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Treating PTSD with Connected Breathing: A Clinical Case Study and Theoretical Implications
Abstract
Extended connected breathing (Rebirthing-Breathwork) has been popular as a self- development tool for more than 4 decades, but has been subjected to minimal scientific research. Similarities between connected breathing and two therapeutic modalities used to treat posttraumatic stress disorder (PTSD) – Eye Movement Desensitization and Reprocessing and Somatic Experiencing – suggest connected breathing to be efficacious in treating PTSD. The underlying theoretical model in these three approaches suggests that trauma is a result of the blocking or repressing of spontaneous somatic and cognitive processing. This study investigated the efficacy of connected breathing to treat PTSD in a firefighter. Pre- and posttreatment measures consisted of instruments to measure PTSD symptom-severity, anxiety, depression and heart rate variability (HRV). After 8 connected breathing sessions the participant’s PTSD and comorbid symptoms were in complete remission. Subjective reports and HRV data-analysis support the blocking/repression theory and suggest a role of the parasympathetic nervous system in the blocking of spontaneous trauma processing. In this case the original trauma appears have been a traumatic birth.
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This study presents the first known randomized controlled study evaluating the effectiveness of somatic experiencing (SE), an integrative body-focused therapy for treating people with posttraumatic stress disorder (PTSD). There were 63 participants meeting DSM-IV-TR full criteria for PTSD included. Baseline clinical interviews and self-report measures were completed by all participants, who were then randomly assigned to study (n = 33) or waitlist (n = 30) groups. Study participants began 15 weekly SE sessions, whereas waitlist participants waited the same period, after which the second evaluation was conducted. All participants were evaluated a third time after an additional 15 weeks, during which time the waitlist group received SE therapy. Pretreatment evaluation showed no significant differences between groups. Mixed model linear regression analysis showed significant intervention effects for posttraumatic symptoms severity (Cohen's d = 0.94 to 1.26) and depression (Cohen's d = 0.7 to 1.08) both pre-post and pre-follow-up. This randomized controlled study of SE shows positive results indicating SE may be an effective therapy method for PTSD. Further research is needed to understand who shall benefit most from this treatment modality.
Background:
Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking.
Methods:
Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics.
Results:
The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed.
Conclusions:
PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
Objective:
To describe the process of cross-cultural adaptation of the Posttraumatic Stress Disorder Checklist 5 (PCL-5) and the Life Events Checklist 5 (LEC-5) for the Brazilian sociolinguistic context.
Method:
The adaptation process sought to establish conceptual, semantic, and operational equivalence between the original items of the questionnaire and their translated versions, following standardized protocols. Initially, two researchers translated the original version of the scale into Brazilian Portuguese. Next, a native English speaker performed the back-translation. Quantitative and qualitative criteria were used to evaluate the intelligibility of items. Five specialists compared the original and translated versions and assessed the degree of equivalence between them in terms of semantic, idiomatic, cultural and conceptual aspects. The degree of agreement between the specialists was measured using the content validity coefficient (CVC). Finally, 28 volunteers from the target population were interviewed in order to assess their level of comprehension of the items.
Results:
CVCs for items from both scales were satisfactory for all criteria. The mean comprehension scores were above the cutoff point established. Overall, the results showed that the adapted versions' items had adequate rates of equivalence in terms of concepts and semantics.
Conclusions:
The translation and adaptation processes were successful for both scales, resulting in versions that are not only equivalent to the originals, but are also intelligible for the population at large.
Taken together, these papers offer evidence supporting continued research into SE. The papers on disaster response in particular, although not definitive, are strongly suggestive of the efficacy of SE as an early, low-dose, culturally flexible intervention for victims and providers in the context of natural disasters.
Conflict of interest statement
Peter Payne is an SE practitioner (SEP) who derives income from his practice. Peter A. Levine declares that teaching, royalties and consulting related to SE are a source of income. Mardi A. Crane-Godreau is an SEP and non-paid member of the Board of Directors of the Somatic Experiencing Trauma Institute™.
Citation: Spates, C.R., Koch, E., Pagoto, S., Cusack K. & Waller, S. (2008) Eye Movement Desensitization and Reprocessing for adults, children, and adolescents. In Foa, E., Keane, T., Friedman, M., and Cohen, J. Effective Treatments for PTSD, Guilford Press, p. 279 ff. ISBN 1606230018, 9781606230015.
Here we present a theory of human trauma and chronic stress, based on the practice of Somatic Experiencing(®) (SE), a form of trauma therapy that emphasizes guiding the client's attention to interoceptive, kinesthetic, and proprioceptive experience. SE™ claims that this style of inner attention, in addition to the use of kinesthetic and interoceptive imagery, can lead to the resolution of symptoms resulting from chronic and traumatic stress. This is accomplished through the completion of thwarted, biologically based, self-protective and defensive responses, and the discharge and regulation of excess autonomic arousal. We present this theory through a composite case study of SE treatment; based on this example, we offer a possible neurophysiological rationale for the mechanisms involved, including a theory of trauma and chronic stress as a functional dysregulation of the complex dynamical system formed by the subcortical autonomic, limbic, motor and arousal systems, which we term the core response network (CRN). We demonstrate how the methods of SE help restore functionality to the CRN, and we emphasize the importance of taking into account the instinctive, bodily based protective reactions when dealing with stress and trauma, as well as the effectiveness of using attention to interoceptive, proprioceptive and kinesthetic sensation as a therapeutic tool. Finally, we point out that SE and similar somatic approaches offer a supplement to cognitive and exposure therapies, and that mechanisms similar to those discussed in the paper may also be involved in the benefits of meditation and other somatic practices.
Incorporation of details from waking life events into Rapid Eye Movement (REM) sleep dreams has been found to be highest on the night after, and then 5-7 nights after events (termed, respectively, the day-residue and dream-lag effects). In experiment 1, 44 participants kept a daily log for 10 days, reporting major daily activities (MDAs), personally significant events (PSEs), and major concerns (MCs). Dream reports were collected from REM and Slow Wave Sleep (SWS) in the laboratory, or from REM sleep at home. The dream-lag effect was found for the incorporation of PSEs into REM dreams collected at home, but not for MDAs or MCs. No dream-lag effect was found for SWS dreams, or for REM dreams collected in the lab after SWS awakenings earlier in the night. In experiment 2, the 44 participants recorded reports of their spontaneously recalled home dreams over the 10 nights following the instrumental awakenings night, which thus acted as a controlled stimulus with two salience levels, high (sleep lab) and low (home awakenings). The dream-lag effect was found for the incorporation into home dreams of references to the experience of being in the sleep laboratory, but only for participants who had reported concerns beforehand about being in the sleep laboratory. The delayed incorporation of events from daily life into dreams has been proposed to reflect REM sleep-dependent memory consolidation. However, an alternative emotion processing or emotional impact of events account, distinct from memory consolidation, is supported by the finding that SWS dreams do not evidence the dream-lag effect.
Copyright © 2015. Published by Elsevier Inc.
Background
We performed the first meta-analysis of clinical studies by investigating the effects of eye-movement desensitization and reprocessing (EMDR) therapy on the symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and subjective distress in PTSD patients treated during the past 2 decades.
Methods
We performed a quantitative meta-analysis on the findings of 26 randomized controlled trials of EMDR therapy for PTSD published between 1991 and 2013, which were identified through the ISI Web of Science, Embase, Cochrane Library, MEDLINE, PubMed, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature electronic databases, among which 22, 20, 16, and 11 of the studies assessed the effects of EMDR on the symptoms of PTSD, depression, anxiety, and subjective distress, respectively, as the primary clinical outcome.
Results
The meta-analysis revealed that the EMDR treatments significantly reduced the symptoms of PTSD (g = −0.662; 95% confidence interval (CI): −0.887 to −0.436), depression (g = −0.643; 95% CI: −0.864 to −0.422), anxiety (g = −0.640; 95% CI: −0.890 to −0.390), and subjective distress (g = −0.956; 95% CI: −1.388 to −0.525) in PTSD patients.
Conclusion
This study confirmed that EMDR therapy significantly reduces the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients. The subgroup analysis indicated that a treatment duration of more than 60 min per session was a major contributing factor in the amelioration of anxiety and depression, and that a therapist with experience in conducting PTSD group therapy was a major contributing factor in the reduction of PTSD symptoms.
Eye movement desensitization and reprocessing (EMDR) is a therapeutic approach guided by the adaptive information processing (AIP) model. This article provides a brief overview of some of the major precepts of AIP. The basis of clinical pathology is hypothesized to be dysfunctionally stored memories, with therapeutic change resulting from the processing of these memories within larger adaptive networks. Unlike extinction-based exposure therapies, memories targeted in EMDR are posited to transmute during processing and are then again stored by a process of reconsolidation. Therefore, a comparison and contrast to extinction-based information processing models and treatment is provided, including implications for clinical practice. Throughout the article a variety of mechanisms of action are discussed, including those inferred by tenets of the AIP model, and the EMDR procedures themselves, including the bilateral stimulation. Research suggestions are offered in order to investigate various hypotheses.
We postulate that the cascade ''Freeze-Flight-Fight-Fright-Flag-Faint'' is a coherent sequence of six fear responses that escalate as a function of defense possibilities and proximity to danger during life-threat. The actual sequence of trauma-related response dispositions acted out in an extremely dangerous situation therefore depends on the appraisal of the threat by the organism in relation to her/his own power to act (e.g., age and gender) as well as the perceived characteristics of threat and perpetrator. These reaction patterns provide optimal adaption for particular stages of imminence. Subsequent to the traumatic threats, portions of the experience may be replayed. The actual individual cascade of defense stages a survivor has gone through during the traumatic event will repeat itself every time the fear network, which has evolved peritraumatically, is activated again (i.e., through internal or external triggers or, e.g., during exposure therapy).When a parasympathetically dominated ''shut-down'' was the prominent peri-traumatic response during the traumatic incident, comparable dissociative responses may dominate responding to subsequently experienced threat and may also reappear when the traumatic memory is reactivated. Repeated experience of traumatic stress forms a fear network that can become pathologically detached from contextual cues such as time and location of the danger, a condition which manifests itself as posttraumatic stress disorder (PTSD). Intrusions, for example, can therefore be understood as repetitive displays of fragments of the event, which would then, depending on the dominant physiological response during the threat, elicit a corresponding combination of hyperarousal and dissociation. We suggest that trauma treatment must therefore differentiate between patients on two dimensions: those with peritraumatic sympathetic activation versus those who went down the whole defense cascade, which leads to parasympathetic dominance during the trauma and a corresponding replay of physiological and dissociative responding, when reminded. The differential management of dissociative stages (''fright'' and ''faint'') has important treatment implications. A coherent mental structure requires organized and intercon-nected representations of salient external and internal events, including sensory perceptions, affective and behavioral responding, and the conscious implications of a given con-text in terms of meaning (Marmar, Weiss, & Metzler, 1998; Van der Hart, Nijenhuis, Steele, & Brown, 2004; Schauer, Neuner, & Elbert, 2005). Experience of overwhelming threat may interfere with the process of integrating active elements of sensation, emotion, and cognition into the particular declarative memory of the event and thus result in disorders of the trauma spectrum (Brewin, 2001; Conway & Pleydell-Pearce, 2000; Ehlers & Clark, 2000; Elbert, Rockstroh, Kolassa, Schauer, & Neuner, 2006; Schauer et al., 2005; Van der Kolk, McFarlane, & Weisaeth, 1996). When later confronted with trauma reminders, survivors typically ''replay'' their original response of the traumatic event (e.g., Keane, Zimering, & Caddell, 1985). When a parasym-pathetically dominated ''shut-down'' was the prominent peritraumatic response to the traumatic incident, comparable dissociative responses may dominate responding to subse-quently experienced threat and may also reappear when the traumatic memory is reactivated, such as during script-driven imagery (Lang, Bradley, & Cuthbert, 1998) or trauma-focused treatment (Schauer & Elbert, 2008). Strong dissociative reactions that may even include fainting obvi-ously prevent the success of therapeutic measures that attempt to integrate the trauma memory into the autobio-graphic narrative and hence pose a serious obstacle to suc-cessful treatment of disorders of the trauma spectrum. Instead of trauma-focused therapy, these patients therefore typically receive skill-training, for example, how to identify and avoid potential triggers that induce detachment or how to end dissociative responding once it has been triggered. Current clinical practice adds to a varying degree elements from dialectic behavior therapy (Hunter et al., 2005; Linehan, 1993). Unfortunately, these strategies are not sufficient rem-edies for patients with trauma-related dissociative symptoms (Dyer, Priebe, Steil, Krüger, & Bohus, 2009) and clinical tri-als have identified dissociative symptoms as predictive for a negative treatment outcome (Spitzer, Barnow, Freyberger, & Grabe, 2007). This is not surprising, since dissociation pre-vents emotional processing and learning (Ebner-Priemer et al., 2009) due to the ''shut-down'' symptomatology typi-cally characteristic of dissociative states (Simeon, Guralnik, Knutelska, Yehuda, & Schmeidler, 2003, p. 93). The current concept of posttraumatic stress disorder (PTSD) does not distinguish whether the reminder of the traumatic experiences results in a fight-flight alarm response
In the context of intense interest in evidence-based practice (EBP), the authors sought to establish consensus on discredited psychological treatments and assessments using Delphi methodology. A panel of 101 experts participated in a 2-stage survey, reporting familiarity with 59 treatments and 30 assessment techniques and rating these on a continuum from not at all discredited to certainly discredited. The authors report their composite findings as well as significant differences that occurred as a function of the experts' gender and theoretical orientation. The results should be interpreted carefully and humbly, but they do offer a cogent first step in consensually identifying a continuum of discredited procedures in modem mental health practice.
We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.
A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.
A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.
Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
The paper reviews recent findings from the WHO World Mental Health (WMH) surveys on the global burden of mental disorders.
The WMH surveys are representative community surveys in 28 countries throughout the world aimed at providing information to mental health policy makers about the prevalence, distribution, burden, and unmet need for treatment of common mental disorders.
The first 17 WMH surveys show that mental disorders are commonly occurring in all participating countries. The inter-quartile range (IQR: 25th-75th percentiles) of lifetime DSM-IV disorder prevalence estimates (combining anxiety, mood, externalizing, and substance use disorders) is 18.1-36.1%. The IQR of 12-month prevalence estimates is 9.8-19.1%. Prevalence estimates of 12-month Serious Mental Illness (SMI) are 4-6.8% in half the countries, 2.3-3.6% in one-fourth, and 0.8-1.9% in one-fourth. Many mental disorders begin in childhood-adolescence and have significant adverse effects on subsequent role transitions in the WMH data. Adult mental disorders are found to be associated with such high role impairment in the WMH data that available clinical interventions could have positive cost-effectiveness ratios.
Mental disorders are commonly occurring and often seriously impairing in many countries throughout the world. Expansion of treatment could be cost-effective from both employer and societal perspectives.
Posttraumatic stress disorder (PTSD) has been the subject of growing recognition since its inception in 1980. Owing in part to the relatively recent inclusion of PTSD in the psychiatric nomenclature, research is only beginning to address its treatment in methodologically rigorous studies. In this review, we discuss issues such as prevalence of trauma and of PTSD, and gold standards for treatment outcome research. We then critically review the extant literature on the treatment of PTSD. Finally, we include a discussion of issues specific to various trauma populations and factors that may influence treatment efficacy across types of trauma.
This paper presents theoretical assumptions and practical rationale for use of breathing, namely the American form of yoga of breath, known as Rebirthing, in treatment of people addicted to alcohol. In the years 1986-1987 the Outpatient Clinic for Alcoholics in Siemianowice, Poland, organized seven day programs, each four week long, entitled "Rebirthers for Alcoholics." Seventy persons attended this program. Self declared sobriety rate one year after the program was above fifty percent.
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This paper clarifies the conditions under which prenatal experiences produce lifelong effects and describes the perspectives necessary to understand the effects of prenatal traumatization.
• Clinical research indicates a tendency to compulsive repetitions of traumatic experiences. Such phenomena have not been studied experimentally and so the generality of the tendency has been uncertain. With development of operational definitions and content analysis techniques, it was possible to quantify and examine intrusive and stimulus-repetitive thought in a series of experiments with controlled variations in subject selection, stimuli, demand set, and context.
Comparison of data across experiments indicates a tendency toward intrusive and stimulus-repetitive thought that is not restricted to "traumas" or a few predisposed individuals. Intrusive and repetitive thought appears to be a general stress-response tendency seen in a large proportion of persons after even mild to moderately stressful events. It is concluded that the intrusive repetitions observed clinically are extreme forms of this general stress-response tendency.
The brain does not retain all the information it encodes in a day. Much is forgotten, and of those memories retained, their subsequent evolution can follow any of a number of pathways. Emerging data makes clear that sleep is a compelling candidate for performing many of these operations. But how does the sleeping brain know which information to preserve and which to forget? What should sleep do with that information it chooses to keep? For information that is retained, sleep can integrate it into existing memory networks, look for common patterns and distill overarching rules, or simply stabilize and strengthen the memory exactly as it was learned. We suggest such 'memory triage' lies at the heart of a sleep-dependent memory processing system that selects new information, in a discriminatory manner, and assimilates it into the brain's vast armamentarium of evolving knowledge, helping guide each organism through its own, unique life.
The study of traumatic memories challenges several basic notions about the nature of memory: (i) that memory always is a constructive process; (ii) that memory is primarily declarative (i.e. that people can articulate what they know in words and symbol) (iii) that memory is present in consciousness in a continuous and uninterrupted fashion; and (iv) that memory always disintegrates in accuracy over time. A century of study of traumatic memories shows that (i) semantic representations may coexist with sensory imprints; (ii) unlike trauma narratives, these sensory experiences often remain stable over time, unaltered by other life experiences; (iii) they may return, triggered by reminders, with a vividness as if the experience were happening all over again; and (iv) these flashbacks may occur in a mental state in which victims are unable to precisely articulate what they are feeling and thinking. The present paper reviews the literature on traumatic memories and discusses the recent neuroimaging studies which seem to clarify the neurobiological underpinnings of the differences between ordinary and traumatic memories.
Breathwork is an increasingly popular experiential approach to psychotherapy based on the use of a specific breathing technique,
however, claims of positive mental health outcomes rely on anecdotal clinical evidence. To ascertain the likely efficacy of
breathwork this review clarifies the approach and its theoretical assumptions and examines relevant empirical research relating
to breathing inhibition, suppression of inner experience, and possible neurological and physiological effects. Additionally,
research into mindfulness-based psychotherapy and yoga breathing-based interventions with comparable features to breathwork
are examined. Findings suggest qualified support for the key theoretical assumptions of a three component breathwork model,
referred to as Integrative Breathwork Therapy (IBT), and its possible utility in the treatment of anxiety and depression.
Further research aimed at exploring specific efficacy of this approach for these disorders may yield a useful additional treatment
option utilising a different process of change to existing treatments.
KeywordsAnxiety–Breathwork–Depression–Mindfulness–Psychotherapy–Respiration–Somatic
Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures. Little is known about ictal autonomic nervous system (ANS) activity changes in epilepsy and PNES. This study compares ictal heart rate variability (HRV) parameters as a reflection of ANS tone in epileptic seizures and PNES, and explores differences between interictal and ictal ANS tone in both patient groups.
Ictal HRV parameters were extracted from single-lead electrocardiography (ECG) data collected during video-electroencephalography (EEG) recordings of 26 patients with medically refractory temporal lobe epilepsy and 24 age- and sex-matched patients with PNES. One seizure per patient in a resting, wake, supine state was analyzed. Interictal ECG data were available for comparison from 14 patients in both groups. HRV parameters in time and frequency domains were analyzed (low frequency [LF], high frequency [HF], standard deviation of all consecutive normal R wave intervals [SDNN], square root of the mean of the sum of the squares of differences between adjacent normal R wave intervals [RMSSD]). CVI (cardiovagal index), CSI (cardiosympathetic index), and ApEn (approximate entropy) were calculated from Lorenz plots.
There were significant differences between ictal HRV measures during epileptic and nonepileptic seizures in the time and frequency domains. CSI (p < 0.001) was higher in epileptic seizures. Time interval between two consecutive R waves in the ECG (RR interval) (p = 0.002), LF (p = 0.02), HF (p = 0.003), and RMSSD (p = 0.003) were significantly lower during epileptic seizures. Binary logistic regression yielded a significant model based on the differences in CSI classifying 88% of patients with epilepsy and 73% of patients with PNES correctly. The comparison between resting and ictal states in both seizure disorders revealed significant differences in RR interval (epilepsy p < 0.001, PNES p = 0.01), CSI (epilepsy p < 0.001, PNES p = 0.02), HF (epilepsy p = 0.002, PNES p = 0.03), and RMSSD (epilepsy p = 0.004, PNES p = 0.04). In patients with epilepsy there were also significant differences in ictal versus interictal mean values of ApEn (p = 0.03) and LF (p = 0.04). Although CSI was significantly higher, the other parameters were lower during the seizures. Stepwise binary regression in the 14 patients with epilepsy produced a significant model differentiating resting state from seizures in 100% of cases. The same statistical approach did not yield a significant model in the PNES group.
Our results show greater ANS activation in epileptic seizures than in PNES. The biggest ictal HRV changes associated with epileptic seizures (CSI, HF, and RMSSD) reflect high sympathetic system activation and reduced vagal tone. The reduced ApEn also reflects a high sympathetic tone. The observed ictal alterations of HRV patterns may be a more specific marker of epileptic seizures than heart rate changes alone. These altered HRV patterns could be used to detect seizures and also to differentiate epileptic seizures from PNES. Larger studies are justified with intergroup and intragroup comparisons between ictal and resting states.
A new non-linear method of assessing cardiac autonomic function was examined in a pharmacological experiment in ten healthy volunteers. The R-R interval data obtained under a control condition and in autonomic blockade by atropine and by propranolol were analyzed by each of the new methods employing Lorenz plot, spectral analysis and the coefficient of variation. With our method we derived two measures, the cardiac vagal index and the cardiac sympathetic index, which indicate vagal and sympathetic function separately. These two indices were found to be more reliable than those obtained by the other two methods. We anticipate that the non-invasive assessment of short-term cardiac autonomic function will come to be performed more reliably and conveniently by this method.
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