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UMass Boston Spring 2022

Psych 441 Peggy Vaughan

Family Health and Stress: Focus on Well-being, Coping and Resilience

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Week 5 � Family health, stress and coping models � Historical models of family stress � Review of stress in the context of the pandemic � Stress and life event measures in research � Contextualization of stress in family life � Considerations of child stressors and coping strategies � Tools for stress: Action as well as communication,

healing, relaxation, and mindfulness.

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Stress, Health, and Coping � Family health is a dynamic process ref lecting how the

group develops strategies and ideas about what is essential for healthy living (Fiese and Hammons, 2013). Ideally, the family group must respond to normative transitions in healthy ways.

� Family health theory is linked to the socioecological framework.

� Families engage in specific behaviors in response to stress and health challenges. Healthy living is a goal for families (Fine & Fincham, 2013 ,p. 400, Figure 22.1)

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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 accessible and available resources, and the presence or absence of coping strategies.

¨ Adaptation exists on a continuum from positive adaptation to maladaptation, resulting in changes in family functioning.

¨ Note: The nature of stress in the context of well-being was discussed previously in terms of individual stress: positive, tolerable, toxic. From the Center on the Developing Child Video_Week 1.

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Stress and Types of Stressors (Anderson & Sabatelli, 2011) n Stress

n The degree of pressure exerted on the family to alter the strategies it employs to accomplish its basic tasks.

n Normative stressor events n The expected and ordinary developmental transitions

affecting the family. Their key distinguishing features are that they are expected, occur regularly over time, and carry with them ordinary difficulties.

n Non-normative stressor events n Unexpected events that create unanticipated hardships and

require adaptations or alterations in the strategies used by the system to execute some or all of its basic tasks.

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Parenting: Impacts due to COVID-19 No masks on babies under 2 years

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Children and Teens Wearing Masks in Schools and Changes with Lifting of Mandates

� https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k- 12-guidance.html

� https://www.cdc.gov/media/releases/2022/s0218-children-wellbeing-covid- 19.html

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Family Stress

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Stressors and/or Transitions? Transition as Metaphor (Walsh, 2015) � Normative Transitions:

� These are expected and predictable based on biological, psychological or social norms.

� Non-Normative Transitions; � These are less predictable statistically and often

unexpected. � Some family transitions or events, such as divorce are

hard to classify in this way.

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Factors in Defining a Stressful Event

S The nature of the stressor. S The degree of hardship or the kind of problems the

stressor creates. S The families previous successful experience in the

event crises. S How families define stress in the context of resources

and supports. S Childhood legacies of adult family members.

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Family Stress Impacting Family Health � Your Ideas.

� What helps with coping?

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Types of Stressors � Ambiguous loss – Link to stress theory

� Pauline Boss describes ambiguous loss as loss that is unclear, incomplete or partial (Falicov, in F. Walsh, 2015, p.302).

� Two Types � physically absent but still emotionally a part of the family

(non-residential parent after divorce, family member who has migrated, missing person or soldier missing in action).

� physically present, but emotionally or psychologically absent (family member with a drug /alcohol addiction; Alzheimer’s disease patient, family member with a severe psychiatric illness).

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Types of Stressors � Caring for a dependent or disabled family member. � Demoralizing events - job loss, unwanted pregnancy,

poverty, homelessness, having one’s child in foster care, mental illness, criminal prosecution.

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ABC-X Theory

¨Rueben Hill (1949): Developed the original family stress theory. Hill studied families’ responses to war, war separation, and eventual reunion after WWII.

¨The ABC-X Model detailed how the three factors (the ABC components) of a stressor event specifically (A), the family’s existing resources (B) and the family’s perception of that stressor (C) interacted to predict the likelihood of a crisis (X) occurring.

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ABC-X Component Interactions

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

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ABC-X Model of Family Stress-Crisis

search 2.webloc

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Concepts: ABC-X 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

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ABC-X Components � 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

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ABC-X Components � 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?

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Crisis or X � 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.

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The Double ABC-X Model n McCubbin and Patterson (1983) developed the Double

ABC-X Model. Their model added post-crisis variables (e.g. coping mechanisms) to the original model explain how families recover from crisis and adapt over time.

n The Double ABC-X Theory was originally based on longitudinal research involving families in which a father/husband was a POW or MIA during the Vietnam war.

n Families facing a stressor event experience stages of adjustment and adaptation identified by a range of processes in which the variables interact.

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Link to Systems theory S Components

S Individuals, family, environment, and health and well- being in the face of stress/stressors S The family is viewed as the “system”, where the experiences of

one family member affect the experiences of other family members.

S Family systems theory and the Double ABC-X model highlight the mutual influence of the family system on each individual member's development and vice-versa.

S Systems theory (and the Double ABC-X model) see interactions of the parts are not "static" and constant but "dynamic" processes.

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Double ABC-X Model

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Double ABC-X Model � 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.

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Double ABC-X Model � 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.

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Double X Model � 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.

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Double X Model � 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.

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Meeting A Crisis Creatively

S A positive outlook S Spiritual values and support groups S Open, supportive communication S Adaptability S Informal social support S An extended family S Community and cultural resources S Other ideas?

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Family Adjustment and Adaptation Response (FAAR) (Patterson,1988 in Fine and Fincham, 2013)

S Another Extension of ABC-X Model S Phases

S Adjustments -----Adaptation S Adjustments (may deny or remove demand)

S Facing demands, stress, stressors and hassles S Role of capabilities

S Based on resources and coping behaviors S Adaptations (work and address demands– look to

restore balance) S Demands, meanings and capabilities

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Levels of Stress (Burr & Klein, 1994)

� Three levels of abstraction � Level I – birth of a child

� cope via changing of role expectations or rules.

� Level II � more essential changes needed in terms of how family relates

� Coping with adolescent and monitoring/safety rules � Level III

� questioning; is family in trouble?

� fundamental (moral) dilemmas, spiritual and life questions examined. � Family member completely withdraws from family activities;

others react; members react or lash out; major communication failures

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Research and Practice S Current family research focuses on family adaptation

under stress such as to the stress of separations, disability or chronic illness.

S Therapists and providers must be able to understand the specific stressors and identify how families respond.

S Identifying and understanding models of stress and adaptation allows for a more holistic view of family life and its challenges.

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Areas for Consideration � Ethnicity and cultural components � Intervention studies that foster adaptation and

adjustment � The use of instruments in increasingly complex family

structures � Family measures in future classes.

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Coping � Coping: The cognitive and behavioral problem- solving

strategies that are used to respond to a stressor event. � Behavioral coping strategies: What the family actually

does to manage stress. � Cognitive coping strategies: The perceptions and

appraisals that people and families make with regard to specific stressor events.

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Coping � Coping efficacy: The adequacy of the efforts

undertaken by the family to reduce stress. � Coping resources: Those properties, attributes, or skills

individuals, families, or societies have at their disposal when adapting to novel and demanding situations. Coping resources serve to minimize vulnerability to stress.

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Realities in Family Studies ¨ Increasing number of “stressors” and “chronic stressors”

faced by families ¨ Increasing prevalence of a variety of stressors such as those

linked to chronic conditions, chronic diseases, natural disasters, and the prolonged pandemic.

¨ Increasing complexity and diversity of family structures ¨ Note: Although applying a stress/adaptation model in its

entirety can be cumbersome, specific aspects can be easily looked at in the light of family experience; the perception of the stressor (s) is a critical aspect.

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Promoting Resilience

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Resilience S Resilience can be defined as the capacity to rebound

from adversity stronger and more resourceful. S It’s important not to equate resilience with competent

functioning. S Resilience is more than just “getting through” or

coping with a challenging situation. Resilience involves positive transformation and growth that enables one to deal effectively with challenges. S (Froma Walsh, Keys to Resilience)

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Resilience S One way to think of resilience is to compare it to a

rubber band. In order for a rubber band to move forward we need to pull it back first.

S The same thing happens in life. Something might happen that knocks us back for a while but, if we are resilient, we stretch ourselves and spring forward.

S Froma Walsh, a researcher and family therapist developed a family resilience framework that can be useful for families and individuals who are dealing with adversity.

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Family Resilience (Walsh, 2015)

� According to Walsh, the family resilience framework applies to various types of family structures as well as formal and informal kin networks. Resilience is related to three areas. � Area 1: Belief Systems

� Make meaning of crisis and challenge

� Maintain a positive outlook � Value transcendence and spirituality

� Area 2: Family Organization and Resources � Flexible � Connected

� Supported by social and economic resources

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Family Resilience (Walsh,2006)

� Area 3: Family Communication � Share clear and constant messages

� Openly express emotions

� Use collaborative problem solving

Resources: F. Walsh, 2015;

Walsh, F. (2006) Strengthening Fam ily Resilience (Second Edition). New York: The Guilford Press

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Factors Enhancing Family Resilience – Linked to the Framework

� Family beliefs and meaning making � Spirituality � Cohesive and close relationships � Social, economic and instrumental supports � Capacity to re-organize; flexible strategies � Positive, open, clear and constructive communication � Openness to growth and change � Collaborative approaches to facing problems � Energy for seeking services when needed � Reaching out to communities of caring

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Factors Impacting Family Stress and Resilience

� Child and family health � Child challenges or disabilities � Grief and loss � Unexpected transitions � Pile-up stressors � All ACES (Adverse Childhood Experiences) � Lack of available and consistent support

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