Self-Subliminal Therapy for Adolescent Major Depressive Disorder with School Refusal: An 18-Month Longitudinal Case Study

<title>Abstract</title> <p>Background: Adolescent depression has reached epidemic proportions in urban Chinese cohorts, with prevalence estimates exceeding 20% in some regions. Standard interventions achieve only partial remission in a substantial minority of cases, and treatment resistance is especially common when family-system dynamics perpetuate the depressogenic environment. Case Presentation: We report the case of “Z.,” a 17-year-old male adolescent with major depressive disorder, generalized anxiety, school refusal, and disordered gaming, who had declined pharmacotherapy and electroconvulsive therapy. The patient presented following academic setback, romantic dissolution, and familial conflict exacerbated by the COVID-19 pandemic. Intervention: Treatment consisted of 18 months of weekly video-based psychotherapy grounded in the Universal Law of Subconscious State Change (ULSSC), delivered concurrently to the patient and his mother. The intervention integrated cognitive training, behavioral activation, and family-systems restructuring. Results: The patient resumed educational engagement, achieved university admission, and demonstrated sustained functional recovery at 18-month follow-up. Depressive symptomatology reduced from severe to subclinical levels; suicidal ideation resolved by month four and did not recur. Conclusion: This case illustrates the potential efficacy of family-integrated subconsciousstate therapy for treatment-resistant adolescent depression. Controlled trials are warranted.</p>