Table 2.

Summary of Self-Regulation Protocol

Sessioin	Description
(1)	Introduction and rationale for the self-regulation approach and its relation to the dialysis treatment regimen. Brief review of how and why fluid-intake guidelines are established and the immediate and long-term effects of nonadherence.
(2)	An overview of the association between self-regulatory processes (i.e., self-monitoring, self-evaluation, self-reinforcement) and behavior. Examples of this overview include the effect of self-monitoring on enhancing awareness and perceived control over behavior and the association between reinforcement contingencies and the likelihood of repeating a behavior in the future.
(3)	Self-monitoring is reviewed/discussed. Instruction in self-monitoring skills and begin homework consisting of self-monitoring of daily fluid intake, mood, behavior, setting, and other antecedents. Daily recording and evaluation of target behavior (i.e., fluid-intake) begins. Weekly self-evaluation of target behavior performance and interdialytic weight gain relative to goals begins. Patients’ use of behavioral self-regulatory coping skills also reviewed/discussed. Any problems in meeting goals are discussed.
(4)	Goal-setting discussion and patient goal-setting for fluid-intake between treatments. Homework assignments include each patient discussing goals with their renal care providers as well as continued self-monitoring of fluid-intake.
(5)	Establishing self-administered reinforcement strategies. Both covert reinforcers (e.g., positive self-evaluation) and overt reinforcers (e.g., engaging in pleasurable activities) are discussed. Homework assignments include identifying realistic and adaptive reinforcers as well as continued self-monitoring of fluid-intake.
(6)	Teaching behavioral stimulus-control (e.g., removing drinking-related cues from the table; constraining drinking to a single, modest-sized fluid container that must be refilled/reused), self-instruction (e.g., use of cues/reminders in the home environment to promote fluid-adherence), and related behavioral coping skills to promote regulation of fluid-intake and appropriate corrective responses for fluid-intake behavior as well as continued self-monitoring of fluid-intake.
(7)	Review/evaluation of group experience. Discussion of relapse prevention strategies (i.e., how to respond to and prevent “backsliding” of fluid-intake behavior using tools gained in group sessions). Group close.