Revisiting therapeutic landscapes in the spa context: toward a multisensory, evidence-based framework for healing environments

The therapeutic potential of spa landscapes represents an emerging intersection between environmental psychology, medical geology, health geography, and wellness tourism research. This narrative review synthesizes existing empirical findings and theoretical frameworks to examine how spa environments contribute to human health and well-being outcomes. Historically, European spa towns exemplify therapeutic landscapes, rooted in the use of natural healing resources such as mineral waters, gases, peloids, and climate. These environments are shaped not only by their physical resources but also by multisensory qualities, spatial aesthetics, and cultural traditions, which together create complex therapeutic settings. Drawing from landscape architecture, environmental psychology, therapeutic horticulture, and medical geography, this review explores the mechanisms through which natural and designed spa landscapes facilitate healing processes. Evidence suggests that benefits arise from interactions between environmental quality, embodied experiences, and social and cultural factors. Yet scientific understanding remains fragmented, and no unified typology of spa environments, whether medical or wellness-oriented, or across various global contexts, currently exists. This review highlights the need for interdisciplinary empirical studies and proposes a conceptual basis for future research bridging environmental science, health geography, and wellness studies.