The Theory of Family Stress and Adaptation(McCubbin and Patterson)

BiWei DongElizabeth Hopewell

Sarah KlineRobyn SimmonsJulie Wellborn

Theory Overview An individual family’s experience of stress,

crises, and subsequent adaptation is an ongoing and dynamic process.

The process of adaptation is affected by the family’s response to a stressful event, their available resources, and presence or absence of effective coping strategies.

Adaptation exists on a continuum from positive adaptation (bonadaptation) to maladaptation, resulting in increased or decreased family functioning.

Development of the theory

The original family stress theory was developed by Reuben Hill (1949), who studied families’ responses to war, war separation, and eventual reunion after WWII. The ABCX Model detailed how the three

factors (the ABC components) of a stressor event, the family’s perception of that stressor, and the family’s existing resources interacted to predict the likelihood of a crisis (X) occurring.

Sociologists McCubbin and Patterson (1983) developed the Double ABCX Model, which added postcrisis variables (e.g. coping mechanisms) to explain how families recover from crisis and achieve adaptation over time. Theory originally based on longitudinal

research involving families in which a father/husband was a POW or MIA during the Vietnam war.

Families facing a stressor event experience phases of adjustment and adaptation, exemplified by a range of processes in which the variables interact.

An Inductive Research Approach

Example of a “bottom-up” approach Specific observations regarding the families

involved in the study led to the identification of patterns and regularities, resulting in broader theoretical statements and hypotheses.

These hypotheses have been tested extensively in subsequent studies (in various disciplines), leading to the validation of the theory.

Later DevelopmentsThe FAAR (Family Adjustment and Adaptation

Response) Model (1988) emphasizes adaptation as the key outcome

More recent models incorporates additional variables (i.e. community relationships) to explain how families function in periods of tranquility as well as stress.

New emphasis on resiliency

Current Nursing ResearchCurrent nursing research uses this model

extensively to study family adaptation while dealing with chronic and life threatening illness.

Example: LoBiondo-Woods 2004 work on examining the relationship of family stress, severity of the stressor, uncertainty, coping, and family adaptation from the pretransplantation to the posttransplantation phase of liver transplantation in children.

Explicit Assumptions1. Families over the course of life face

hardships and changes as a natural and predictable aspect of family life.

2. Families develop basic competencies, patterns of functioning and capabilities to foster the growth and development of family members and the family unit, and to protect the family from major disruptions in the face of transitions and changes.

3. Families develop basic and unique competencies, patterns of functioning, and capabilities designed to protect the family from unexpected or non-normative stressors and strains and to foster the family’s recovery following a family crisis or major transition or change.

4. Families draw from and contribute to the network of relationships and resources in the community, including its ethnicity and cultural heritage, particularly during periods of family stress and crises.

5. Families faced with crisis situations demanding changes in the family’s functioning work to restore order, harmony and balance even in the midst of change.

McCubbin, M.A., McCubbin, H. I. (1996). Resiliency in families: A conceptual model of family adjustment and adaption in response to stress and crises. In Family assessment: Resiliency, coping and adaptation (p. 14). Madison: University of Wisconsin Press.

Implicit AssumptionsFamilies like to live an orderly and balanced

life and are willing to cope with stress.The family variables are existent prior to

their connections to each other and they can be clearly distinguished

World ViewModel grew out of a systems theory/holism

approachHolism focuses on alleviating problems

within a system by emphasizing on the system as a whole and understanding that member parts ultimately aggregate to create that whole.

Assumptions: all phenomena can be viewed as a web of

relationships among elements, or a system.all systems have common patterns and

behaviors that can be understood and used to develop greater insight into the behavior of complex phenomena.

Systems theory and the Double ABCX Model

The family is viewed as the “system”, where experiences of one family member affect the experiences of other family members.

Family systems theory and the Double ABCX model highlights the integral influence of the family system on each individual member's development and vice-versa

Systems theory (and the Double ABCX model) recognize interactions of the parts are not "static" and constant but "dynamic" processes.

Relevant Metaparadigm ElementsPerson (family): viewed as encountering hardships and

changes as an inevitable part of family over the lifecycle

Environment (within the family system): viewed as an open system and a component of the larger community and society. Families benefit from and contribute to the network of relationships and resources in the community.

Health: family resiliency or the ability of the family to respond to and eventually adapt to the situations and crises encountered

Nursing: the role of nursing is to not only promote family members’ health, but also to support and enhance family strengths, to assist families in maintaining linkages with community supports, and to aid families in arriving at a realistic expectation of what the best “fit” for them in their situation.

Concepts: ABCX Components

Stressor (A)

Life event or transition impacting the family unit that has the potential for changing the family social system.

Defined as distinct from stress.Can occur in any aspect of the family’s life-

roles, functions, goalsExamples include chronic illness in children,

cancer, and elder care

Existing Resources (B)

All families have some level of resources.Concept of existing resources is the family’s

use of community and intrafamilial systems. i.e. SES, parents education

May be adequate or inadequate depending on the nature of the stressor event or family’s level of functioning

Perception of the Stressor (C)

Defined by Hill (1958) and McCubbin and Patterson (1983) as the meaning the family assigns to the crisis event and the total circumstances that lead to the crisis.

In lay terms: how well does the family define the problem, grasp the problem and understand the situation?

Crisis (X)

Defined as the “demand for change”.Continuous variable that reflects the sum of

the family’s disorganization, turmoil, disruption which is triggered by an event.

In the model- crisis is regarded as the family’s inability to retain stability.

If the family is able to meet the demands of the stressor than the crisis may be averted.

 

ABCX Component Interactions

Stressor (A) → interacts with resources (B) → family’s perception of stressor/how stressor defined (C) → produces the crisis (X).

Concepts: Double ABCX Components Pile-up (Aa Factor)

The effect of managing changes, strains, and stressors over the time continuum.

These stressor “pile-up” and accumulate affecting each member.

Existing and New Resources (bB)

Allow the family to adapt and meet demands and needs by potentially adding expanded resources.

Existing resources = usual mechanisms of support + New expanded resources → new resources strengthened or developed in response to the crisis or as a result of the pile-up of stressors.

A family in the face of crisis will call on existing resources in order to prevent an event from creating further crisis.

Family Perception of the Stressor (cC)

The way the family views, defines, and the significance given to the stressor.

The family that aims at understanding the meaning of the crisis can help the other members manage and cope, utilize/develop resources= adaptation.

The family’s perception of the crisis is key and is the central factor to it’s coping.

Adaptation (xX)

Realized when there is a balance between levels.The family has accommodated, compromised,

worked together and defined/recognized the meaning in the crisis.

Considered at the individual family member level, unit, and community level.

Adaptation exists as a continuum from bonadaptation to maladaptation.

Bonadaptation is positive= family has achieved balance= utilization of resources, coping mechanisms, accepts and understands crisis.

Maladaptation is negative= typified by family imbalance

 

A Disscussion of ClarityThe theory reads easily (parsimonious). Major concepts are operationally defined,

and are presented clearly, and consistent throughout the theory (semantic clarity/consistency).

Relationships between the concepts can be easily presented visually/graphically (structural).Causes and consequences are carefully

separated.Multiple applications are available in the

literature . Serves to further clarify the major concepts

and relationships between variables. Provides both content and construct validity.

Congruence: Is the theory internally consistent?Theory makes logical sense.Variables have been operationally defined with

reliable instruments.Some concepts may be too limited in definition.

Crisis event is too narrow; concept of a situation may be more accurate.

The number of concepts can be cumbersome with extensions of the model.

Clarity and congruence can be diminished with extensionsExample: Individual resources are interchangeable with

family resources, even though they are conceptualized separately.

Researchers must identify whether they are testing part of the model or the total model.

Researchers must identify and define which variables they are testing.

A True Middle Range Theory!Theory of Family Stress and Adaptation meets the

qualifications of a Middle Range theory:

Moderately abstract, i.e., stressor, perception, etc.Organized within the limited scope of families

adaptation to stressLimited number of variables, which are testable in

a direct mannerStrong relationship with research and practice in

various disciplines, directly applicable to nursing actions/practice

Putting Theory into PracticeCurrent nursing research focuses on

family adaptation to chronic illness.Requires nurses to understand the stages

of illness and how families respond to the illness process

Theory assumptions help to guide practice that recognizes family needs beyond a one-time event

A Sample Nursing Plan:

An established relationship of trust is inherentAssess what aspects of the disease and family

dynamics present the most stressAssess and plan for coping strategiesDevelop both a short- and long- term plan for

individuals and familyPhysical and psychological parameters

Incorporate the unique strengths and vulnerabilities of each individual family member

Areas for further testing:Current concept variables have been tested

repeatedly with validated instruments Family Inventory of Life Events & Changes (FILE)

used to measure pile-up (reliability = .78) Coping Health Inventory for Parents (CHIP) used to

measure coping (reliability = .89)

Prediction models need to be tested to determine which variables of the model and in what order best explain family adaptation in applied situations

Areas for further testing (cont.):Ethnicity and cultural componentsIntervention studies that foster adaptation

and adjustmentThe use of instruments (i.e. FILE) in

increasingly complex family structuresCurrent reliability and validity testing focuses

on “traditional” family roles of mother and father

Future Developments (?)Increasing number of “stressors” faced by

familiesIncreasing prevalence of chronic diseaseIncreasing complexity of family structureAlthough the model in its entirety can be

cumbersome, the elements can easily be broken down and applied to an almost infinite combination of factors.

References Hill, R. (1949). Families under stress: Adjustments to the crises of

war, separation, and reunion. New York: Harper

Lavee, Y., McCubbin, H., & Patterson J. (1985). The double ABCX modelof family stress and adaptation: An empirical test by analysis of structural equations and latent variables. Journal of Marriage and the Family. 42(4): 811-825.

LoBiondo-Wood, G., Williams, L., Kouzekanani, K., & McGhee, C. (2000). Family adaptation to a child’s transplantation: Pretransplant phase. Progress in Transplantation. 10. 81-87.

McCubbin, H.I., & Patterson, J. M. (1983). The family stress process: The double ABCX model of adjustment and adaptation. Marriage and Family Review, 6(7), 7-37

References (continued) McCubbin, M.A., McCubbin, H. I. (1989). Familis coping with illness:

The Resiliency Model of Family Stress and Adaptation. In C. Danielson, B. Hamel-Bissel, & P. Winstead-Fry (Eds.). Families, health, and illness: Perspectives on coping and intervention. St. Louis: Mosby.

McCubbin, M.A., McCubbin, H. I. (1993). Family coping with health crises: The Resiliency Model of Family Stress and Adaptation. In C. Danielson, B. Hamel-Bissel, & P. Winstead-Fry (Eds.). Families, health, and illness . New York: Mosby.

Patterson, J.M. (1988). Families experiencing stress. The family adjustment and adaptation response model. Family Systems Medicine, 7(4), 428-442.

References (continued) Van Sell, S. L. & I. A. Kalofissudis. Formulating Nursing Theory.

Retrieved October 25, 2008 from http://www.nursing.gr/theory/theory.html.