“I’m concerned whether we are behaving ethically by restraining one patient to prevent them from self-mutilating while placing another patient on one-on-one supervision to prevent them from self-mutilating.” Which ethical principle most clearly applies to this situation?

Choice A reason: Discussing ego states is rooted in transactional analysis, not cognitive therapy. Ego states involve conscious and unconscious personality aspects, unrelated to addressing cognitive distortions like negative self-perception in inadequacy. Cognitive therapy targets thought patterns, not personality structures, making this approach scientifically irrelevant for the described intervention.

Choice B reason: Cognitive therapy focuses on identifying and modifying distorted thoughts, such as irrational beliefs about inadequacy, which are linked to altered serotonin and dopamine signaling in depression. By restructuring these thoughts, the therapy improves emotional regulation and behavior, aligning with evidence-based treatment for addressing feelings of inadequacy.

Choice C reason: Negative reinforcement is a behavioral therapy technique, not cognitive therapy. It involves removing aversive stimuli to increase desired behaviors, unrelated to addressing cognitive distortions like self-blame. Cognitive therapy targets thought patterns, not behavioral conditioning, making this approach scientifically inappropriate for the described therapeutic context.

Choice D reason: Focusing on unconscious processes is psychoanalytic, not cognitive, therapy. Inadequacy feelings stem from conscious cognitive distortions, not unconscious conflicts. Cognitive therapy corrects faulty thinking linked to neurotransmitter imbalances, not repressed memories, making this option misaligned with the scientific basis of the therapy described.

Choice A reason: Suppressing anger ignores countertransference, which can impair therapeutic neutrality. Anger may stem from patient behaviors linked to dopamine-driven paranoia, but suppression risks unconscious bias affecting care. Addressing feelings through supervision maintains professionalism, making this response less effective for managing emotions.

Choice B reason: Discussing anger with a manager addresses countertransference, a reaction to patient behaviors like suspicion from dopamine dysregulation. This allows reflection, reducing bias and maintaining therapeutic neutrality. It supports professional care by processing emotions, aligning with evidence-based psychiatric nursing practices for managing countertransference.

Choice C reason: Expressing anger directly risks damaging the therapeutic alliance. Suspicion, tied to mesolimbic dopamine excess, may escalate with confrontation, increasing patient anxiety. This approach disregards professional boundaries and neurobiological sensitivities, making it inappropriate for maintaining effective psychiatric care.

Choice D reason: Reassigning the patient avoids addressing countertransference, neglecting professional growth. Suspicion, linked to neurobiological paranoia, requires consistent care. Reassignment disrupts continuity, potentially worsening patient trust and outcomes, making this an ineffective response compared to processing feelings through supervision.