The Differential Effects of First-Person and Third-Person Motor Imagery on Anxiety and Psychological Readiness in Athletes Recovering from ACL Reconstruction: A Longitudinal Study

Nobuchika Yamaki ^*

• King's College London, London, United Kingdom

Introduction: Psychological factors, such as anxiety and fear of reinjury, play a pivotal role in the recovery process following anterior cruciate ligament (ACL) reconstruction. Motor imagery (MI), particularly first-person and third-person imagery, has emerged as a potential tool to enhance psychological readiness and reduce anxiety during rehabilitation. This study examines the differential effects of first-person and third-person imagery on psychological readiness and anxiety in athletes recovering from ACL reconstruction. Methods: This longitudinal study included 100 athletes (50 male, 50 female) aged 18 to 25 years. First-person and third-person imagery abilities were assessed using the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2). Psychological readiness was evaluated using the ACL-Return to Sport after Injury scale (ACL-RSI), and anxiety levels were measured using the State-Trait Anxiety Inventory (STAI). Assessments were conducted at baseline, 3 months, 6 months, and 9 months post-return to sport. Data were analyzed using repeated measures ANOVA and regression analyses. Results: First-person imagery was significantly associated with increased ACL-RSI scores (p < 0.001) and decreased STAI scores (p < 0.01) across all time points, emphasizing its role in enhancing psychological readiness and reducing anxiety throughout rehabilitation. Third-person imagery, on the other hand, showed a significant effect on reducing situational anxiety at 6 months post-return to sport (p = 0.05). Regression analysis identified first-person imagery as a significant predictor of psychological readiness (β = 0.46), while third-person imagery was significantly associated with reductions in situational anxiety (β = 0.28). Conclusion: The findings underscore the complementary roles of first-person and third-person imagery in ACL rehabilitation. First-person imagery is essential for enhancing psychological readiness, while third-person imagery effectively mitigates situational anxiety as athletes approach full return to sport. Integrating both imagery types into rehabilitation programs can optimize psychological recovery and support athletes' overall well-being during their recovery journey.