Families and Chronic Illness

Module Sections:

Double ABC-X Model: McCubbin & Patterson

Pile-Up (Factor aA): Since crises occur over a period of time, and often occur simultaneously (not just one at a time) it is very common for families to experience a pile-up of stressors. There are five broad types of stressors that McCubbin & Patterson (1983) identified as commonly contributing to a pile-up for the family:

  1. The initial stressor and its hardships
  2. Normative transitions (e.g., children leaving the home to start college)
  3. Prior strains (e.g., stressors the family is still coping with when another stressor or strain is introduced and experienced)
  4. Consequences of family efforts to cope (e.g., an inability to cope well leads to more stress)
  5. Ambiguity (e.g., not knowing what will happen next; an inability to find closure to a stressor or situation)

Family Adaptive Resources (Factor bB): There are two general types of adaptive resources—a family’s adaptive resources can be: (1) existing resources or (2) expanded family resources (McCubbin & Patterson, 1983).

  1. Existing resources “are already part of the family’s repertoire and serve to minimize the impact of the initial stressor and reduce the probability that the family will enter into a crisis” (McCubbin & Patterson, 1983, p. 15). For example, the degree to which a family is cohesive is an existing resource, as is the family’s previous experience with the same or a similar stressor (Rolland, 1994).
  2. Expanded family resources are new resources. The new resources can be ones developed by the family or existing resources that the family has strengthened as a response to the crisis or as a result of pile-up. For instance, the family has learned what agencies or organizations to access when presented with health care needs.

Perception (Factor cC): McCubbin and Patterson (1983) stated: “The cC factor is the meaning the family gives to the total situation which includes the stressor believed to have caused the crisis, as well as the added stressors and strains, old and new resources, and estimates of what needs to be done to bring the family back into balance.” In other words, it is the family’s subjective world-view in relation to their specific stressors.

For example, in relation to perceptions (factor cC), in an article by Gordon, et al (2002), the authors found that women who were religious were better able to cope than those who did not practice spirituality/religiosity. Similarly, Roland and Walsh (2005) found that chronically ill individuals who found ways to help others or advocate social policy found greater meaning in their illness, and consequently coped better. Both are examples of how experiences, beliefs, and values shape the way one perceives the illness.

Family Adaptation Balancing (Factor xX): This is a continuous variable, in that it varies on a continuum from “bonadaptation” (positive changes and reactions to the original stressor [a] and/or pile-up [aA]) to “maladaptation” (negative changes and reactions to a and/or aA). McCubbin & Patterson (1983) further posit: “Systems theorists (Hill, 1971; von Bertalanffy, 1968) point out that it is characteristic of living systems to evolve toward greater complexity, and consequently, families may actively initiate changes to facilitate such growth” (p. 17). Therefore, maladaptation, even though initially it may be stressful and anxiety provoking to the family, may help to promote change within the family system. For instance, in a state of maladaptation, the family may feel they have hit “rock bottom.” However, in this condition, they will realize that changes need to be made to get them out of their plight. With this in mind, maladaptation may ultimately lead to changes in the overall way families react to stressors and pile-up, and utilize and view their resources and stressors.