The scale of the analysis was substantial. Using synonym-expanded Scopus searches conducted in August 2026, the researchers initially retrieved 3,041 documents on therapeutic architecture and 2,004 on wellness resort environments. A documented, rule-based relevance screen then removed records that matched the search terms in unrelated senses, such as wound-healing biomaterials matching the phrase healing environment, or health-policy studies matching wellness centre. That screen excluded 592 therapeutic architecture records and 835 wellness resort records, yielding the final analysed corpora. A parallel Web of Science search corroborated the existence and scale of both literatures, with DOI matching identifying 1,443 shared therapeutic architecture records and 746 shared wellness resort records between the two databases.

The growth trajectory of the therapeutic architecture literature is striking. The corpus began with just 31 publications in 2000 and stayed mostly below 70 documents per year through the 2000s and early 2010s. Growth accelerated from 2019 onwards, reaching 102 documents in 2020, 147 in 2021, and 213 in 2024. By 2025, annual output had climbed to 281 publications, roughly nine times the 2000 figure, with 280 documents already recorded in the partial year of 2026 at the time of the search. The wellness resort corpus followed a similar but smaller pattern, growing from 6 publications in 2000 and crossing 100 documents per year for the first time in 2025, when it reached 129.

Both fields are clearly expanding, but the analysis showed they are expanding in largely separate orbits. In the therapeutic architecture corpus, the leading journals were Buildings with 56 documents, the International Journal of Environmental Research and Public Health with 55, and the Journal of Environmental Psychology with 52. In the wellness resort corpus, Sustainability (Switzerland) led with 33 documents, followed by the International Journal of Biometeorology with 15. The International Journal of Environmental Research and Public Health was the only journal appearing in both top-five lists, and the Journal of Environmental Psychology, home to the most-cited restorative environment research, did not appear anywhere in the wellness resort corpus.

Citation analysis revealed the intellectual foundations of each field. The therapeutic architecture literature rests on restorative-environments research addressing stress recovery and attention restoration. Its most-cited work is Hartig and colleagues’ 2003 field study tracking restoration in natural and urban settings, with 1,790 citations, followed by Berto’s 2005 experimental work on restorative environments and attentional capacity with 1,016 citations, and van den Berg and colleagues’ 2010 population-level study on green space as a buffer against stressful life events with 995 citations. The wellness resort corpus, by contrast, draws its most-cited works from wellness tourism market analysis, spa and health-resort medicine, and tourism-industry responses to COVID-19, led by Wen and colleagues’ 2021 study on COVID-19 effects on Chinese lifestyle and travel with 663 citations.

The theoretical underpinnings of therapeutic architecture are well established. Attention Restoration Theory, developed by Kaplan and Kaplan, explains how natural environments help people recover from mental fatigue by engaging involuntary attention through shifting light, birdsong, and organic forms. Stress Recovery Theory, developed by Ulrich, approaches the same topic physiologically, showing that natural environments rapidly lower measurable stress markers such as cortisol, blood pressure, and heart rate. Salutogenesis, from Antonovsky, asks what keeps people well rather than what makes them ill, and Evidence-Based Design applies clinical research standards to architectural decisions. Biophilic design, grounded in the biophilia hypothesis, translates humanity’s innate affinity for natural systems into concrete design principles involving plants, water, natural light, and spatial experiences that echo nature.

From these frameworks, the authors derived seven working principles of therapeutic architecture to serve as an analytical lens: nature connection, natural lighting, natural ventilation, multi-sensory design, privacy, aesthetic harmony, and artwork and colour. Each principle was required to trace to at least one named framework, and each was operationalised as specific keyword variants for the bibliometric search. The authors are explicit that this grouping is an exploratory, transparently derived lens rather than an externally validated taxonomy, since it lacked independent expert panel validation or dual-reviewer sorting.

The keyword co-occurrence analysis produced the study’s central finding. Using VOSviewer with a common occurrence threshold of 17, the therapeutic architecture network yielded 43 keywords resolving into five clusters, including a 17-keyword cluster centred on healing environment, an 11-keyword cluster centred on restorative environments, and a 10-keyword cluster centred on mental health. Only one of the seven therapeutic principles, nature connection through biophilic design and green space, achieved node-level representation in that network. In the wellness resort network, which yielded 17 keywords in four clusters anchored by wellness tourism as the dominant node, none of the seven principles met the occurrence threshold at all. No wellness-resort-specific terms such as spa, resort, or hotel appeared anywhere in the therapeutic architecture network, and terms such as healing environment, restorative environment, and attention restoration did not appear in the wellness resort map.

Text-matching analysis confirmed that all seven principles do occur at non-zero rates in both corpora, but at markedly different levels. In the therapeutic architecture corpus, nature connection appeared in 9.1 percent of documents, privacy in 2.9 percent, and multi-sensory design in 2.4 percent. In the wellness resort corpus, all seven principles were rare, ranging from 0.26 percent for artwork and colour to 1.71 percent for aesthetic harmony. The authors caution that two of these figures are inflated by polysemous terms: beauty referred to beauty spas or treatments in 15 of 19 documents, and about nine of 15 documents containing privacy concerned data privacy or clinical confidentiality rather than spatial privacy. The dependable result, they stress, is uniformly low explicit keyword representation, not a ranking among the principles, and the pattern held when the corpus was restricted to facility-type terms.

The authors are careful about what this separation does and does not mean. The bibliometric separation is documentary, not theoretical or disciplinary: keyword absence does not show that the principles are absent from the studies themselves, since authors may discuss daylight, privacy, or nature without using the selected keywords, and title and abstract matching cannot see full-text treatment. Indeed, 39 documents appear in both searches, pointing to a small emerging bridging literature, and two authors, Marco Gola and Stefano Capolongo, appear among the most productive contributors in both corpora. The study also found a strong concentration of high-income-country authorship, with 88.0 percent of the Web of Science therapeutic architecture records including at least one high-income-country author and only 0.42 percent including a Nigeria-based author, suggesting that non-Western therapeutic design traditions, from Balinese healing architecture to Japanese onsen culture and Ayurvedic spa design, are thinly represented in the peer-reviewed literature captured by these English-language searches. The authors frame the map as a starting point for future work, including post-occupancy evaluations of wellness resorts that would test therapeutic principles directly and supply the resort-specific evidence that this mapping found missing.

Subject of Research: A bibliometric mapping review comparing the therapeutic architecture and wellness resort design literatures from 2000 to 2026

Article Title: Therapeutic architecture and wellness resort design: a bibliometric mapping review (2000–2026)

Article References: Adetoro, O. C., & Akingbade, J. O. (2026). Therapeutic architecture and wellness resort design: a bibliometric mapping review (2000–2026). Frontiers in Built Environment, 12, 1950756. https://doi.org/10.3389/fbuil.2026.1950756

Image Credits: AI Generated

DOI: 10.3389/fbuil.2026.1950756

Keywords: therapeutic architecture, wellness resort design, bibliometric analysis, restorative environments, biophilic design, attention restoration, stress recovery theory, evidence-based design, wellness tourism, keyword co-occurrence, salutogenesis, healing environment