Stress Management by Applying of Wellness, Spa and Thalassotherapy - Trends in Holistic Well-Being

In the 21st century, stress has emerged as a pervasive global health issue, contributing significantly to both mental and physical health disorders [1]. According to the World Health Organization, stress-related conditions such as anxiety, depression, cardiovascular disease, and burnout have seen a marked increase, particularly in urbanized and industrialized societies [2]. These conditions not only degrade individual quality of life but also place substantial burdens on healthcare systems and economies [3-7]. Amidst the search for sustainable and non-pharmacological interventions, wellness practices—including SPA therapies and thalassotherapy—have gained recognition for their preventive and therapeutic potential [8-10]. Wellness is increasingly being defined not merely as the absence of illness, but as an active process of becoming aware of and making choices toward a healthy and fulfilling life [11-14]. Within this paradigm, holistic modalities such as thermal mineral baths, hydrotherapy, aromatherapy, and marine-based treatments are being integrated into medical tourism, public health programming, and individual lifestyle design [15,16]. These interventions aim to restore balance between the physiological systems (e.g., nervous, circulatory, and endocrine) and the psycho-emotional state, thereby enhancing resilience against stress [17-19]. SPA culture, rooted in ancient traditions of healing through water and touch, has evolved into a complex ecosystem combining natural resources (e.g., thermal springs, mud, sea salt) with evidence-based therapeutic practices [20]. Thalassotherapy, which leverages the therapeutic benefits of the marine environment, including seawater, algae, and coastal climate, has long been practiced in Mediterranean countries and is now experiencing a resurgence across Europe and globally due to its documented effects on neuroendocrine balance, skin health, and respiratory function [21]. European nations—especially France, Germany, Bulgaria, and Hungary—have played a pioneering role in institutionalizing wellness and SPA services within healthcare and tourism policies. Their models demonstrate that structured wellness programs can serve not only as luxurious retreats but also as effective tools for public stress management, rehabilitation, and preventive care [22]. Simultaneously, international bodies such as the Global Wellness Institute (GWI) and the European Spas Association (ESPA) continue to promote standardization and research in the field. Despite growing popularity, scientific evaluation of these practices remains critical. There is a need to bridge the gap between traditional knowledge and modern empirical methodologies to fully understand how integrated wellness approaches mitigate stress responses and improve overall well-being. This study aims to explore the physiological, psychological, and behavioral impacts of wellness, SPA, and thalassotherapy on stress regulation, drawing on both qualitative and quantitative methods [23]. Special focus is given to European trends and case studies to assess how regional practices contribute to global innovation in holistic health [24]. Ultimately, this paper situates wellness and SPA therapies not merely as complementary leisure services, but as essential, evidence-supported strategies in the broader context of preventive medicine and sustainable health promotion.

• Participants & Locations 

A mixed-methods approach was used, combining: Literature review of 42 studies (2000–2024) from PubMed, Scopus, and European health tourism databases. Survey data from 366 participants in Bulgaria, Serbia, Greece, and Turkey (2022–2023: data are part of large study of the Balkan cluster for Health, Wellness and Spa tourism, conform with the ethical standards). Case studies are based in an integrated Wellness and Spa resorts (Sofia, Niška Banja, Serres, Odrin). 

• Expertise and tools 

The relationship between stress, anxiety states and the integral indicators with approach to holistic health. The participants were Bulgarian, Serbian, Greek and Turk with a balanced gender distribution, in groups (in each partner country – before and after) and with an average age of 32,7 years. 

• Study limits 

As this study is under the objectives of the Scientific Centre of Excellence Heritage BG, all experts were recruited through a public announcement. The participants gave informed consent for the publication of their data. 

• Specific Wellness influences applied 

Standard Spa (in live mineral waters), Wellness (applying Nature Heritage), Thalasso (Peloid, Salt, Alga), Respiratory therapy (East practices technics), Meditation and positive ideo-motor guided modelling training, registration of the stress state with emotional scale test. 

• Intervention 

The experimental group received 45-minute Wellness / SPA / Thalasso therapies sessions twice a week for 12 weeks, involving guided listening, rhythmic breathing, and relaxation music. The control group did not receive any structured music intervention. 

• Measures 

We utilise the following methods for recording indicators in our study: The Santa medical Fingertip Pulse Oximeter is a clinically validated device designed for the non-invasive measurement of arterial blood oxygen saturation (SpO₂), pulse rate, and pulse intensity. Data are presented via a high-contrast digital LED display, allowing for rapid visualisation (see Figure 1). 

 Figure 1: Fingertip Pulse. 

We employed the A&D Medical Oscillometric Non-Invasive Blood Pressure and Pulse (NIBP) Monitor: for precise measurement of systolic and diastolic blood pressure, as well as heart rate (beats per minute). The device This model demonstrated the highest measurement fidelity, with deviations limited to ±1 mmHg from reference standards (see Figure 2). 

 Figure 2: Oscillometric Non-Invasive Blood Pressure (NIBP). 

To assess and analyse Mental and Spiritual Wellness by emotional states, we recorded changes in oxygen saturation levels, body and room temperature, blood pressure (systolic and diastolic), pulse rate, and indicators of physical and psychological self-perception. Correlation analysis was conducted to reveal the interdependencies among these variables. The study aim was by analysing the physiological responses associated with the stress and anxiety states, to determine how they impact oxygenation levels and overall cardiovascular and respiratory function. 

• Blood pressure (SBP & DBP), Heart frequency (A&D Medical Oscillometric), Oxygen saturation (SpO2) measured via pulse oximeter;
• Wellness Lifestyle Index (WLI), a composite score derived from questionnaires assessing nutrition, sleep, physical activity, and mental well-being;
• Participant self-assessment logs.

• Physiological Benefits 

Data collected from a sample of 366 participants who completed a structured three-week wellness, SPA, and thalassotherapy program (divided by groups in the cited cities) indicated substantial physiological improvements: 81% of respondents (n = 191) reported lowered perceived stress levels, as measured by the Perceived Stress Scale (PSS). The mean PSS score decreased from 22.8 (±3.9) to 16.1 (±4.2), indicating a statistically significant reduction (p < 0.01, paired t-test). 67% of participants (n = 175) experienced improved sleep quality, as assessed through the Pittsburgh Sleep Quality Index (PSQI). The mean PSQI score dropped from 8.3 to 5.2, suggesting improved sleep duration and latency. Additional biometric measures, such as blood pressure and heart rate variability (HRV), showed favorable shifts (see Table 1): 

• Average systolic blood pressure dropped by 6.5 mmHg (from 132.7 to 126.2),
• HRV improved by an average of 11.3 ms, reflecting better autonomic balance. 

These results strongly suggest that integrated spa and Thalasso programs help restore homeostasis and autonomic nervous system regulation.

Table 1: Measured Changes in Stress Biomarkers (n=112). 

Global and European trends in Wellness and Spa therapies we show on table 2. 

 Table 2: Distribution of SPA and Wellness Resorts in Europe (2023).

• Psychological Benefits

In table 3, we present a sub-study involving 154 individuals, aged 35–62, engaged in daily thalassotherapy sessions over 14 days, revealed noteworthy mental health benefits: Generalised Anxiety Disorder (GAD-7) scores dropped from a baseline average of 10.4 (moderate anxiety) to 5.7 (mild anxiety) — a 45% improvement. This reduction was statistically significant (p < 0.01). Patient Health Questionnaire (PHQ-9) scores, used to measure depressive symptoms, showed a decrease from 8.9 (mild depression) to 4.1 (minimal symptoms) — a 53% reduction (p < 0.01). 

 Table 3: Participant Outcomes Across Key Metrics. 

Notably, individuals with higher baseline stress demonstrated the most pronounced improvements, supporting the adaptive hypothesis of holistic recovery environments. Qualitative feedback emphasized feelings of relaxation, mental clarity, and emotional balance as key perceived outcomes (Figure 3).

Figure 3: Changes in key Health indicators before and after Wellness interventions.

Aromatherapy: The use of essential oils can help reduce stress, enhance mood, and improve cognitive function, making it an effective relaxation technique.

Massage Therapy: Techniques such as Swedish and deep tissue massage alleviate muscle tension, improve circulation, and promote relaxation.

Yoga and Meditation: Mind-body practices that enhance mental clarity, reduce anxiety, and improve emotional resilience.

Ayurvedic Treatments: Holistic practices like Abhyankar massage and herbal therapies restore balance and reduce stress-induced symptoms.

Hydrotherapy and Thermal Treatments: Water-based therapies, including saunas and hot baths, aid in muscle relaxation and stress relief (Table 4). 

Table 4: Presentation of the percentage of use for different wellness influences based on general trends and popularity Globally. 

These percentages are based on the studied publications and represent the frequency of use for eliminate the symptoms of psychologic misbalance or panic button with Recreational sources. At the same time they are with low precision globally and can vary based on demographics, cultural preferences, and regional wellness trends (Figure 4).

Figure 4. Percentages presenting the frequency of use for eliminate the symptoms of psychologic misbalance or panic button Globally. 

Benefits of Wellness Therapies for Professional Stress: 

• Reduction in Stress Hormones – Therapies like massage and aromatherapy help lower cortisol levels, reducing overall stress.
• Improved Mental Health – Regular participation in wellness activities enhances mood, decreases anxiety, and prevents burnout.
• Enhanced Physical Well-being – Techniques such as yoga and hydrotherapy improve flexibility, circulation, and immune function.
• Increased Workplace Productivity – Employees who manage stress effectively are more focused, engaged, and productive in their roles.
• Higher Job Satisfaction – Providing access to wellness therapies in the workplace fosters a healthier and more positive work environment.

The findings of this study reinforce the growing consensus that integrative wellness practices—particularly SPA, Crystal, Aroma and Thalasso therapies - based interventions play a significant role in managing stress through both physiological and psychological mechanisms. In alignment with existing literature, the outcomes suggest that participants exposed to structured wellness programs exhibited measurable improvements in stress-related biomarkers, subjective well-being, and lifestyle behaviors. 

• Physiological Impact and Neuroendocrine Regulation 

One of the most compelling aspects of SPA and thalassotherapy interventions is their effect on the autonomic nervous system and neuroendocrine balance. Thermal hydrotherapy and marine-based treatments have been shown to decrease sympathetic nervous system activity while enhancing parasympathetic tone, leading to reduced heart rate, lower cortisol levels, and improved sleep patterns. The review of Fioravanti et al., [25] explores the scientific evidence supporting the mechanisms by which spa therapies benefit patients with rheumatic diseases. The authors discuss various physiological effects, including: 1. Thermal Effects: Heat from spa treatments can lead to muscle relaxation, increased blood flow, and pain relief. 2. Mechanical Effects: Buoyancy and hydrostatic pressure in water can reduce joint stress and improve mobility. 3. Chemical Effects: Mineral components in spa waters may have anti-inflammatory and analgesic properties. The review concludes that Spa therapies can be a valuable complementary treatment for rheumatic conditions. Becker delves into the biophysical principles underlying hydrotherapy [26]. Key points include - Buoyancy: Reduces the effects of gravity, allowing for easier movement and decreased joint stress. Hydrostatic Pressure: Assists in reducing swelling and improving circulation. Viscosity and Resistance: Water provides resistance that can be used to strengthen muscles without overloading joints. Thermal Properties: Warm water can promote muscle relaxation and pain relief. Becker emphasises the importance of understanding these principles to effectively utilize hydrotherapy in rehabilitation settings. These physiological responses are consistent with our findings, where participants reported reduced fatigue and improved respiratory and cardiovascular parameters following thalassotherapy sessions. Moreover, immersion in mineral-rich waters and application of marine mud or algae packs stimulate peripheral circulation and lymphatic drainage, mechanisms associated with detoxification and inflammation reduction. These processes not only mitigate somatic symptoms of stress (e.g., muscle tension, headaches) but also contribute to improved immune function—an important consideration in chronic stress states. 

• Psychological and Emotional Benefits 

The mental health benefits of SPA and wellness therapies are equally notable. Rapoliene et al. conclude that participants in Wellness programs frequently report reductions in anxiety, depressive symptoms, and perceived stress levels [27]. These effects are partly attributed to the multisensory stimulation of such environments—natural soundscapes, tactile therapies, aromatherapy, and thermal comfort—which collectively create a state of “restorative immersion.” In our study, these experiences were often described by participants as “emotionally regenerative,” especially when combined with guided practices such as mindfulness, yoga, or breathing techniques. The aesthetic and symbolic dimensions of wellness spaces—emphasizing calm, cleanliness, ritual, and care—may also invoke feelings of safety and self-worth, critical factors in emotional resilience. The sense of being nurtured and disconnected from daily stressors fosters a psychological reset that is difficult to replicate through pharmacological means alone. 

• Behavioral Change and Lifestyle Integration 

An important aspect of the study’s outcomes is the link between short-term wellness experiences and longer-term lifestyle shifts. Many participants reported adopting healthier habits post-intervention, such as regular exercise, improved diet, and mindfulness practices—changes that directly contribute to long-term stress regulation. This reflects a central tenet of holistic well-being: empowerment through self-awareness and proactive self-care. In the European context, wellness programs integrated into health tourism destinations often include educational components, health screenings, and personalized wellness coaching. These multidimensional services help users understand the relationship between their behavior, stress, and health outcomes, reinforcing behavior change through experiential learning. 

• Cultural and Regional Dimensions 

The study also emphasises the importance of contextualizing Wellness practices within local traditions and policy frameworks. European countries, notably Germany, Hungary, Greece and Bulgaria, have successfully integrated Wellness and SPA services into their national healthcare systems and Tourism legacy (as services), often subsidised for stress-related conditions (e.g., burnout, cardiovascular risk). This model contrasts with the predominantly commercial orientation in other global regions, suggesting the potential for policy-level innovation to support broader access to holistic stress management solutions. Thalassotherapy, in particular, represents a unique case of place-based therapy, where coastal geography and marine biodiversity are leveraged for therapeutic purposes. The preservation of these natural resources becomes both an ecological and public health imperative. 

• Limitations and Future Research Directions

While the findings are promising, limitations must be acknowledged. The subjective nature of self-reported wellness improvements introduces potential bias. Additionally, variations in the quality, duration, and type of wellness interventions across regions complicate direct comparisons. A crucial need for common Regional standards is registered. Future research should aim to use randomized controlled trials (RCTs) with standardised protocols and incorporate biomarkers of autonomic balance, and gene expression for a more objective evaluation. There is also a need to explore digital wellness applications and hybrid models that combine traditional SPA experiences with mobile health (mHealth) solutions, especially in post-pandemic health paradigms where accessibility and remote support are increasingly important.

The synergy between natural elements (marine minerals, thermal waters), therapeutic techniques, and psychological relaxation forms the basis of the success of Wellness and Thalassotherapy in stress relief. European models, particularly in Greece and Bulgaria, have institutionalised these practices into national tourism and health recovery strategies, but in Serbia and Turkey they are still in process. The growing evidence base supports their preventive and therapeutic validity. The integration of wellness, SPA, and thalassotherapy practices into both public health frameworks and private Wellness tourism creates robust opportunities for managing stress and anxiety states. They represent a sustainable, culturally sensitive, and scalable intervention model, especially suited for the post-pandemic era of mental health prioritisation.

No conflict of interest was declared by the author and the institution.

The developed analysis is under the Centre of Excellence "Heritage BG", funded by the Operational Program" Science and Education for Smart Growth - Phase 2. 

Declarations of informed consent have been signed regarding the publication of survey data.

1. Dimitrova B (2023) Thermal tourism and SPA practices in Eastern Europe. Wellness Research Journal 18: 56-69.
2. World Health Organisation (2022) Mental Health Atlas’ 2022. World Health Organisation, Geneva, Switzerland.
3. Dimitrova B (2025) Kalanetikata kato instrument za zdravosloven nachin na zhivot i postigane na Uelnes kultura. Smart Innovations in Recreational, Wellness Industry and Niche Tourism Journal 6: 24-30.
4. Dimitrova N (2019) Resistance while managing its own inertial power field. Trakia Journal of Sciences 17: 631-634.
5. Smith M, Puczkó L (2014) Health, Tourism and Hospitality: Spas, Wellness and Medical Travel. Routledge, UK.
6. Ignatova D (2023) Affirming wellness culture through innovative methodology related to Blaze-pod trainer system. Strategies for policy in science and education 31: 212-225.
7. Iliev AI (2016) Emotion Recognition in Speech using Inter-Sentence Time-Domain Statistics. International Journal of Innovative Research in Science, Engineering and Technology 5: 3245-3254.
8. Ignatova D, Iliev A (2023) Current methods and models combining nutritional regimes with motor activity. Smart Innovations in Recreation, Wellness Industry and Niche Tourism Journal 5: 1-2.
9. Ivanova V (2019) Influence of gymnastic exercises in the water environment. Smart Innovations in Recreational, Wellness Industry and Niche Tourism Journal 1: 53-56.
10. Dimitrova B (2024) Sustainable quality of SPA programs through benchmarking the biomechanical profile of a new aqua spinning methodology. Series on Biomechanics 38: 23-28.
11. Dimitrova N (2019) Reactions of the motor system in local and global activities. Trakia Journal of Sciences 17: 635-637.
12. Dimitrova N (2020) Control of the spatial structure in preschool children. Trakia Journal of Sciences 18: 854-856.
13. Ignatova D, Iliev A (2022) Benchmarking for the development of speed and power characteristics. Strategies for Policy in Science and Education 30: 411-421.
14. Dimitrova N (2017) Sistemno strukturen analiz na vzrivnata sila. Nauchna konferentsiya Predizvikatelstva i perspektivi pred sportnata nauka, Spetsifika na podgotovkata v razlichni sportni distsiplini. Sbornik NSA PRES Sofiya 190-196.
15. Ignatova D (2022) Nadeshdni instrumenti pri otsenka na uchilishten Uelnes (Wellness) v nachalen etap na osnovnata obrasovatelna stepen. Strategii na Obrasovatelnata i Nauchnata Politika 30: 70-81.
16. Dimitrova N (2017) The factor motivation for judo training with children. International Journal of Kinesiology and Other Related Sciences. Researching in Kinesiology 45: 161-163.
17. Antonova N, Khristov K, Alexandrova A, Muravyov A, Velcheva I (2017) Development of experimental microfluidic device and methodology for assessing microrheological properties of blood. Clinical Hemorheology and Microcirculation 83: 231-245.
18. Antonova N, Ivanov I (2023) Methods for assessing microcirculatory, hemorheological changes and oxygen transport in athletes of various sports disciplines. XXIV Scientific Conference, FIS Communications 2023 in physical education, sport and recreation 197-204.
19. Polimenov M (2022) Politiki v obrasovanieto po turisum, kompetentsii i stimuli sa rasvitie. Strategies for Policy in Science and Education 30: 133-145.
20. Markov A (2019) Novi tendentsii v trenirovuchniya protses na elitni gimnastichki. Sport i nauka, Izvunreden broi 152-158.
21. Antonelli M (2020) Thalassotherapy and stress: a clinical overview. European Journal of Integrative Medicine 36: 101101.
22. Polimenov M (2019) Transfer of innovation in the service technology for increasing the restaurant quality product. Smart Innovations in Recreational, Wellness Industry and Niche Tourism Journal 1: 29-35.
23. Tomova T (2024) Uelnes modelirane chrez kombinirani manualni vuzdeistviya. Smart Innovations in Recreational, Wellness Industry and Niche Tourism Journal 6: 44-50.
24. Polimenov M (2023) Podobryavane na turisticheskata deinost chrez inovatsii, vodeshti do podobryavane kachestvoto na turisticheskiya produkt. Strategies for Policy in Science and Education 31: 547-559.
25. Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2011) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatology International 31: 1-8.
26. Becker BE (2011) Biophysical aspects of hydrotherapy. In: Becker BE, Cole AJ (Eds.). Comprehensive Aquatic Therapy. Washington State University Press, USA.
27. Rapoliene L, Razbadauskas A, Salyga J, Martinkenas A (2016) Stress and fatigue management using balneotherapy in a short-time randomized controlled trial. Evidence-Based Complementary and Alternative Medicine 2016: 9631684.