R u n n i n g h e a d : D O U B L E A B C X MO D E L | 1

A Review of the Double ABCX Model and its Applications

Hitha Srivatsan
Converse College







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Abstract
The 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










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A Review of the Double ABCX Model and its Applications
Research 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
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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
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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 Model
McCubbin, 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)
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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
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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).
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Figure 3. Causal Structural Equation Model for Double ABCX Model. (Source: Lavee,
McCubbin & Patterson, 1985)

Applications of the Double ABCX Model
The 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.

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Families of Children with Illnesses or Disabilities
The 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
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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.
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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
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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).
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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
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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.
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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 them
for 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
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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
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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 Disabilities
The 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
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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
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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 Remarriage
Given 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.
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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.
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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 Clergy
Families 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,
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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 Families
Having 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
D O U B L E A B C X MO D E L | 23

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 Families
The 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
D O U B L E A B C X MO D E L | 24

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 Level
McCurry, 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
D O U B L E A B C X MO D E L | 25

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.



D O U B L E A B C X MO D E L | 26

Discussion and Conclusions
Limitations 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 Model
Since 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
D O U B L E A B C X MO D E L | 27

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).
D O U B L E A B C X MO D E L | 28

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 Research
Future 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.
Conclusions
The 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
D O U B L E A B C X MO D E L | 29

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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