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In the United States, an increase in the number of births of extremely preterm infants and in their survival potential has occurred over the last decade. Determining the survival prognosis for the infant of a pregnancy with threatened preterm delivery between 22 and 25 completed weeks of gestation remains problematic. Many physicians and families encounter the difficulty of making decisions regarding the institution and continuation of life support for an infant born within this threshold period. This report addresses the process of counseling, assisting, and supporting families faced with the dilemma of an extremely preterm delivery.

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Simulation of covert pain, as reported by the hidden observer method, proved very successful for 12 simulator subjects known to be unable to reduce overtly reported pain through hypnotic analgesia procedures, as compared with 12 highly hypnotizable subjects whose pain had been shown to be reduced by at least one third through hypnotic analgesia suggestions. Preliminary practice in dissociation (and in simulated dissociation) through amnesia for a word list and through attempted automatic writing also demonstrated successful simulation. However, in an honesty inquiry by a staff member not participating as a hypnotist-experimenter, no simulator claimed to have been amnesic, to have performed automatic writing, or to have reduced pain beyond the reduction that could be achieved through waking suggestion. The methods by which the successful simulation was achieved were explored in subsequent interviews. In contrast with the simulators, no highly hypnotizable subject modified any earlier report on the basis of the honesty inquiry. The results confirm the importance of postexperimental honesty interrogation when the real-simulator design is used. They lend support to the reality of the covert experience of pain in the absence of its overt experience in hypnotic analgesia.

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