The effect of reflective image meditation on depressive affect in middle-aged men: A single-case study

This study explores the depression experience of a middle-aged male with depressive affect and aims to identify the impact of a Reflective Image Meditation (RIM)-based meditation counseling intervention on his emotional state through a single-case study. To this end, an 8-session meditation counseling program, incorporating RIM to help the participant observe mental phenomena as they are, recognize, clarify, and accept unresolved issues, was conducted with a middle-aged male client reporting depression. Data were collected through the analysis of the counseling case. The research findings are as follows: First, the participant expressed his depressive affect by stating he felt ‘trapped’ or ‘like he was wearing a straitjacket,’ conveying deep feelings of isolation. His thoughts were consumed by ruminations like ‘I won’t be able to move forward,’ likening it to a ‘mental brake’ that left him feeling stifled and unable to progress. Furthermore, in interpersonal relationships, he tended to suppress his emotions rather than expressing them directly, which manifested as psychosomatic reactions such as indigestion. Second, this depression was found to stem from feelings of loneliness and fear, originating from the lack of emotional and physical care in his childhood, leading to abandonment anxiety. The prolonged experience of not being protected from violence resulted in a fear of abandonment by others, causing him to hesitate in expressing needs and making demands. This persistent feeling of suffocation was identified as contributing to his current depressive state. Third, after the RIM intervention, the participant’s depressive affect showed significant change. He began to safely confront his repressed emotions and care for himself through self-empathy and solace. Consequently, his pre-intervention depression scale (BDI) score dramatically decreased from 20 (severe depression) to 6 (normal range) post-intervention, indicating a clear quantitative improvement. Additionally, qualitative changes were observed, such as overcoming helplessness, newly recognizing his right to be protected, and experiencing relief from the suppression of emotional expression. Fourth, the participant demonstrated changes in seeking practical alternatives, including accepting his depressive affect rather than avoiding it, practicing daily meditation, and formulating concrete action plans for economic activities. Notably, he resolved to prioritize action over overthinking when implementing these plans. This study presents a concrete case illustrating how Reflective Image Meditation impacted the depressive affect of a middle-aged male participant. Furthermore, it holds significance by clarifying the potential role of Reflective Image Meditation as an effective intervention strategy for middle-aged men experiencing depressive affect.