Five minutes with Natascha Van Zyl Interview Making dietary and lifestyle changes can be challenging, but a good health practitioner will have plenty of skills to support clients in reaching their goals. Behaviour change specialist Natascha Van Zyl, a naturopath and senior academic at ION, discusses the barriers to making lasting changes and techniques to overcome them. What are the main barriers or challenges that clients face when trying to adopt healthier habits? “Great question! In truth, barriers are multifaceted – a client may struggle with motivation, or perceive tasks as complex or overwhelming, or their circumstances may make achieving specific goals difficult. “People can be motivated for different reasons. They may see value in it and it’s important to them – called internal or intrinsic motivation. Or there may be a promise of a reward (e.g. a prize or recognition) or a threat of something unpleasant (e.g. a fine or restrictions) – called external or extrinsic motivation. “Internal motivation is a good starting point to work from, although people can literally 'shut down' when internal motivation is low and the change appears complex. “But people can also become numb to external motivators – for example messaging around smoking – thus affecting how behaviour is maintained. “Work, relationships and life events can also be barriers to change because they impact our identity, sense of self and how we interact with the world – so it’s important to look at what’s going on with clients.” How can behaviour change techniques help practitioners and clients? “It’s the icing on the cake! As practitioners we have the skills, qualifications and professional registrations. Yet, at times, consultations may not necessarily live up to our expectations, with poor outcomes for clients. We may be addressing behaviours that have become so ingrained and habitual that they involve little conscious thought. “Behaviour change theories and models provide a framework for understanding human behaviour and how to facilitate change. The emphasis of practice is collaboration and patient-led care, rather than more traditional models of care that are more prescriptive. From my perspective, it’s all about human connection and our capacity to relate to one another. In South Africa, where I grew up, this connection is called ubunthu and centres on the belief that a universal bond of sharing connects all humanity. In short, if we understand, we can change.” What kind of behavioural strategies do you use in practice to support clients? “I’m in a very fortunate position because I trained in naturopathy and health psychology. As a result, I use several techniques to achieve therapeutic goals (i.e. goals made in collaboration with clients). These are as unique as the individual client, but include: Motivational Interviewing – a style of communication used in healthcare settings. Cognitive behavioural therapy techniques – e.g. exploring unhelpful thinking styles and self-limiting beliefs, goal setting and review, etc. Acceptance-based strategies – focusing on strengths, working with what we have, living in the present moment, etc. Positive psychology strategies – cultivating kindness, expressing gratitude, prioritising important relationships, and exploring strengths. Education – teaching clients about their health problems so they understand what is going on, demonstrating skills like cooking, referral to various resources to facilitate change, and using social prescribing initiatives like gardening, art clubs, dance or meditation, for stress relief. Environmental restructuring – e.g. putting a gym bag in the car boot, putting healthy food in kitchen cupboards that are at eye-level, using beautiful imagery to serve as prompts (e.g. a picture on the fridge as a reminder of your goals), changing the layout of a room, or removing items that may prompt negative behaviours (e.g. ashtrays, sweets drawer). Mindfulness – meditation, colouring, gardening, exercises like yoga or Tai Chi.” What results have you seen in clients after applying these techniques? “I work predominantly with clients experiencing significant stress, struggling with addiction, living with obesity and chronic illness. Overall, clients report that my integrative approach tailored to meet their needs is invaluable because it is accessible and achievable. However, some clients can be a little resistant, and then I know I have set the bar too high and need to re-think the intervention strategy. In this context, I invite clients to re-examine goals, and we co-create interventions that will work for them. That’s not to say I will not present them with challenges to facilitate change, but rather that I recognise their starting point and work from there. I am humbled to witness the challenges my clients have overcome, and behaviour change strategies helped make this possible.” How has applying behaviour change impacted your business? “Clients value my integrative approach to care, and my business has grown since implementing behavioural change techniques.” How can people avoid falling back into old habits? “I could write a thesis on this! But in summary: it’s about ownership of the problem; being honest about our limitations and recognising strengths; seeking help and sharing the load with like-minded people (like the 12 steps programme for Alcoholics Anonymous); accepting that relapse is part of the process; recognising that you have made changes before and can do so again but perhaps a new strategy is needed; and finding your joy, something that gives you the dopamine rush (e.g. move more, good sleep hygiene, varied healthy diet, meditation, listening to music and address stress). Finally, as Dory famously says in Finding Nemo: ‘Just keep swimming!’.” What’s your advice to health professionals who are struggling to keep their clients on track? “Our collective shared goal as healthcare professionals is to serve humanity in times of need. We do this by working closely with clients and facilitating their care and supporting positive health outcomes. If things are not going to plan, we must ask ourselves why. Consider the meaning of person-focused care and reflective practice. So why do health professionals think there is a problem? What is the precise nature of the problem? How is success measured (i.e. from the client’s or practitioner's perspective)? And more poignantly, have they asked their clients? “It is all about the client's journey. At times, we may need to monitor our egos because it’s not about us. Sometimes clients want a sounding board; at other times they need structure with clearly delineated steps to get them where they need to go. The focus needs to be on keeping things simple, at a level that clients can engage with, encouraging their autonomy, and facilitating their competency development. “Be clear about goal setting and the value of reviewing progress. Frame perceived failures as positive learning opportunities because this feedback allows strategies to be changed and reduces the guilt. Keep things real, authentic, and in perspective by managing expectations! Consider family involvement, social support and social prescribing initiatives to add that additional layer or buffer, which some clients need because change can be difficult to navigate. Recognise that we all change in our own time. Lastly and most importantly, truly listen to your client and see them for who they are – the rest will follow.” ION’s fast-track undergraduate degree top-up and Graduate Diploma in Integrative Function Nutrition both include behaviour change modules to provide practitioners with the skills they need to help their clients succeed. Qualified healthcare professionals can also take the GDip module Behaviour Change in Nutrition and Lifestyle Practice as a short course. For more information about our courses visit www.ion.ac.uk or call 020 8614 7815.