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The Theory of Family Stress and Adaptation McCubbin and Patterson

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Title: 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 familys experience of stress,
    crises, and subsequent adaptation is an ongoing
    and dynamic process.
  • The process of adaptation is affected by the
    familys 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
    familys perception of that stressor, and the
    familys 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 familys 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 familys 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 familys 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 familys 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 familys 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
    familys disorganization, turmoil, disruption
    which is triggered by an event.
  • In the model- crisis is regarded as the familys
    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) ?
    familys 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 familys perception of the crisis is key and
    is the central factor to its 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
  •  

24
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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.

33
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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
    childs 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.
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