Tai chi chih (TCC) is as effective as cognitive behavioral therapy (CBT) for improving insomnia among survivors of breast cancer, according to a study published in the Journal of Clinical Oncology.1

Up to 30% of breast cancer survivors suffer from insomnia, and CBT for insomnia (CBT-I) is the gold standard for treatment. Implementing CBT-I in clinical practice and oncology care, however, can be difficult. The purpose of this study was to determine if TCC — a mind-body intervention that consists of slow physical activity and relaxation — can produce similar outcomes as can CBT-I.

The partially blinded, non-inferiority trial randomly assigned 90 breast cancer survivors with insomnia to participate in CBT-I or TCC. Insomnia was defined as sleep difficulty 3 times or more per week for longer than 3 months.

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CBT-I and TCC were conducted for 120 minutes each week to a group of 7 to 10 patients for 3 months.

TCC was non-inferior to CBT-I at 15 months, with response demonstrated by 43.7% of patients in the CBT-I group compared with 46.7% in the TCC group (P < .02). Non-inferiority was also demonstrated at 3 (P = .02) and 6 months (P < .01).

Insomnia remission was also similar between groups, and occurred in 46.2% of patients in the CBT-I arm and 37.9% in the TCC arm.

Patients in both groups reported similar improvements in sleep quality, sleep diary measures, and related symptoms. There was, however, no improvement in polysomnography.

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According to the authors, “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.”


  1. Irwin MR, Olmstead R, Carrillo C, et al. Tai chi chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: a randomized, partially blinded, noninferiority trial. J Clin Oncol. 2017 May 11. doi: 10.1200/JCO.2016.71.0285 [Epub ahead of print]