Development and Feasibility of a Cognitive Behavioral Therapy and Virtual Reality Protocol for Athletes After Anterior Cruciate Ligament Reconstruction

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Abstract
This study aimed to develop and assess the feasibility of a cognitive behavioral therapy protocol integrated with virtual reality for supporting athletes undergoing rehabilitation after anterior cruciate ligament reconstruction. The protocol targeted reinjury anxiety, rehabilitation adherence, self-efficacy, and kinesiophobia (fear of reinjury). It was developed in four phases, and in a fifth phase, feasibility was assessed for four athletes. Data were collected using self-report scales, electrodermal activity devices, and heart rate monitors. Due to the small sample size, descriptive analysis was employed. Descriptive pre–post patterns were consistent with the intervention targets, and electrodermal activity/heart rate data used as manipulation checks suggested that the exposure sessions elicited emotional activation as intended. Taken together, these findings indicate that the cognitive behavioral therapy plus virtual reality protocol was feasible and acceptable in this small sample and may warrant further evaluation in randomized controlled trials.

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