The Theory of Family Stress and Adaptation McCubbin and Patterson

1. The Theory of Family Stress and Adaptation(McCubbin and Patterson) BiWei Dong Elizabeth Hopewell Sarah Kline Robyn Simmons Julie Wellborn

2. 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.

3. 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.

4. 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.

5. 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.

6. Later Developments The 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

7. Current Nursing Research Current 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.

8. Explicit Assumptions Families over the course of life face hardships and changes as a natural and predictable aspect of family life. 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.

9. 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. 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.

10. 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.

11. Implicit Assumptions Families 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

12. World View Model grew out of a systems theory/holism approach Holism 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.

13. 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.

14. Relevant Metaparadigm Elements Person (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.

15. 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, goals Examples include chronic illness in children, cancer, and elder care

16. 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

17. 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?

18. 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. �

19. ABCX Component Interactions Stressor (A) ? interacts with resources (B) ? family�s perception of stressor/how stressor defined (C) ? produces the crisis (X).

20. 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.

21. 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.

22. 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.

23. 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 �

25. A Disscussion of Clarity The 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.

26. 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 extensions Example: 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.

27. 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 stress Limited number of variables, which are testable in a direct manner Strong relationship with research and practice in various disciplines, directly applicable to nursing actions/practice

28. Putting Theory into Practice Current 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

29. A Sample Nursing Plan: An established relationship of trust is inherent Assess what aspects of the disease and family dynamics present the most stress Assess and plan for coping strategies Develop both a short- and long- term plan for individuals and family Physical and psychological parameters Incorporate the unique strengths and vulnerabilities of each individual family member

30. 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

31. Areas for further testing (cont.): Ethnicity and cultural components Intervention studies that foster adaptation and adjustment The use of instruments (i.e. FILE) in increasingly complex family structures Current reliability and validity testing focuses on �traditional� family roles of mother and father

32. Future Developments (?) Increasing number of �stressors� faced by families Increasing prevalence of chronic disease Increasing complexity of family structure Although the model in its entirety can be cumbersome, the elements can easily be broken down and applied to an almost infinite combination of factors.

34. 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

35. 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.

36. References (continued) Van Sell, S. L. & I. A. Kalofissudis. Formulating Nursing Theory. Retrieved October 25, 2008 from http://www.nursing.gr/theory/theory.html.