Treat Insomnia in Breast Cancer Survivors with Tai Chi
By John M. de Castro, Ph.D.
“Breast cancer survivors often don’t just come to physicians with insomnia. They have insomnia, fatigue and depression. And this intervention, tai chi, impacted all those outcomes in a similar way, with benefits that were as robust as the gold standard treatment for insomnia.” – Leigh Hopper
Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. But, surviving cancer carries with it a number of problems. Insomnia is a common occurrence in the aftermath of surviving breast cancer.
Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress, sleep disturbance, and anxiety and depression. Tai Chi or Qigong practice has been shown to improve quality of life, reduce fatigue, lower blood pressure and cortisol levels, improve balance and reduce the likelihood of falls. Mindfulness-based practices have been reported to improve sleep amount and quality. Tai Chi practice has also been shown to improve sleep. It is not known, however, how effective Tai Chi practice is relative to other know insomnia treatments.
In today’s Research News article “Tai Chi Chih Compared with Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549450/ ), Irwin and colleagues recruited women who had survived breast cancer and who were diagnosed with insomnia. They were randomly assigned to receive a 3-month program of either Tai Chi or Cognitive Behavioral Therapy for Insomnia (CBT-I). Both treatments were delivered in groups of 7 to 10 participants in weekly 120-minute sessions. CBT-I contained cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. Tai Chi consisted of mindful performance of repetitious, nonstrenuous, slow-paced movement. Participants were measured during baseline, at the end of the treatment period and three months and one year later, for insomnia severity, insomnia remission, sleep quality, sleep diary records, fatigue, daytime sleepiness, depression, body size, and physical activity.
They found that both groups showed equivalent and significant improvement in insomnia severity, insomnia remission, sleep quality, fatigue, daytime sleepiness, and depression at posttreatment and 3 and 12 months later. Hence, both Tai Chi practice and Cognitive Behavioral Therapy for Insomnia (CBT-I) were effective in treating insomnia in breast cancer survivors with insomnia.
It is remarkable that Tai Chi practice is just as effective as a psychotherapy that was designed specifically to treat insomnia and which is considered the gold standard of insomnia treatments. Tai Chi practice, though, has marked advantages over CBT-I. Tai Chi is gentle and safe, is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion, is inexpensive to administer, can be performed in groups or alone, at home or in a facility, and can be quickly learned. In addition, it can be practiced in social groups. This can make it fun, improving the likelihood of long-term engagement in the practice. So, Tai Chi practice would appear to be an almost ideal gentle exercise to releive insomnia is breast cancer survivors.
So, treat insomnia in breast cancer survivors with Tai Chi
“given that standardized TCC is both scalable and community accessible compare with the limited availability of CBT in most medical centers, immediate access to TCC would address the need to reduce the morbidity associated with insomnia in survivors of breast and other cancers.” – Irwin et al. 2017
CMCS – Center for Mindfulness and Contemplative Studies
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Irwin, M. R., Olmstead, R., Carrillo, C., Sadeghi, N., Nicassio, P., Ganz, P. A., & Bower, J. E. (2017). Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial. Journal of Clinical Oncology, 35(23), 2656–2665. http://doi.org/10.1200/JCO.2016.71.0285
Cognitive behavioral therapy for insomnia (CBT-I) and Tai Chi Chih (TCC), a movement meditation, improve insomnia symptoms. Here, we evaluated whether TCC is noninferior to CBT-I for the treatment of insomnia in survivors of breast cancer.
Patients and Methods
This was a randomized, partially blinded, noninferiority trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response—that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index—at 15 months. Secondary outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression.
Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests of noninferiority showed that TCC was noninferior to CBT-I at 15 months (P = .02) and at months 3 (P = .02) and 6 (P < .01). For secondary outcomes, insomnia remission was 46.2% and 37.9% in CBT-I and TCC, respectively. CBT-I and TCC groups showed robust improvements in sleep quality, sleep diary measures, and related symptoms (all P < .01), but not polysomnography, with similar improvements in both groups.
CBT-I and TCC produce clinically meaningful improvements in insomnia. TCC, a mindful movement meditation, was found to be statistically noninferior to CBT-I, the gold standard for behavioral treatment of insomnia.