The Enhancing sleep and reducing anxiety in the elderly: A narrative review of tai chi and benson relaxation techniques

Mahek Mohani; Snehal Samal; Purva Gulrandhe

doi:10.31893/multirev.2025295

Keywords:

anxiety

geriatric patients

benson relaxation technique

tai chi

sleep quality

Abstract

One major public health concern is the incidence of anxiety and sleep disorders in the senior population. Since conventional treatments frequently have poor long-term success rates, alternative therapies are gaining popularity. This review highlights the importance of two such therapies, tai chi and benson relaxation, in enhancing elderly patients' sleep and reducing their anxiety. Benson relaxation, a type of relaxation response training, and tai chi, an ancient Chinese martial art that blends movement and meditation, have gained popularity due to their potential health benefits. The most recent research on these therapies is summarized in this review. These findings demonstrate that tai chi and benson relaxation significantly enhance sleep quality and lessen anxiety in older people. Owing to its physical and meditative elements, tai chi appears particularly effective in promoting sleep through better physical and psychological well-being. Benson relaxation focuses on triggering the relaxation response, which lowers stress levels, promotes better sleep and reduces anxiety. This review also discusses how these therapies function, such as how they enhance parasympathetic nervous system activity, lower the sympathetic nervous system and support a balanced mind-body condition. The incorporation of these strategies into routine care for elderly individuals presents practical problems as well, underscoring the need for conventionally accessible, cost-effective nonpharmacological therapy options. Research has shown that tai chi and benson relaxation are effective, scientifically validated techniques for improving sleep quality and reducing anxiety in older adults.
References
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2. Abu Maloh, H. I. A., Soh, K. L., AbuRuz, M. E., Chong, S. C., Ismail, S. I. F., Soh, K. G., & Abu Maloh, D. I. (2022). Efficacy of Benson’s relaxation technique on anxiety and depression among patients undergoing hemodialysis: A systematic review. Clinical Nursing Research, 31(1), 122–135. https://doi.org/10.1177/10547738211024797
3. Akbar, S., Tiwari, S. C., Tripathi, R. K., Pandey, N. M., & Kumar, A. (2018). Prevalence of psychiatric illness among residents of old age homes in Northern India. Journal of Neurosciences in Rural Practice, 9(2), 193–196. https://doi.org/10.4103/jnrp.jnrp_340_17
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5. Bagheri, H., Moradi-Mohammadi, F., Khosravi, A., Ameri, M., Khajeh, M., Chan, S. W.-C., Abbasinia, M., & Mardani, A. (2021). Effect of Benson and progressive muscle relaxation techniques on sleep quality after coronary artery bypass graft: A randomized controlled trial. Complementary Therapies in Medicine, 63, 102784. https://doi.org/10.1016/j.ctim.2021.102784
6. Beary, J. F., & Benson, H. (1974). A simple psychophysiologic technique which elicits the hypometabolic changes of the relaxation response. Psychosomatic Medicine, 36(2), 115–120. https://doi.org/10.1097/00006842-197403000-00003
7. Carek, P. J., Laibstain, S. E., & Carek, S. M. (2011). Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine, 41(1), 15–28. https://doi.org/10.2190/PM.41.1.c
8. Cheng, L., Chang, S., Wang, B., He, B., & Tan, Y. (2023). Cross-sectional study of depression tendency and sleep quality in 1352 people practicing Tai Chi. Research in Sports Medicine, 31(5), 650–662. https://doi.org/10.1080/15438627.2021.2024832
9. Choo, Y. T., Jiang, Y., Hong, J., & Wang, W. (2020). Effectiveness of Tai Chi on quality of life, depressive symptoms and physical function among community-dwelling older adults with chronic disease: A systematic review and meta-analysis. International Journal of Nursing Studies, 111, 103737. https://doi.org/10.1016/j.ijnurstu.2020.103737
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12. Gao, R., Greiner, C., Ryuno, H., & Gao, S. (2022). Tai Chi or conventional exercise on physical performance, sleep, and quality of life in older people with dementia. Innovation in Aging, 6(Suppl 1), 467. https://doi.org/10.1093/geroni/igac059.1813
13. Gerogianni, G., Babatsikou, F., Polikandrioti, M., & Grapsa, E. (2019). Management of anxiety and depression in haemodialysis patients: The role of non-pharmacological methods. International Urology and Nephrology, 51(1), 113–118. https://doi.org/10.1007/s11255-018-2022-7
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15. Harorani, M., Davodabady, F., Farahani, Z., Hezave, A. K., & Rafiei, F. (2020). The effect of Benson’s relaxation response on sleep quality and anorexia in cancer patients undergoing chemotherapy: A randomized controlled trial. Complementary Therapies in Medicine, 50, 102344. https://doi.org/10.1016/j.ctim.2020.102344
16. Heidari Gorji, M. A., Davanloo, A. A., & Heidarigorji, A. M. (2014). The efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients. Indian Journal of Nephrology, 24(6), 356–361. https://doi.org/10.4103/0971-4065.132998
17. Hemmeter, U. M., & Ngamsri, T. (2022). Physical activity and mental health in the elderly. Praxis, 110(4), 193–198. https://doi.org/10.1024/1661-8157/a003853
18. Irwin, M. R., Olmstead, R., & Motivala, S. J. (2008). Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of Tai Chi Chih. Sleep, 31(7), 1001–1008.
19. Li, F., Fisher, K. J., Harmer, P., Irbe, D., Tearse, R. G., & Weimer, C. (2004). Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: A randomized controlled trial. Journal of the American Geriatrics Society, 52(6), 892–900. https://doi.org/10.1111/j.1532-5415.2004.52255.x
20. Li, L., Li, X., Huang, Y., Li, H., Li, C., Ma, Y., Zhang, J., Peng, F., & Lyu, S. (2024). An RCT meta-analysis based on the effect of Tai Chi exercise therapy on the outcome of elderly patients with moderate-to-severe sleep disorders: A systematic review study. Heliyon, 10(2), e24085. https://doi.org/10.1016/j.heliyon.2024.e24085
21. Martella, D., Marotta, A., Fuentes, L. J., & Casagrande, M. (2014). Inhibition of return, but not facilitation, disappears under vigilance decrease due to sleep deprivation. Experimental Psychology, 61(2), 99–109. https://doi.org/10.1027/1618-3169/a000229
22. Morin, C. M., Hauri, P. J., Espie, C. A., Spielman, A. J., Buysse, D. J., & Bootzin, R. R. (1999). Nonpharmacologic treatment of chronic insomnia: An American Academy of Sleep Medicine review. Sleep, 22(8), 1134–1156. https://doi.org/10.1093/sleep/22.8.1134
23. Nair, S. S., Raghunath, P., & Nair, S. S. (2015). Prevalence of psychiatric disorders among the rural geriatric population: A pilot study in Karnataka, India. Central Asian Journal of Global Health, 4(1), 138. https://doi.org/10.5195/cajgh.2015.138
24. Nguyen, M. H., & Kruse, A. (2012). A randomized controlled trial of Tai Chi for balance, sleep quality and cognitive performance in elderly Vietnamese. Clinical Interventions in Aging, 7, 185–190. https://doi.org/10.2147/CIA.S32600
25. Ohayon, M. M., & Vecchierini, M.-F. (2005). Normative sleep data, cognitive function and daily living activities in older adults in the community. Sleep, 28(8), 981–989.
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28. Rambod, M., Pourali-Mohammadi, N., Pasyar, N., Rafii, F., & Sharif, F. (2013). The effect of Benson’s relaxation technique on the quality of sleep of Iranian hemodialysis patients: A randomized trial. Complementary Therapies in Medicine, 21(6), 577–584. https://doi.org/10.1016/j.ctim.2013.08.009
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33. Sun, H., Lv, W., & Lee, J. (2023). Effect of Tai Chi exercise on healthcare and quality of life of middle-aged and elderly patients with hypertension. International Journal of Healthcare Information Systems and Informatics, 18, 1–12. https://doi.org/10.4018/IJHISI.326130
34. Sun, Y., Huang, K., Hu, Y., Yan, S., Xu, Y., Zhu, P., & Tao, F. (2019). Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLOS ONE, 14(5), e0216870. https://doi.org/10.1371/journal.pone.0216870
35. Wang, C., Bannuru, R., Ramel, J., Kupelnick, B., Scott, T., & Schmid, C. H. (2010). Tai Chi on psychological well-being: Systematic review and meta-analysis. BMC Complementary and Alternative Medicine, 10, 23. https://doi.org/10.1186/1472-6882-10-23
36. Zhou, J., Wu, B., Su, L., & Ma, X. (2024). The influence of Tai Chi on the death anxiety of elderly people living alone: The chain mediating effect of social support and psychological capital. Frontiers in Psychology, 14, 1303524. https://doi.org/10.3389/fpsyg.2023.1303524
37. Zou, L., Zhang, Y., Liu, Y., Tian, X., Xiao, T., Liu, X., Yeung, A. S., Liu, J., Wang, X., & Yang, Q. (2019). The effects of Tai Chi Chuan versus core stability training on lower-limb neuromuscular function in aging individuals with non-specific chronic lower back pain. Medicina, 55(3), 60. https://doi.org/10.3390/medicina55030060

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to cite

Mohani, M., Samal, S., & Gulrandhe, P. (2025). The Enhancing sleep and reducing anxiety in the elderly: A narrative review of tai chi and benson relaxation techniques. Multidisciplinary Reviews, 8(11), e2025295. https://doi.org/10.31893/multirev.2025295

[1] Abarghoee, S. N., Mardani, A., Baha, R., Aghdam, N. F., Khajeh, M., Eskandari, F., & Vaismoradi, M. (2022). Effects of Benson relaxation technique and music therapy on the anxiety of primiparous women prior to cesarean section: A randomized controlled trial. Anesthesiology Research and Practice, 2022, 9986587. https://doi.org/10.1155/2022/9986587

[2] Abu Maloh, H. I. A., Soh, K. L., AbuRuz, M. E., Chong, S. C., Ismail, S. I. F., Soh, K. G., & Abu Maloh, D. I. (2022). Efficacy of Benson’s relaxation technique on anxiety and depression among patients undergoing hemodialysis: A systematic review. Clinical Nursing Research, 31(1), 122–135. https://doi.org/10.1177/10547738211024797

[3] Akbar, S., Tiwari, S. C., Tripathi, R. K., Pandey, N. M., & Kumar, A. (2018). Prevalence of psychiatric illness among residents of old age homes in Northern India. Journal of Neurosciences in Rural Practice, 9(2), 193–196. https://doi.org/10.4103/jnrp.jnrp_340_17

[4] Ancoli-Israel, S., Poceta, J. S., Stepnowsky, C., Martin, J., & Gehrman, P. (1997). Identification and treatment of sleep problems in the elderly. Sleep Medicine Reviews, 1(1), 3–17. https://doi.org/10.1016/S1087-0792(97)90002-2

[5] Bagheri, H., Moradi-Mohammadi, F., Khosravi, A., Ameri, M., Khajeh, M., Chan, S. W.-C., Abbasinia, M., & Mardani, A. (2021). Effect of Benson and progressive muscle relaxation techniques on sleep quality after coronary artery bypass graft: A randomized controlled trial. Complementary Therapies in Medicine, 63, 102784. https://doi.org/10.1016/j.ctim.2021.102784

[6] Beary, J. F., & Benson, H. (1974). A simple psychophysiologic technique which elicits the hypometabolic changes of the relaxation response. Psychosomatic Medicine, 36(2), 115–120. https://doi.org/10.1097/00006842-197403000-00003

[7] Carek, P. J., Laibstain, S. E., & Carek, S. M. (2011). Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine, 41(1), 15–28. https://doi.org/10.2190/PM.41.1.c

[8] Cheng, L., Chang, S., Wang, B., He, B., & Tan, Y. (2023). Cross-sectional study of depression tendency and sleep quality in 1352 people practicing Tai Chi. Research in Sports Medicine, 31(5), 650–662. https://doi.org/10.1080/15438627.2021.2024832

[9] Choo, Y. T., Jiang, Y., Hong, J., & Wang, W. (2020). Effectiveness of Tai Chi on quality of life, depressive symptoms and physical function among community-dwelling older adults with chronic disease: A systematic review and meta-analysis. International Journal of Nursing Studies, 111, 103737. https://doi.org/10.1016/j.ijnurstu.2020.103737

[10] Cooke, J. R., & Ancoli-Israel, S. (2011). Normal and abnormal sleep in the elderly. In P. J. Vinken & G. W. Bruyn (Eds.), Handbook of clinical neurology (Vol. 98, pp. 653–665). Elsevier. https://doi.org/10.1016/B978-0-444-52006-7.00041-1

[11] Gadie, A., Shafto, M., Leng, Y., & Kievit, R. A. (2017). How are age-related differences in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults. BMJ Open, 7(7), e014920. https://doi.org/10.1136/bmjopen-2016-014920

[12] Gao, R., Greiner, C., Ryuno, H., & Gao, S. (2022). Tai Chi or conventional exercise on physical performance, sleep, and quality of life in older people with dementia. Innovation in Aging, 6(Suppl 1), 467. https://doi.org/10.1093/geroni/igac059.1813

[13] Gerogianni, G., Babatsikou, F., Polikandrioti, M., & Grapsa, E. (2019). Management of anxiety and depression in haemodialysis patients: The role of non-pharmacological methods. International Urology and Nephrology, 51(1), 113–118. https://doi.org/10.1007/s11255-018-2022-7

[14] Gharehbaghi, M., Mirhosseini, S., Minaei Moghadam, S., Salari, M., Grimwood, S., & Vaghee, S. (2024). Benson relaxation technique to address sleep quality and aggression among patients with bipolar type I disorder: A randomized clinical trial study. Heliyon, 10, e30648. https://doi.org/10.1016/j.heliyon.2024.e30648

[15] Harorani, M., Davodabady, F., Farahani, Z., Hezave, A. K., & Rafiei, F. (2020). The effect of Benson’s relaxation response on sleep quality and anorexia in cancer patients undergoing chemotherapy: A randomized controlled trial. Complementary Therapies in Medicine, 50, 102344. https://doi.org/10.1016/j.ctim.2020.102344

[16] Heidari Gorji, M. A., Davanloo, A. A., & Heidarigorji, A. M. (2014). The efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients. Indian Journal of Nephrology, 24(6), 356–361. https://doi.org/10.4103/0971-4065.132998

[17] Hemmeter, U. M., & Ngamsri, T. (2022). Physical activity and mental health in the elderly. Praxis, 110(4), 193–198. https://doi.org/10.1024/1661-8157/a003853

[18] Irwin, M. R., Olmstead, R., & Motivala, S. J. (2008). Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of Tai Chi Chih. Sleep, 31(7), 1001–1008.

[19] Li, F., Fisher, K. J., Harmer, P., Irbe, D., Tearse, R. G., & Weimer, C. (2004). Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: A randomized controlled trial. Journal of the American Geriatrics Society, 52(6), 892–900. https://doi.org/10.1111/j.1532-5415.2004.52255.x

[20] Li, L., Li, X., Huang, Y., Li, H., Li, C., Ma, Y., Zhang, J., Peng, F., & Lyu, S. (2024). An RCT meta-analysis based on the effect of Tai Chi exercise therapy on the outcome of elderly patients with moderate-to-severe sleep disorders: A systematic review study. Heliyon, 10(2), e24085. https://doi.org/10.1016/j.heliyon.2024.e24085

[21] Martella, D., Marotta, A., Fuentes, L. J., & Casagrande, M. (2014). Inhibition of return, but not facilitation, disappears under vigilance decrease due to sleep deprivation. Experimental Psychology, 61(2), 99–109. https://doi.org/10.1027/1618-3169/a000229

[22] Morin, C. M., Hauri, P. J., Espie, C. A., Spielman, A. J., Buysse, D. J., & Bootzin, R. R. (1999). Nonpharmacologic treatment of chronic insomnia: An American Academy of Sleep Medicine review. Sleep, 22(8), 1134–1156. https://doi.org/10.1093/sleep/22.8.1134

[23] Nair, S. S., Raghunath, P., & Nair, S. S. (2015). Prevalence of psychiatric disorders among the rural geriatric population: A pilot study in Karnataka, India. Central Asian Journal of Global Health, 4(1), 138. https://doi.org/10.5195/cajgh.2015.138

[24] Nguyen, M. H., & Kruse, A. (2012). A randomized controlled trial of Tai Chi for balance, sleep quality and cognitive performance in elderly Vietnamese. Clinical Interventions in Aging, 7, 185–190. https://doi.org/10.2147/CIA.S32600

[25] Ohayon, M. M., & Vecchierini, M.-F. (2005). Normative sleep data, cognitive function and daily living activities in older adults in the community. Sleep, 28(8), 981–989.

[26] Paluska, S. A., & Schwenk, T. L. (2000). Physical activity and mental health: Current concepts. Sports Medicine, 29(3), 167–180. https://doi.org/10.2165/00007256-200029030-00003

[27] Parsa Yekta, Z., Sadeghian, F., Taghavi Larijani, T., & Mehran, A. (2017). The comparison of two types of relaxation techniques on postoperative state anxiety in candidates for the mastectomy surgery: A randomized controlled clinical trial. International Journal of Community Based Nursing and Midwifery, 5(1), 61–69.

[28] Rambod, M., Pourali-Mohammadi, N., Pasyar, N., Rafii, F., & Sharif, F. (2013). The effect of Benson’s relaxation technique on the quality of sleep of Iranian hemodialysis patients: A randomized trial. Complementary Therapies in Medicine, 21(6), 577–584. https://doi.org/10.1016/j.ctim.2013.08.009

[29] Saeed, S. A., Antonacci, D. J., & Bloch, R. M. (2010). Exercise, yoga, and meditation for depressive and anxiety disorders. American Family Physician, 81(8), 981–986.

[30] Saeed, S. A., Cunningham, K., & Bloch, R. M. (2019). Depression and anxiety disorders: Benefits of exercise, yoga, and meditation. American Family Physician, 99(10), 620–627.

[31] Sharma, M., & Haider, T. (2015). Tai Chi as an alternative and complementary therapy for anxiety: A systematic review. Journal of Evidence-Based Complementary & Alternative Medicine, 20(2), 143–153. https://doi.org/10.1177/2156587214561327

[32] Siu, P. M., Yu, A. P., Tam, B. T., Chin, E. C., Yu, D. S., Chung, K.-F., Hui, S. S., Woo, J., Fong, D. Y., Lee, P. H., Wei, G. X., & Irwin, M. R. (2021). Effects of Tai Chi or exercise on sleep in older adults with insomnia: A randomized clinical trial. JAMA Network Open, 4(2), e2037199. https://doi.org/10.1001/jamanetworkopen.2020.37199

[33] Sun, H., Lv, W., & Lee, J. (2023). Effect of Tai Chi exercise on healthcare and quality of life of middle-aged and elderly patients with hypertension. International Journal of Healthcare Information Systems and Informatics, 18, 1–12. https://doi.org/10.4018/IJHISI.326130

[34] Sun, Y., Huang, K., Hu, Y., Yan, S., Xu, Y., Zhu, P., & Tao, F. (2019). Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLOS ONE, 14(5), e0216870. https://doi.org/10.1371/journal.pone.0216870

[35] Wang, C., Bannuru, R., Ramel, J., Kupelnick, B., Scott, T., & Schmid, C. H. (2010). Tai Chi on psychological well-being: Systematic review and meta-analysis. BMC Complementary and Alternative Medicine, 10, 23. https://doi.org/10.1186/1472-6882-10-23

[36] Zhou, J., Wu, B., Su, L., & Ma, X. (2024). The influence of Tai Chi on the death anxiety of elderly people living alone: The chain mediating effect of social support and psychological capital. Frontiers in Psychology, 14, 1303524. https://doi.org/10.3389/fpsyg.2023.1303524

[37] Zou, L., Zhang, Y., Liu, Y., Tian, X., Xiao, T., Liu, X., Yeung, A. S., Liu, J., Wang, X., & Yang, Q. (2019). The effects of Tai Chi Chuan versus core stability training on lower-limb neuromuscular function in aging individuals with non-specific chronic lower back pain. Medicina, 55(3), 60. https://doi.org/10.3390/medicina55030060

Abstract

References

How to cite