Which principle should guide the nurse in determining when to use silence during a patient interview?

Choice A reason: Flooding involves intense, immediate exposure to the feared stimulus, like elevators, overwhelming amygdala-driven fear responses. This contrasts with gradual exposure, which calms norepinephrine surges incrementally. Flooding is less controlled and riskier, making it incorrect for the described gradual relaxation technique.

Choice B reason: Systematic desensitization pairs gradual exposure to a fear, like elevators, with relaxation to reduce amygdala hyperactivity and norepinephrine-driven panic. This counterconditions fear responses, promoting calm neural pathways, aligning with the described technique and making it the correct choice for this therapeutic approach.

Choice C reason: Combination therapy involves multiple modalities, like medication and psychotherapy, not specifically gradual exposure with relaxation. The described technique targets phobia-specific amygdala responses, not a broad approach, making combination therapy too vague and incorrect for this targeted intervention.

Choice D reason: Cognitive restructuring modifies thought patterns, not exposure-based fear responses. While it addresses distorted beliefs, the described technique uses relaxation with gradual exposure to reduce norepinephrine-driven panic, not cognitive reframing, making this incorrect for the specific therapeutic method described.

Choice A reason: Silently adding an inappropriate outcome disregards patient safety and autonomy. Outcomes must align with neurobiological needs, like serotonin modulation for depression. This approach fails to engage the patient in decision-making, risking ineffective treatment and neglecting evidence-based collaborative care principles.

Choice B reason: Formulating outcomes without patient input violates autonomy. Collaborative goal-setting, considering neurobiological factors like dopamine imbalances, ensures patient engagement and effective treatment. Excluding the patient disregards their perspective, reducing adherence and therapeutic alliance, making this approach contrary to evidence-based psychiatric nursing.

Choice C reason: Exploring consequences respects autonomy while guiding patients toward safe outcomes. Discussing implications, like medication non-adherence worsening dopamine-driven symptoms, fosters informed decisions. This collaborative approach aligns with cognitive-behavioral principles and neurobiological treatment needs, ensuring effective, patient-centered care in psychiatric practice.

Choice D reason: Educating that an outcome is unrealistic may dismiss patient autonomy. While addressing neurobiological realities, like serotonin deficits, is important, unilateral education risks disengagement. Collaborative exploration of consequences is more effective, promoting informed choices and adherence, making this option less suitable than discussion.