Interventions for Behavior Change of Moderate Carbohydrate Intake

Maria Kounsalieh

Department of Psychology, Wheaton College

PSY 265: Health Psychology

Dr. Michael Berg

March 25, 2021

Introductory Goal Statement:

My behavior change goal for the last month was to reduce the number of

carbohydrates that I consume to between 150-180 grams of carbohydrates per day or a

range of 50-55% of calories consumed being carbohydrates. In addition to this, I will

replace the simple carbohydrates with more complex carbohydrates like fruits and

vegetables.

Health Consequences:

The consumption of large quantities of carbohydrates, can cause weight gain,

which can put a person at risk for diabetes, cardiovascular disease, high cholesterol. On

the other hand, while maintaining a low-carb diet for about a week can be beneficial,

restricting carbohydrates for long periods of time (i.e., months-years) can lead to serious

complications. These “complications include as heart arrhythmias, cardiac contractile

function impairment, sudden death, osteoporosis, kidney damage, increased cancer risk,

impairment of physical activity and lipid abnormalities.” (Bilsborough, Crowe, 2003)

Cardiovascular diseases are very complex in their nature, due to them not being as

straightforward as say an infection, for example. Rather, the problem tends to lie within

the organism itself. They remain in the prevalence of the influence of catabolism

(destructive metabolism), represented by catecholamines (neurotransmitters) and cortisol,

over the role of anabolism (constructive metabolism), represented by testosterone and

insulin, leading to an increase in cholesterol level.

Luckily, there are a variety of treatments available, such as medications used to

reduce LDL (Low-density lipoprotein), improve blood flow, or to regulate arrythmia,

surgery, such as coronary artery bypass and valve replacement, and lifestyle changes,
such as adjusting diet and exercise. It is noticeable how cardiovascular disease can also

be an underlying cause for diabetes and higher cholesterol, making these health issues

connected to each other.

According to the biopsychosocial framework, which focuses on the holistic well-

being of the person, and in addition to the previous section, all of the health concerns will

end up causing high levels of stress. If anything it seems as if though stress is a bigger

factor since it is more chronic and can happen at all ages. High stress levels can take an

extreme toll on the mind and in turn on the body, making the need of prevention of

cardiovascular disease even more important as one would think. As someone who has

cardiovascular issues, diabetes, cancer, and much more in my family, I would hope fixing

something like the way I eat (which in the grand scheme of things is not that difficult nor

time consuming) would be able to help prevent me from getting such diseases. Moreover,

if not in the long term, I can already see some of the benefits now. I just feel better

overall, and more alive I suppose is the right term, which feels nice with everything else

going on in the world.

Current Research on Behavior Change Promotion:

The first study was conducted by Fremouw et al over a 25-week period with

alternating five-week phases of stimulus control (avoiding and managing triggers) and

contingency contracting (enlisting family/friends to help manage

reinforcements/punishments) as a means to modify people’s eating habits. By reducing

the amount that a person snacks and eating rates it showed a moderate amount of weight

loss in participants. This was possible because the instructions in stimulus control

produced changes in the participants monitored eating behaviors while the contingency
contracting also produced improvements in some eating behaviors. I thought that this was

actually a very effective way of trying to modify a behavior, by alternating the

interventions, I feel like it helps acknowledge what exactly is causing the behavior and

that they have people that care about them also helping, a support system. I haven’t used

much of contingency contracting, because I find that if I get people involved it’s more

confusing for me, however, stimulus control has been a life saver because I now know

what exactly sets me off and how to make sure it doesn’t happen. In the study, they a

person that knows the participants help with preventing triggers and monitor their

progess.

The second study, conducted by Bongers et al, looked at uncovering information

on the origin of emotional eating by testing whether any classical conditioning processes

might play a role. The researchers did this by introduced subjects to either a negative or

neutral mood induction. After this, participants were subjected to a differential classical

conditioning procedure, using neutral stimuli (in this case, a green vase with fake red

roses and an orange vase with fake white daises) and appetizing food (chocolate

mousse). In both mood conditions, the results showed conditioned eating desires, but

participants in the negative mood condition showed a significantly smaller differential

response to the conditioned stimuli. This means that participants in the negative mood

condition learned appetitive desire to eat was weaker than the learned appetitive desire in

the neutral mood condition. This was one aspect of the behavior that I am trying to

change, as I do tend to use eating as a coping mechanism for negative emotions. I don’t

think that I would use this as a technique by myself and on its own, because I know my

myself and I can’t classically condition myself to do anything. I would pair it with
contingency contracting and get my friend to help me out, only because she’s also a

psychology major and knows how to do something like this better than I can. With this, I

think it would work really well.

The third and final study, conducted by, Brewer et al, reviews how operant

conditioning promotes habit-based reward-related eating and how the current diet

programs/methods may not target this type of eating. In addition, they describe how

mindfulness training that targets reward-based learning may create an appropriate

intervention to rewire the learning process around eating. At the end, they finished off

with examples that show how teaching people to act on intrinsic (ex: not over-eating,

enjoying the healthy eating) instead of the extrinsic (ex: weighing yourself) reward

mechanisms and that this is what will ultimately improve people’s relationships with

food. This is definitely has worked for me as this is what I have been doing as part of my

behavior change. I know that I work well with a reward/punishment system and so this

seemed like a good study to add in.

As a part of my behavioral interventions, I have reduced my carbohydrate intake

from what I calculated to be around 70% and higher, calories being carbohydrates to a

range of 50-55% of calories being carbohydrates. The initial intervention was just to cut

down on items with white flour, i.e., white breads, pastas and fried food as well. In

addition to this cut out sugary drinks, i.e., Diet Coke, Snapple, and other concentrated

sweet drinks. As part of my second behavior change, I added in the following

replacement food items that have complex carbs, i.e., whole grain items (quinoa, brown

rice, whole wheat bread, and wheat pasta), vegetables (zucchini, broccoli, spinach,

cauliflower, cabbage, carrots, eggplants, potatoes, etc.), legumes (chickpeas), fruits

(bananas, apples, berries), dairy (Greek yoghurt), and nuts as a snack (almonds, peanuts,

hazelnuts, pecans, walnuts). I have seen a dramatic increase in energy for myself, and just

overall feeling better and I believe that this is attributed to with switch in type of

carbohydrate and the among that I am eating as well.

Review of Behavior Change Exercise:

For as long as I can remember, I have always liked eating foods that happen to be

high in carbohydrates. Even the food I ate growing up was centered around heavy

starches, pastas, breads, and more. In addition to this, I have also been trying to cut out a

lot of the simple, or “bad” carbohydrates and introduce more wholesome, healthier

alternatives. I have tried various diets that help reduce carb intake (Atkins, Keto, and

even trying to eat gluten free), however, they just did not seem to work due to my lack of

self-control and discipline. For this last month, once more, I decided to give it another

shot and change this behavior. I want to say that a lot of my behavioral patterns stem

from watching my family and even friends. As for family, I do believe there is a strong

cultural aspect to the way I have been taught about carbs and overall consuming food.

While it certainly has been a challenge, I really put all of my effort in this endeavor

and actually achieve some results for myself. During the first half of my month of

observation, I noticed a consistent pattern and one probably is most likely a large

contributing factor to why I have not been to commit to adjusting my diet. As most

people tend to do, I stress eat and emotion eat, almost as coping mechanism. Even if I

have been doing well with progress, it only takes one small thing that makes me upset

and then my work has been for nothing. As a way to try and fix this I used response

substitution to take this not-so-great coping mechanism and channel it into something
productive and healthy. So instead of eating when I’m upset, I’ll draw, watch something

funny on TV or even call my friends and talk to them. Anything positive so that I stop

myself from being upset but also to prevent myself from doing something I may regret.

Something else I noticed was that when I came to college and met my roommate, I

started eating out a lot more or just in general really. Which brings me to another major

factor that influences how I eat, my friends. I think I can speak for most when I say that

eating with your friends all the time in a college environment at least, can cause you to

eat more quantity and quality wise. For me, this happens when I am with my best friend,

because we would eat out quite often. I think though that this is attributed to social

learning theory, which makes more sense as I analyze our interactions hanging out. It's

kind of like “monkey see, monkey do” in the sense that, after meeting her and seeing the

way that she behaved, it caused me to eventually learn the same behavior, again not to

place blame. However, I think that things like this can be very powerful on the mind.

This was something I had always known subconsciously but was finally able to recognize

and make an effort to change with the help of said friend. The first step that was probably

the most important was to get rid of certain thoughts that I had, in effect, blaming my

friend for my behavior. I used to think that I am only eating like this because she is or is

almost encouraging it, but that was obviously wrong. It’s not like I couldn’t have said no,

I am my own adult and I make my own choices ultimately. With the help of therapy and

cognitive restructuring (changing maladaptive cognitions to more helpful, rational

cognitions), I was able to identify all of my maladaptive cognitions (Unhelpful, irrational

cognitions) and realized that the “problem” lied within myself and no one else. I believe
this was what gave me the motivation to really want to make it work, because I was in

control of it and if I really wanted it, I would get it.

To further the effort, I would trick my mind with the use of operant conditioning

(using rewards/punishments to shape behavior). As someone with ADHD, I saw the

perfect opportunity with this strategy. If I did not stick to my routine of eating a moderate

amount of complex carbohydrates, I would take away things that helped reduce stress or

made me happy. Was it unconventional and somewhat harsh? Yes, it was, however, it did

the job and helped me make sure I stayed on track. For example, if I tried to revert back

to old habits, as punishment, I would not allow myself to watch an episode of a show I

was waiting a week for or I would force myself to wake up at a very early time in the

morning (and trust me I am by no means a morning person at all). For good behavior

(i.e., sticking to the routine), I would allow myself more time to watch TV, or an extra

bowl fresh fruits.

I found that these strategies that I implemented not only allowed me to successfully

modify a behavior I never thought I would escape the cycle of, but also gave me benefits

mentally. It has been a rollercoaster of a month, because while I’m saying all of the

positives, there were a fair share of negatives as well. I was certainly not happy to fail at

times and punish myself, and that was probably the biggest toll this project took on me

(stress and emotion wise). However, throughout it all, I realized that taking responsibility

for my actions has always been somewhat of a struggle for me, but at the end of the

month, I feel that I have sharpened my mind and am becoming better with the choices I

make. I do not think I would have changed a thing about the way I did it, because I have
tried everything in theory and nothing else has worked like this. So, I think I’ll stick to

what I’m doing and hope for the best!

 Reference Page:

Bilsborough, S.A., Crowe, T.C. Low-carbohydrate diets: what are the potential

short- and long-term health implications? Asia Pac J Clin Nutr. 2003;12(4):396-404.

PMID: 14672862.

Bongers, P., Akker, K. van den, Havermans, R., & Jansen, A. (2015, February

16). Emotional eating and Pavlovian learning: Does negative mood facilitate appetitive

conditioning? Appetite.

https://www.sciencedirect.com/science/article/pii/S0195666315000653

Brewer, J. A., Ruf, A., Beccia, A. L., Essien, G. I., Finn, L. M., Lutterveld, R.

van, & Mason, A. E. (2018, July 20). Can Mindfulness Address Maladaptive Eating

Behaviors? Why Traditional Diet Plans Fail and How New Mechanistic Insights May

Lead to Novel Interventions. Frontiers.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01418/

Fremouw, W. J., Callahan, E. J., Zitter, R. E., & Katell, A. (2002, May

24). Stimulus control and contingency contracting for behavior change and weight loss.

https://www.sciencedirect.com/science/article/abs/pii/0306460381900423.