Using the Living Well App with clients
This is a brief guide for professionals on how to best utilise the Living Well Mobile App app in working with your own clients. It is an introductory guide to using the app while working with men who have experienced sexual abuse or sexual assault.
The Living Well App has been specifically designed to assist men who have been sexually abused in childhood. We know that childhood sexual abuse can have a profound impact on men’s lives and relationships. However we also know that men who have been sexually abused can live rich, full lives, develop healthy relationships, and make positive contributions within our communities.
About the app
The Living Well app provides practical resources and suggestions that men who have been sexually abused can make use of. The information and resources draw upon research evidence and practice knowledge to offer suggestions that can enhance well being and help better manage difficulties. The app is also designed to be useful for partners, family members, friends and health care professionals — for anyone looking to enhance their personal wellbeing and their understanding of the effects of sexual abuse or sexual assault.
The app is divided into eight sections:
- Managing Difficulties
We invite you to check it out! Work your way through the app and become familiar with what each section has to offer. Being familiar with it will enable you to to get an idea of what particularly might be of benefit to your client.
“Recovery and resilience do not reflect simply the absence of problematic symptoms, but rather a zest for life; a positive conceptualisation of ones self; the ability to form positive, supportive, and safe relationships; and the ability to achieve a fulfilling quality of life.”
(McMackin et al 2012)
This section details some things that have been shown to improve health and well-being. Research tells us that having these building blocks in place leads to enhanced quality of life and improved coping and resilience.
Our decision to foreground well-being is based on a knowledge that living a fulfilling, connected, active life is possible after sexual abuse and we do not wish to accept a lesser goal for all those whom we live and work with. We have approached this section (and indeed, the whole app) from a trauma recovery framework. Namely, that a practical approach on the part of practitioners is helpful in terms of beginning work from a base of safety and stabilisation. It is hoped that the well-being section highlights the value of establishing a strong base.
The Well-being section is broken up into a number of different sub-sections, each with information and resources that you are encouraged to make use of with your clients. Undoubtedly you would be doing this anyway, however it is hoped that the app will provide a concrete guide for clients to make use of outside of their sessions with you. Using the app as a basis for homework could be particularly helpful in solidifying strategies you have already been going over in session with your client.
The subsections of well-being are:
- Building connections
- Physical Well-being
- Learning and thinking
- Living by your values
As you know, there is no one path to health and well-being. We encourage you and your client to become familiar with what each section has to offer and to work on establishing a routine that works best for your client.
Some aspects of this section might require you to encourage perseverance on the part of your client. You may need to remind your client that by placing a focus on doing things that support well-being, there is no suggestion that problems will just disappear — that's not possible. It is about building solid foundations that can help you better deal with problems when they do arise and keep you on track for living the kind of life you want to live.
This assessment tool uses the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) to measure well-being. Good mental well-being — some people call it happiness — is about more than avoiding mental health problems. It means feeling good and functioning well.
To get a well-being score, your client will need to read through the statements and click on the box that best describes their thoughts and feelings over the last two weeks, then click next to continue on through the 14 questions. They will then will receive information at the end that will provide an assessment of their current well-being and what they can do to enhance it.
This section of the app can be particularly useful to your client, and to your work with them. Encourage your client to take the assessment often, perhaps weekly through your work with them. Their results over time will then be plotted on a graph, providing a clear indication of your client's progress. You can use these results to identify what your client is doing well (that might be contributing to improved scores) and what might need to be worked on if their well-being score drops at any point. (What caused it to drop that week, do you think? How can we plan for this in future?)
Why the well-being scale?
The WEMWBS is an internationally validated assessment of well-being that utilises strength based language less likely to be triggering or distressing for those who have been traumatised.
By integrating and promoting use of the WEMWBS, we are very much aware that childhood sexual abuse and sexual assault can profoundly impact on an individual’s mental and physical well-being. The Learning section of this app provides details some of the particular difficulties people who have been abused can face, as well as some ways of addressing these.
About the well-being scale
The WEMWBS questionnaire for measuring mental well-being was developed by researchers at Warwick and Edinburgh Universities (see Tennant R, Hiller L, Fishwick R, Platt P, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S (2007) The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation, Health and Quality of Life Outcome; 5:63 doi:101186/1477-7252-5-63).
The Warwick-Edinburgh Mental Well-being Scale was funded by the Scottish Executive National Programme for improving mental health and well-being, commissioned by NHS Health Scotland, developed by the University of Warwick and the University of Edinburgh, and is jointly owned by NHS Health Scotland, the University of Warwick and the University of Edinburgh.
The WEMWBS is subject to copyright. We are grateful that we have received permission to use and make available the WEMWBS. Read more about the WEMWBS.
This section provides some basic information about childhood sexual abuse, common impacts, difficulties and challenges that men who have been sexually abused in childhood or sexually assaulted as adults can face. This section is based on the idea that psycho-education is a necessary factor in recovering from trauma. Informing clients as to the common responses to sexual abuse and sexual assault normalises these and plays a very important role in decreasing shame, confusion and a sense of “being crazy.” Further it also empowers clients by giving them the ability to recognise these common issues, how to anticipate them, what they mean, and how to prepare for and manage them. As such we have also included some discussion of different ways of coping with such challenges, as well as questions and suggestions to help your client think through and deal with them.
Reading through this information may be quite stressful and perhaps even triggering for your client. As such it could be a good idea to take a look at the information together, and explore it in a safe and contained space. In terms of your client reading it in their own time, we would suggest encouraging your client to think about the right time and place to read the different parts of the learning section. Suggest placing a limit on how much your client reads at any one point, and to take some time — 10 minutes or so — after reading, to reflect on the information and whether it is relevant or helpful to them.
We have included the facility to make your own notes as you read through — this can be useful for practitioners who use this information in session as it allows you to add your own thoughts and phrasing, and to check in on this as you're working with your client. We encourage you and your clients to use the notes section to keep a record of your reflections and what works best for you.
After exploring the learning section with your client it might be helpful for you to plan with them about what grounding, relaxing activities they can engage in afterwards. Encourage your client to engage in something fun, meaningful, relaxing or energising after reading through a few sections. This is particularly important if they do read this information in their own time, without your supportive presence to contain their responses.
Finally, remind your clients that not everyone is confronted by the same problems; what is important is that they make use of information that is useful for them, and leave to one side anything that is just not relevant.
This section provides suggestions and guidance to help better manage some common difficulties that can confront and overwhelm men who have experienced abuse and trauma.
We know that sometimes distressing memories and thoughts can make it difficult for men to connect with people, stay on track and focus in the present. We know that sometimes feelings such as sadness and anxiety can take hold and overwhelm our current resources and that difficulties and distress can vary throughout the day. We have therefore included a tool kit of suggestions for better managing difficulties.
When you visit the Manage Difficulties section, you will be presented with a list of common difficulties.
- Difficult memories
- Avoiding triggers
- Feeling isolated/disconnected
- Sleeping difficulties
We know that a number of difficulties can appear at once, so invite your client to click on the one that is most pressing at the moment.
When your client taps on a particular difficulty, he will then be asked to ‘Rate current level of distress’ on a sliding scale of 1-10. Zero means the distress is ‘not intense at all’, whilst 10 means ‘the most intense you have felt’.
Depending on the rating and specific difficulty identified, the app will offer a series of randomised suggestions specific to the issue and the intensity with which it is being experienced. Given that men are such a diverse group and that problems can be varied, there is no single prescribed way of resolving difficulties. It might be helpful to point this out to your client, and to encourage them to trial some of the different suggestions until they find one that works for them. There is a bookmark feature included in all sections of the app for easy access later, so your client can then book mark favourites for future reference — the suggestions that are marked will subsequently appear first when your client is seeking to manage a similar level of distress in relation to that particular difficulty.
This section can come in very useful in a practitioner's ongoing work with a client. It can provide a point for checking in with your client as to how they went managing difficulties leading up to a session — what worked and what didn't work and what can be taken away from this experience.
Something that is important for your clients to keep in mind, however, is that whilst this section provides an immediate response to what is going on now, establishing and maintaining a positive, connected well-being routine is worth investing in as it will help reduce and better manage difficulties in the long term.
Calming the mind and body are skills crucial for stabilisation and ultimately for processing past experiences of trauma. One of the quickest and easiest ways for a client to begin to learn to calm their body is through breathing techniques. Attending to breathing is a very basic way to encourage stabilisation and grounding — when feeling stressed or agitated, not entirely in the present, or when struggling with unwelcome or unhelpful thoughts.
Time2Breathe is a section devoted to practising mindful and calming breathing. It differs from the audio mindfulness exercises in the well-being section in that it does not require listening to a voice. Sometimes, when people have been sexually abused or sexually assaulted listening to people talking them through relaxation or mindfulness exercises can be difficult. Just listening to someone speaking slowly and gently can set off a whole load of unhelpful talk in a client's head, especially if those who perpetrated abuse manipulated the situation through speaking kindly or by pretending to be a supportive adult or friend.
The Time2Breathe function is designed so that your client can adjust the number of breaths or beats per minute, and the length of time they wish to do the exercise. You can introduce this concept to your client as not being something they have to spend lots of time on — just a couple of minutes of breathing in and out in time with the beats can help calm their body and mind.
If you have broached the topic of breathing exercises with your client already, Time2Breathe can extend on this. Encourage your client to continue practising breathing outside their work with you; incorporating Time2Breathe into their daily routine. Scheduling a regular time to breathe, be it when your client gets up in the morning, during a break from work, on the way home or at the end of the day, can have wide-reaching positive effects.
Remember, taking time to breathe is just as important for practitioners.
It’s good for us all to settle ourselves and take some Time2Breathe.
The Support section is based on the premise that everyone benefits from being connected and accessing support at different times. Support works best when it is personalised to meet our particular needs, interests and circumstances.
It includes a Support Network section and a Helpful Media section.
The Support Network section comes pre-populated with useful (Australian) support telephone numbers and websites, and includes the function for adding personal support people, friends and professionals. This provides the opportunity of encouraging your client to add your contact details to this list.
The Helpful Media section includes music and images that are calming, encouraging and inspiring. Your client can check out ‘How music can support our well-being’ in the Well-being section and create their own playlist from their music collection on topics such as ‘Music to calm me’ or ‘Music to energise me’. Your client can also add images and photos of important people, pets and places that they have selected.
The community blog offers further information and inspiration, encouragement and hope. It is a place to keep up to date with the latest initiatives and ideas. It is a place where your client can offer encouragement and hope to other men (anonymously if they wish) — where they can post comments, quotes, stories, inspirational images and videos. This is based on recent research in neuroscience that shows that helping others and working cooperatively activates and strengthens certain parts of the brain, enhancing well-being. Encouraging men to do things for other people actually has a beneficial effect on developing their own well-being.
The blog is all about building communities of support offering encouragement and hope. It is designed to help make the app more dynamic — ever improving and evolving. It is an opportunity for your client, and you!, to help make a difference. We value and welcome contributions from men and women, from individuals, groups and organisations.
Settings buttons allow clients to manage reminders for the well-being section, the self assessment and booking in Time2Breathe. It’s all about making the app work for you in your day to day life.
The Living Well App was developed with the financial support of the Australian Commonwealth Department of Social Services and the Community Services Commission of Anglicare Southern Queensland. Living Well, is one of the innovative and specialist services developed and supported by Anglicare Southern Queensland. The App was designed by Gary Foster PhD, with the assistance of Jessica Decker, Cameron Boyd, Kent Smith, Janine Hills. Hugo Teixeira and the team and clients of Living Well.
We welcome feedback.
In order that we might improve the effectiveness and functionality of future versions of the app, we are interested in hearing from you about how you rate this app and what you found useful or not.
It will only take a couple of minutes. Please fill in the feedback form to send us your comments. You can also use this form to report problems and get support for the app.
Partnerships and Donations
We have made the Living Well App available for free. We believe that everyone who has been sexually abused or sexually assaulted should have access to quality information and support, whatever their current circumstances.
We are interested in partnering and working with like minded organisations to improve support to people who have been sexually abused in childhood. We would welcome the opportunity to create an enhanced version of this app.
We recognise also that people value the opportunity to contribute and to support further development of this app and our services. Please feel free to contact us about getting involved.
McMackin R.A., Newman E., Fogler J. M., & Keane T.M. (2012) Trauma therapy in context: the science and craft of evidence based practice. American Psychological Association: Washington.