Relativement peu connue en psychiatrie, la médecine thermale psychiatrique est une approche originale qui commence à faire l’objet d’évaluations rigoureuses. Depuis les années 2000, elle a fait l’objet d’études qui en ont mieux montré les contours et les potentiels domaines d’application. Située à l’interface de la médecine générale et de la psychiatrie, entre la médecine ambulatoire et la médecine hospitalière, la médecine thermale s’adresse essentiellement aux troubles anxieux, aux troubles réactionnels, adaptatifs, et à des situations cliniques telles que le sevrage de benzodiazépines ou la psychoéducation. À base de balnéothérapie, celle-ci est basée sur la qualité de la relation entre le médecin et le patient, sur la mise en place d’un environnement médicalisé, structurant, anxiolytique et a développé des modèles de prise en charge psychoéducatifs inspirés des thérapies cognitives et comportementales. En 2010, la preuve de l’efficacité de la crénothérapie a été apportée dans la prise en charge des troubles anxieux généralisés sur une durée de deux mois. En 2016, une autre étude a permis de démontrer l’intérêt de la balnéothérapie en cure thermale pour réaliser le sevrage de benzodiazépines chez les patients anxieux, consommateurs chroniques et motivés pour l’arrêt. Parallèlement, la balnéothérapie a été évaluée dans les troubles affectifs de pathologies douloureuses chroniques, en particulier de la fibromyalgie. Une autre étude a démontré son intérêt dans la prise en charge du burn-out. Nous résumons ici les résultats de ces principaux travaux.

Relatively little known in psychiatry, spa psychiatric medicine is an original approach, which has started to form the subject of thorough assessments. It concerns 3 week spa therapy stays in practice, the patient being totally free and self-sufficient, though having to go to 3 to 4 prescribed daily bathing sessions and to the medical and psychotherapy follow-up provided within the scope of their medical care. Since the beginning of the years 2000, Spa Medicine has been subject to studies that have better shown the outline and its potential application areas. We present you here, through a review of the literature from these past 30 years, the main elements of scientific proof of its therapeutic activity and as a result, its best documented indications in psychiatry. Therefore, the article is stated by chapter, indication by indication.

The area which brings the best level of proof relates to generalised anxiety disorder. One study called STOP-TAG (Dubois O, Salomon R, Germain C, et al. 2010) (Salamon R, Germain C, Olié JP, Dubois O, 2008) supervised by 2 Inserm units: ISPED in Bordeaux II and Sainte-Anne, brought the proof of a superior efficacy of the therapy compared to Paroxetine over a period of 8 weeks (5 weeks after the end of the course of treatment). This result is supported by other less thorough works that all feed the first initial study. As a consequence, an Austrian study became interested in the effects of spa bathing observed over 3 weeks in burn-out situations. The results show the efficacy of this medical care at the end of the treatment and 3 months afterwards. Subsequently, the interest in a psycho-educative programme carried out in spa therapy for anxiety patients and chronic benzodiazepine consumers, was studied in addiction. The SPECTh study (De Maricourt P, Gorwood P, Hergueta T, Dubois O. et al. 2016) allowed to follow 70 patients, therapeutically stable and motivated in their stopping. Six months after their treatment, 41.42 % of these patients had ceased all consumption and 80 % had reduced by half, whereas 16 % were in a position of therapeutic failure. This area of addiction has not been subject to other studies particularly concerning excessive alcohol consumption or of ta (the indication of which seems by the way less obvious) or tobacco. If few studies have sought to evaluate the significance of Spa Medicine in depressive disorders, many works have brought out the doubtless indirect impact of this practice on reactional depressive states, especially painful chronic states and on a generalised anxiety state. Likewise, it is above all the spa rheumatologists’ works that have brought solid proof of the efficacy of spa therapy and bathing in affective disorders (anxiety, depressive disorder) associated with painful chronic states (fibromyalgia, chronic low back pain, after breast cancer…). As far as the mechanism of action is concerned, numerous hypotheses exist. This is not the place to present them all. However, the result of an original and important pre-study is presented here that highlights the interest of an optimal “letting go” as statistical indicator of a clinical improvement of anxiety in the long run. If the notion of letting go remains to be defined scientifically, it comprises a notion of non-resistance, the giving up of the patient's will to want to control the events, which makes this therapy different from psychological approaches, that are more intellectual directing the patient towards a mastery effort and self and thought control. This specificity in the spa approach by “non-mastered giving up” of its defences and by returning to self, thanks to the taking up again of pleasant physical sensations, often forgotten, seems to be one of the forms of action, psychologically and fundamentally in spa therapy.

Situated at the interface of general medicine and psychiatry, and between ambulatory medicine and hospital medicine, spa medicine is therefore essentially intended for anxiety disorders, adapting reactional disorders and clinical situations such as severance from Benzodiazepines or psycho-education. Centred on the spa bathing practice, it is also based on the quality of the relation between doctor and patient, on the setting up of a structuring, anxiolytic medicalised environment. Furthermore, these past few years, examples of psycho-educative medical care inspired from cognitive and behavioural therapies have been developed at the heart of the “psy spa resorts”. It is important to appreciate the effort carried out by these spa centres, far away from schools of medicine, that make the effort of bringing thorough scientific proof validating their interest in psychiatry, what is more in areas (anxiety, Benzodiazepine severance, chronic pain, burn-out…) where solutions and therapeutic alternatives are not exactly legion.