Trauma-related sensitisation of fear responses: clinical and balneological perspectives in neurorehabilitation

Abstract

Trauma-related sensitisation of fear responses is a key mechanism underlying the development and persistence of post-traumatic stress disorder (PTSD) and related stress-associated conditions. Traumatic exposure may increase fear reactivity, impair extinction processes, and contribute to emotional dysregulation, sleep disturbance, cognitive dysfunction, autonomic imbalance, and somatic symptoms that can affect functional recovery. Neurobiologically, these changes are associated with dysregulation of limbic–prefrontal circuits, altered hypothalamic–pituitary–adrenal axis activity, changes in neurotransmitter regulation, neuroimmune activation, oxidative stress, and impaired neuroplasticity. Understanding these mechanisms is important for developing integrative rehabilitation strategies addressing both the psychological and physiological consequences of traumatic stress. From a clinical and balneological perspective, spa-based neurorehabilitation may offer supportive effects through combined thermal, hydrostatic, environmental, physical, and behavioural stimuli. Balneotherapy, hydrotherapy, climatotherapy, therapeutic exercise, and structured spa rehabilitation programmes may support stress regulation, sleep quality, autonomic balance, emotional stabilisation, and functional recovery. Exposure to restorative natural environments and predictable therapeutic routines may additionally facilitate adaptive coping and participation in rehabilitation. Nevertheless, current evidence does not establish balneological interventions as specific treatments for PTSD. Their potential role should therefore be considered complementary to established psychiatric, psychological, and rehabilitative care. Trauma-related sensitisation of fear responses may represent a relevant target for personalised neurorehabilitation strategies integrating contemporary neurobiological knowledge with appropriately selected balneological and environmental interventions.