family can call upon (McCubbin, Olson & Patterson, 1983).In order to maintain functional stability, the family attempts to draw meaning (Factor cC) from the events that precipitate crisis, and even redefine their hardship. Oftentimes, spiritual beliefs come into play. The authors also believed that this meaning-making process helped the rest of the family members deal with the grief of their loss (McCubbin, Olson & Patterson, 1983). Discussing xX, McCubbin and colleagues refer back to Burrs (1973) addition of regenerative power to the ABCX model. To them, adaptation is not a process, but the final outcome- a desirable one- of the process of adjustment to stress. McCubbin and Patterson (1983) suggest that if cC is positive, the family might more likely head toward bonadaptation. An imbalance in any of the factors may lead to maladaptation, instead. McCubbin and colleagues acknowledge that, although adaptation may be defined, successful adaptation and compromise may be more difficult to characterize. McCubbin and colleagues have attempted to empirically test the Double ABCX Model (Lavee, McCubbin & Patterson, 1985). In a sample of 288 families of enlisted soldiers that were facing the hardships associated with relocation to the then-called West Germany, the researchers used 15 measures to test the latent variables predicted by the model to be associated with family stress. They measured relocation strain (composed of pre-travel strain and post-travel hardships), life events, family system resources (including family cohesion, family adaptability and supportive communication), social support (including community support, friendship support and community activity), coherence and meaning (including family-army fit, predictability and commitment), and adaptation (operationalized by general well being, satisfaction and family distress). Structural equation modeling was used, as depicted in the figure 3 below. The authors found that a pile-up of stressors does indeed influence general well-being and satisfaction with their lifestyle. Family cohesion, supportive communication, and flexible family systems are more conducive to family adaptation, but do not mitigate the severity of the strain. Social support played only an indirect role and helped the family to perceive the crisis in positive terms. This study did not attempt to include either personal resources or coping strategies as variables, and is therefore not entirely sufficient in supporting the model (Lavee, McCubbin & Patterson, 1985).

Figure 3. Causal Structural Equation Model for Double ABCX Model. (Source: Lavee, McCubbin & Patterson, 1985)

Applications of the Double ABCX ModelThe following subsections will discuss the application of the Double ABCX Model in the context of families of children with illnesses/disabilities, families of adults with illnesses/disabilities, divorce and remarriage, clergy families, military families, rural families and guidelines based on the Double ABCX model for practicing in the community at large. Finally, some cultural considerations will be discussed.

Families of Children with Illnesses or DisabilitiesThe Double ABCX model has been very popularly used in studying the process of adjustment and adaptation in families of children with disabilities. In fact, Studman, Roberts, Hay & Kane (2003) suggest that this model has shown the most relevance for populations with disabilities. Several authors have studied family stress specifically in the context of families of autism-affected children (Manning, Wainwright & Bennett, 2011; Hall & Graff, 2012; Ramisch, 2012). This model has been used as a framework for various studies in other areas, as well, such as intellectual disabilities (Saloviita, Italinna, & Leinonen, 2003; Shin & Crittenden, 2003; Xu, 2007), cancer (Han, 2003), epilepsy (Austin, 1990) and deafness (Lampropoulou & Konstantareas, 1998). One avenue explored by researchers is exploring the difference between caregiver strain and psychological distress in a sample of 514 families of children receiving mental health services (Brannan & Heflinger, 2001). They measured Factor aA of the Double ABCX model using measures of behavioural problems, and life stressors experienced by families. Factor bB was represented by measures of family functioning, material resources, and social support. Factor xX was represented by assessing psychological symptoms and caregiver strain. Structural equation modeling was performed, and resulted in the conclusion that caregiver strain can be distinguished from psychological distress, albeit both concepts are related. Furthermore, caregiver strain was predicted by child symptoms, while life stressors best predicted distress. Family functioning was found to have no effect on either strain or distress. Social support was a direct influence on distress, and caregiver strain seemed associated with lower material resources. Limitations of the study included its cross-sectional, self-report design, and a sample that primarily consisted of military families (Brannan & Heflinger, 2001). Another consideration may be the lack of explanation for not measuring Factor cC, which may have had an impact on distress and strain.Another avenue explored by Brannan and colleagues is the pattern of use of mental health services and how it is influenced by caregiver strain and other factors of the Double ABCX model (Brannan, Heflinger & Foster, 2003). Using a sample of 574 children and their caregivers, who made use of services, the researchers measured predictor variables including family stressors, resources and caregiver strain. To investigate service use patterns, they examined combination, sequencing, continuity and amount (in cost) of services used. Using standard multiple regression and logistic regression, they found that service use patterns were associated with caregiver strain, material resources, life events and family functioning. The study was limited by its sample consisting predominantly of military families, a relatively high attrition rate and the reliance on the information provided by only one family member (Brannan et al, 2003). Cancer. Han (2003) studied the psychosocial adjustment of 200 Korean mothers to their childrens cancer. Performing hierarchical regression analysis on variables including stress (both in individual life and as pile-up in family life), coping, social support, and psychosocial adjustment, they concluded that poorer psychosocial adjustment was found to be associated with more stress (more in case of pile-up of events, rather than only individual stress), poor coping, poor social support and lesser time since diagnosis. The study reported some limitations: the non-random sampling method and the cross-sectional, self-report design (Han, 2003). Another consideration is that social support is not the only resource that the model lists under Factor bB; therefore, more variables may have been studied.Deafness. A study was conducted by Lampropoulou and Konstantareas (1998) on 42 mothers of deaf children in Greece, examining stress (Factor aA), availability of support (Factor bB), involvement with the child, and affective tone of involvement. This study is notable for the fact that it adapted the Double ABCX model, using elements of Brofenbrenners (1979) social ecology model to evaluate cross-cultural comparisons with Canadian mothers of children with or without disabilities. MANOVA and Benferronis t test were used. The researchers concluded that higher maternal involvement was associated with higher maternal stress, and was also found more in case younger and male children. Negative or neutral affective tone of involvement was associated with higher stress levels, and was found more frequently in Greek mothers than in Canadian ones, despite there being no difference in stress levels of the two sets of mothers. The researchers reported two limitations: the difficulty in relying on self-reported data, and in generalizing the data (Lampropoulou & Konstantareas, 1998). A more glaring limitation, however, is that the measurement of the variables did not fit entirely with the model. Factor cC, which might have shed more light on the variations in the affective tone of involvement, was not directly measured.Epilepsy and Asthma. In an effort to extend the Double ABCX model to explain specifically the adjustment process of each member of families of children with childhood epilepsy and asthma, Austin (1990) examined each factor (aA, bB and cC) separately for parents and for children. She also added variables specific to the children with childhood epilepsy or asthma, such as episodes, demographic variables and school status. The general extended model for both asthma and epilepsy is depicted in Figure 4. Her sample included 126 children with epilepsy and 120 children with asthma. Structural equation modeling was carried out to find two separate models for epilepsy and for asthma. The model for epilepsy seemed more complex than the one for asthma, as it included more exogenous variables (socio-economic status, childs age, and family demands), and had indications for the necessity for more. Family demands (aA) seemed a strong predictor in the epilepsy model, but was deleted from the asthma model (Austin, 1990).

Figure 4. General Extended Double ABCX Model for Childhood Epilepsy and Asthma. (Source: Austin, 1990) Autism. Researchers have studied autism from various angles using the Double ABCX model. One such example of a study was conducted by Hall and Graff (2010). They first conducted a pilot study, using a focus group interview of 11 primary caregivers of autism-affected individuals. The focus of the group was on the experiences and challenges of parenting children with autism. Conventional content analysis revealed three emergent categories: sources of stress, coping strategies, and resources and supports, all of which seemed interconnected (Hall & Graff, 2010).There were some features to this study that could count as a source of rich information. The children with autism had an age range of 2 to 12 years, which is a wide enough range to bring up a wide range of problems from different stages of the family life-cycle. Also, a few of the participants were fathers or grandmothers of the child with autism, which could also bring in different perspectives of caregiving. However, one major limitation of this study is that this advantage was not exploited. Using the data from this pilot study, Hall and Graff (2011) went on further to design larger studies, using the Double ABCX model to examine the relationship that stress, coping and support have with adaptive and then maladaptive behaviours. In one of these studies, 75 primary caregivers, most of them Caucasian mothers with some college education, were given questionnaires for coping strategies, family support, parenting stress, and adaptive behavior of the child. Pearson correlation, t-test and multiple regression analysis were done. The authors concluded that caregivers of children with autism have high stress levels, need for support and have coping difficulties (Hall & Graff, 2011). A major limitation of this study, however, was the application of multiple regression analysis only to find that the coping patterns were associated with each othersomething that the authors avoid addressing in their discussion. Also, no real effort was taken to tie the results in with the Double ABCX model, although they had stated that the methodology was informed by it. They also simply measured parental stress, which is not enough of a measure of the pile-up of stress that the model predicts there should be.Hall and Graff went on to perform another study, this time investigating the relationship of maladaptive behaviour of children with autism with factors predicted by the Double ABCX model, such as family support, parental stress and parental coping (Hall & Graff, 2012). Using data from their previous study, the researchers drew a sample of 70 parents, most of whom were mothers of children with autism aged 21 years and below. The instrument they used to measure adaptive behavior, Vineland Adaptive Behavior Scales, also has a Maladaptive Behavior Index (Sparrow, Cichetti & Balla, 2005). Performing Pearson correlation, t-test and multiple regression analysis, they found that higher levels of maladaptive behaviour in the child, especially internalizing behavior, are associated with higher levels of parental stress, as predicted by the model (Hall & Graff, 2012). Again, the researchers made no attempt to measure pile-up of stress, and only made a superficial attempt to tie the results of the study with the Double ABCX model.Manning, Wainwright & Bennett (2011) investigated the relationship between the severity of autism and behavior problems, and family adaptation, social support, religious coping and reframing. Their racially diverse sample was composed of the primary caregivers of 195 6-12 year old children with autism or pervasive developmental disorder. The researchers used a questionnaire or checklist to measure each factor of the Double ABCX model, and analyzed their data using linear regression models. Results revealed that, although parents experienced high levels of stress, they still reported positive family functioning. Social support and spiritual support as means of coping, which speak to factor bB, seemed to be associated with higher levels of family functioning and lower levels of distress. Positive reframing, which speaks to factor cC, was also found to affect family functioning and distress. The researchers concluded that their research hypothesis that the Double ABCX model predicts family coping was supported by the data. However, there were some limitations to the study. The study relied largely on parents report, which may have been biased by social-desirable responses (Manning et al, 2011). Another shortcoming is that their racially diverse sample consisted of 59% Caucasian, and less than a quarter each of African American and Latino caregivers. Ramisch (2012) advocates the use of the Double ABCX model as both a means of assessment as well as of intervention. In her paper, she presents a case study of a couple of lower-middle socio-economic status, who had no local resources to help them cope with raising their 3-year old son, who was diagnosed with autism. Their therapist systematically broke down their sessions to deal specifically with each factor of the Double ABCX model. In the first session, she facilitated the couple to talk about their stressors and helped them make preliminary plans to deal with themfor instance, making date nights. The second session dealt with the couples resources, and used role-playing to help them talk to people about their childs autism and ask for help. The therapist then facilitated a meaning-making discussion about how the couple felt about raising a child with autism. In this paper, Ramisch (2012) then goes on to make specific suggestions for ways in which therapists can design their interventions according to the Double ABCX model. Intellectual Disability. There have been a few studies based on the Double ABCX model that have looked into the process of adjustment in families of children with intellectual disability. Of these, one study aiming to explain parental stress using this model in a sample of Finnish parents of children with intellectual disability (Saloviita et al, 2003). Using stratified random sampling from a population of consumers of public special services for children with disability, the researchers final sample included 116 mothers and 120 fathers of children aged between 1 and 10 years, representing all levels of disability (mild, moderate, severe and profound). The researchers measured a variety of variables apart from parental stress: Factor aA of the model was represented by measuring childs age, adaptive skills, challenging behavior, and level of disability. Factor bB included family adaptive resources, expressive support, instrumental support, informal and formal support, experienced social acceptance of the child, perceived control by parents over life events, and ways of coping. Factor cC was measured by social readjustment and definition of situation as catastrophe. Stepwise regression analysis was done with parental stress as criterion and other principal variables identified through separate principal component analyses for mothers and fathers, and then rotated by varimax rotation. Saloviita and colleagues (2003) found that the stressors (Factor aA) predicted a relatively smaller percentage of the parents stress than do their resources (bB) or perception (cC). More importantly, they found that the strongest predictor of stress was negative definition of the stressor, which was associated to behavioural problems by mothers, and to the experienced social acceptance of the child by fathers (Saloviita et al, 2003). As thorough as this study was, it still yields limited information by its cross-sectional, self-report, and correlational design. Another study aimed to make a comparison of the psychological well-being of mothers of children with intellectual disability between USA and Korea, in the context of the Double ABCX model (Shin & Crittenden, 2003). Mothers of elementary school-aged children from one metropolitan area each from either country were recruited. They were given questionnaires to measure traditional values, childs maladaptive functioning, social support, maternal attitude towards the child with disabilities and mothers stress. The authors found that Korean mothers reported more traditional values, lower social support, more negative attitude towards the child, and more stress. Path analyses on the data from the two countries showed that the model was true for American mothers, but not for Korean mothers, as traditional values played a greater role than the childs maladaptive behavior in explaining mothers stress. This study had several limitations: The researchers recruited only Caucasian mothers to control for effects of ethnicity in the USA sample. The way the instrument measuring traditional values was constructed may not have been applicable to American mothers. The study measured the factors of the model with single scales (Shin & Crittenden, 2003). This last limitation is particularly important because it does not bring out the dimension of time that the Double ABCX model emphasized so much, over-simplifying, for instance, the concept of pile-up of stress.Families of Adults with Illnesses or DisabilitiesThe psychosocial adaptation of adults with chronic illnesses or disabilities has also been studied to some extent by researchers using the Double ABCX model as a framework.One such study examined family functioning of patients after a stroke (Clark, 1999). Sixty patients diagnosed with stroke were assessed using measures for stroke severity, length of rehabilitational stay, resident medical officer to the probably medical outcome of the patient, functional status, depression, level of activity and abnormal illness behaviours, to represent Factor aA. Factor bB was measured by initial family functioning and knowledge of stroke. And finally, Factor cC was represented by expectations from the rehabilitation programme, and satisfaction with the progress. As a measure of Factor xX, current family functioning was assessed. Path analysis revealed that the model was reasonably well supported by the data. Family adaptation was best predicted directly by the patients recovery-related variables, such as activity level, depression, functional status and abnormal illness behaviours, and also by the patients satisfaction. The familys resources were found to be weak but significant predictors of family adaptation. Using this data, the author suggested modifying the model to include feedback loops between xX and aA, as poor adaptation can be a stressor and between bB and aA, as lack of knowledgea crucial resourcemay be perceived as stressful (Clark, 1999). Some major limitation of this study is its small sample size, and its cross-sectional design.Another study targeted specifically at women with severe physical disabilities aimed to validate the Double ABCX model in Israel (Florian & Dangoor, 1994). A research group of 94 Israeli Jewish women with disabilities such as neurological, or musculo-skeletal conditions, or chronic diseases, and a control group of 94 women without disabilities, all living with their families, were given instruments measuring family demands/stress, strain, sense of coherence, social support, coping styles, personal adaptation and family adaptation. Path analysis showed that the double ABCX model was supported, and the models for both groups were similar, with some minor differences in the strength of relationships. However, social support and coping styles were not found to be significant mediators in the models of either group. The researchers acknowledged the disadvantage of the path analysis method, as limiting them to investigate only relationships between main variables (Florian & Dangoor, 1994). A major strength of this study is their comparison of the double ABCX model for women with and without disabilities.The Double ABCX model has also been applied to adults with autism in order to examine their individual and marital adaptation (Renty & Roeyers, 2007). A sample of 21 Flemish couples, in which the men had been diagnosed with an autism spectrum disorder (ASD), who had been married or cohabiting for more than a year, and who had at least one child at home. The level of ASD traits, the couples informal and formal social support, coping strategies, individual adaptation, and marital adaptation were measured. Bivariate associations between the factors of the Double ABCX model (ASD traits, social support and coping) and adaptation was performed for men and women, and then multiple regression analysis was done to find the effect of coping and social support on adaptation in men and women. Informal social support and avoidance coping were found to be associated with adaptation, and formal social support, approach coping and severity of ASD traits were found to be unrelated to adaptation. The researchers found that severity of ASD traits was unrelated to individual adaptation although severity of ASD traits did seem to be inversely correlated to marital adaptation for women alone. Spousal support was found to have a significant relationship with marital adaptation, but not individual adaptation in men and women. The researchers acknowledged several limitations, including their small and probably non-representative sample, and the use of their ASD trait measure in other-report format (Renty & Roeyers, 2007). Another consideration is that the researchers limited operationalization of Factor aA as only the ASD traits of them men, which may have caused them to conclude stressor severity is unrelated to adaptation.Divorce and RemarriageGiven that the Double ABCX model is meant to explain chronic stressors, researchers have employed it in explaining the various aspects of the process of adjustment to the crisis of divorce. It has also been used to look into adjustment to remarriages and living in step-families.In a longitudinal study by Tschann, Johnston and Wallerstein (1989), the adjustment of 184 divorcees was examined over a period of two years. The participants were asked to complete a battery of self-report questionnaires and projective tests at baseline, one year and two years. They also completed a conflict checklist and parental questionnaires, and had a clinician assess clinical ratings for them at baseline. One year later, parental questionnaires were repeated. At the two year follow up, participants were asked to complete the parental questionnaires, and other clinicians completed clinical ratings of the participants. Factor analysis, principal component analysis with varimax rotation and path analysis were used. The variables analyzed were family stage, SES, pre-separation general functioning, months since separation, decreased income, conflict with ex-spouse, rejecting parent-child relationships, social involvement, supportiveness of new relationship, and positive and negative attachment to ex-spouse. Post-separation adjustment was measured by effective coping, psychological disturbance and emotional distress. The results revealed that adjustment is similar in men and women, but are influenced by different personal resources, such as higher SES for men and better psychological functioning in women. Adjustment is also negatively influenced by conflict leading to negative attachment with ex-spouse, and positively influenced by socialization that leads to lower positive attachment with the ex-spouse. Some limitations recognized by the authors include limited generalizability and the possible effect of the preventive counseling offered to the participants on the adjustment process (Tschann et al, 1989). Another limitation is that the authors were vague about the measurements used in the procedure.A more recent study examined the mediating effects of mental outlook (which could be said to be part of Factor cC) for adult offspring of divorce (Kahl, Steelman, Mulkey, Koch, Dougan & Catsambis, 2007). Their sample consisted of 4165 married adults who had been raised in either an intact or divorced homes. The mediating variables examined were marital commitment and personal optimism; the dependent variables were positive/negative adaptation and self-reported marital satisfaction. Independent variables included length of marriage, number of times married, years of education, total family income, race, sex, raised in intact/divorced home, religious fundamentalism and previous cohabitation. Logistic regression showed that while parental divorce is associated with poorer second-generation marriage outcomes, being raised in an intact home does not prevent second-generation marital dissatisfaction, but does seem associated to self-satisfaction. Optimism and marital commitment were found to be strong predictors of good marital outcomes, but did not show mediating effects (Kahl et al, 2007). The researchers seemed to oversimplify the Double ABCX model, and grouped Factors aA and bB in their attempt to find a mediating relationship between cC and xX. However, their finding that optimism and commitment could positively influence marital outcomes may merit further study.On the concept of remarriage, Crosbie-Burnett (1989) suggested in her paper that the Double ABCX model could help therapists assess as well as design interventions for facilitating step-families. Using a case example, she explains each factor of the Double ABCX model, and how to use them to assess families going through divorce and remarriage. Remarriage could be a stressor event (Factor A), with several distinct difficulties that come with it, such as new family members to get acquainted to, redistribution of resources, boundary ambiguity between the various subsystems, role ambiguities in step-parents and children, conflicting stages of the family life-cycle, sexual tension and confusions in loyalty to parents of the same sex. Factor B, the resources of the family, could include individual and familial resources, as well as those of the community. Factor C predicts that the families in question will have certain perceptions of the remarriage, and may experience the necessity to change them. Imbalances in these factors cause a crisis (factor X), signified by a variety of resistances and attempts to establish systems and rules. While trying to cope, the families may experience a pile-up of stressors (Factor aA), such as normative developmental changes in addition to the initial stressor, and consequences of trying to cope with the stress and ambiguity. Those resources that the families use to meet the crisis are their adaptive resources (Factor BB). Adaptation (Factor xX) can happen if there is a positive spin in the meaning-making process of evaluating the situation (Factor cC). Having explained all this, Crosbie-Burnett (1989) goes on to make suggestions for the kind of interventions and policies that can be designed for imbalances in whichever of the factors the model encompasses. Families of the ClergyFamilies of clergymen are vulnerable to both normative life stressors as well as additional stressors that come from their role in the church (Ostrander & Henry, 1990; Frame & Shehan, 1994). A paper by Ostrander & Henry (1990) was the first to summarize the literature on the clergy and suggest that the Double ABCX model could be appropriately applied to this context. A later study by Frame and Shehan (1994) examined how families of clergymen responded to the stressors specific to relocation. Their sample consisted of 212 Caucasian married clergymen and their spouses, who had been relocated to their current locations for 4 years or more. Appraisal of relocation, life events, family problem-solving strategies, and general well-being were measured quantitatively, and responses to two open ended questions about relocation were analyzed qualitatively. Quantitative analyses were done by t-tests and hierarchical regression analysis. Results showed that women reported higher stress, negative perceptions of relocation, lower coping resources and lower well-being than men. They also found that, while relocation itself had no effect on well-being, positive life experiences, coping resources (in men) and subjective appraisal of the relocation were associated with well-being. Qualitative data analyses were also presented to augment quantitative data. Content analysis of responses to the two questions revealed 8 themes, such as increased demand for domestic labour, a lack of opportunity to make a home out of the parsonage, disruption of childrens social networks and school life, onus on the wives to reestablish the family in the new community, disruption of wives employment, financial burdens, disruption of wives social network, and lack of support from husbands preoccupied with career transitions.Military FamiliesHaving a family member serve in a military capacity is a chronic stressor, and a concept that has sparked off several research studies, including the classic studies by Hill (1949), and by McCubbin and Patterson (1983), as well. A few others have also applied the Double ABCX model to military families with varying objectives in mind. Two such researches are described below.In a qualitative study, Powell (2008) suggested that attachment relationships may serve as the primary resource to families of military personnel during deployment. Constant comparison method of two in-depth interviews with the spouses and children of two military personnel yielded the conclusion that the Double ABCX model may have been a good fit to the study participants descriptions of their experience of deployment. The researcher also suggests that secure attachments increase the likelihood of navigating the stressful situation successfully (Powell, 2008). This observation may merit investigation through quantitative means, as well. Another older study by Bowen (1990) proposed a conceptual model of family adaptation by integrating the Double ABCX model with the Person-Environment Fit model (French, Caplan & Harrison, 1982). In this integrative model, environmental system factors (army policies, role demands, and adaptive resources) and personal system factors (personal resources, values, and expectations) are linked to family adaptation on four levels (family, personal, army and community levels). Rural FamiliesThe Midwest Farm Crisis of the Eighties produced great economic strain on several rural families, and led to several negative consequences (Manning, 2008). Jurich and Russel (1987) designed an intervention based on the Double ABCX model for families that had been affected by this crisis. Well-being, marital stress, parental stress and marital satisfaction of husbands and wives were measures prior to and after the intervention and at a 3-month follow-up. The intervention included techniques such as joining, reframing, and mobilizing resources. The therapists used more straightforward interventions to maintain rapport with rural clients, for instance, not focusing on matters like metacommunication and not using strategic interventions. The authors found that although, when compared to general sample of clients, the rural families tended not to have as much decreased stress levels, and also tended to report lower general satisfaction at the follow-up, these rural families did show a slightly better increase in well-being (Jurich & Russel, 1987). A major limitation with this study was that the methodology and data analyses were reported in a vague fashion. Practicing at the Community LevelMcCurry, Revell and Roy (2009) suggest that the Double ABCX model need not be restricted to only understanding functioning at the family level, but also communities in crises. They suggest that nurses can utilize middle-range theories such as this model to guide community practice at the individual and community levels, especially when disaster management is called for. In another paper, Revell and McCurry (2010) outline the nursing process for post-flood management with families affected by floods. They list the criteria needed to assess families under each factor of the model and suggest appropriate goals and interventions for them. Cultural Considerations Most studies on the Double ABCX model have been conducted on American families. In this literature review, only a few studies were found that were conducted on populations of other countries, namely Greece, Canada, Finland, and Korea. Studies conducted on Finnish, Canadian and Greek populations have shown support for the suitability of the Double ABCX model for their respective cultural contexts (Saloviita et al, 2003; Lampropoulou & Konstantareas, 1998). A literature review by Amfani-Joe (2012) suggested the suitability of the Double ABCX model for studies in family stress in Nigeria, especially considering the fact that Nigerian women are beginning to move away from traditional roles, and are pursuing education and gainful employment. However, as this paper did not go into the details of how the Double ABCX model could be suitably adapted to Nigerian social norms, and no other research concerning the subject was found, further research in its applicability in this cultural context is required.With families of Asian descent, there are mixed results. On the one hand, the study by Shin and Crittenden (2003) that was discussed in the section on families of children with illnesses or disabilities is example of the model not being universally applicable. This paper found that the double ABCX model did not hold true for Korean families, as the role of traditional values may be a factor that has not been considered in the model itself. However, the authors acknowledged that using an instrument measuring traditional values based on Korean culture may not have been suitable to be used with the American population. On the other hand, however, Xu (2007) suggests that the Double ABCX model may, in fact, be used with families of culturally diverse backgrounds, as the objective in using this model is to empower families to help themselves. She uses brief case example of two families, one African American family and one Asian American family, whose struggles against multiple stressors, including having to raise a child with disabilities, were assessed using the model. She then proceeds to offer suggestions for early interventionists for empowering families of children with disabilities.

Discussion and ConclusionsLimitations of Research on the Double ABCX Model Research on the Double ABCX model has been reviewed in this paper, with an eye toward its applicability in various contexts. It has been found that the research on the model has covered a variety of populations. However, there have been some gaps and shortcomings in the research that need to be addressed. In some of the studies discussed in this paper, the methodology does not lend itself to measuring the concepts of the Double ABCX model appropriately. Oftentimes, the concept of pile-up of stressors (Factor aA) is measured by a single stressor, which defeats the purpose of differentiating factors A and aA.Most of the research has followed a cross-sectional design. While this design may be convenient to carry out, and yields much useful information, it is also important for researchers to consider longitudinal studies. This is particularly important since the Double ABCX model stands apart from the ABCX model by its emphasis on time as an important consideration in the process of adjustment.The Double ABCX model has been used to guide interventions as well as assessments. However, only very few studies that have quantitatively measured the effectiveness of such interventions have been found. More such studies are therefore warranted.Advantages and Disadvantages of the Double ABCX ModelSince its inception, there have been several discussions about the merits and demerits of the Double ABCX model. It has several advantages: It has enjoyed some popularity among researchers because of its ease in being employed in studies. The models that have followed it seem to have a lot more intricate details that do not yield themselves conveniently to be studied in research (Smith, 1984). The Double ABCX model has especially been validated in the case of families of people with disabilities (Studman et al, 2003). A few studies have employed this model to guide therapists in designing interventions for a variety of populations (Ramisch, 2012; Crosbie-Burnett, 1989).The disadvantages of the Double ABCX model have also been noted by some researchers. Smith (1984) pointed out that this model is limited by is unclear definition of concepts. She points out that it is not often that one can distinguish between a stressor and the familys inability to cope with the stressor as the source of the stress itself. While efforts have been made to define crisis by normative as well as catastrophic events, there seems to be a singular inattention to the normal everyday stressors and stresses accompanying the family lifecycle.Smith (1984) also notes that Factor c and cC are problematic, in the sense that one cannot be sure whose definition of events is to be taken into accounteach individuals or the familys as a group. How a group definition comes into existence is what needs to be addressed. The Double ABCX model is not a theory of family stress, but instead a scale model that can be used in describing but not predicting families behaviour. The model merely describes the structural relations between various concepts, and does not focus on processes (Smith, 1984).Another shortcoming of the model is in its static nature. The processes behind the families actual participation in adjustment are not clear. To be specific, the model needs to answer the question: how does each individual in the family contribute? Family-community fit also needs to be looked in to (Smith, 1984).One other major drawback of this model has been inherited, in a sense, from the ABCX model. The ABCX model has been criticized for its lack of emphasis on socio-historical contextual factors (Walker, 1985). The Double ABCX model only superficially talks about families reaching out to the community for resources, and this has been addressed to a slightly larger degree in the models that followed it. However, it does not take in to account the complexities of the interactions between a family and its environment (Smith, 1984; Dollahite, 1991). In an attempt to correct this failing, some researchers have tried to integrate this model with others that do take into account the environment of a family. Some examples are Bowens (1990) family adaptation model, which explains adaptation of military families using the Double ABCX Model and the Person-environment fit model (French et al, 1982); and Dollahites (1991) ABCD-XYZ model, which integrates concepts from the Double ABCX model with those from several others on family resource management. Suggestions for Future ResearchFuture studies on the Double ABCX model may need to address several important issues. More longitudinal studies on the model are required. Researchers may want to consider further studying the suitability of the model in various cultures in more cross-cultural studies. The model itself may need some rethinking, to address its limited emphasis on environmental/contextual factors and process details.ConclusionsThe Double ABCX model has been shown to be versatile, in the sense that it can be applied in a variety of situations that involve families in crisis. Despite its disadvantages, it has been successfully used in explaining family stress and adaptation, and has been useful in guiding therapeutic interventions for families struggling against crises. Continued efforts to refine this model and address its limitations through more well-designed research are required.

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