Cancellation Anxiety Is Becoming a Mental Health Crisis
- Dr. Chloe Carmichael, PhD
- Jul 16
- 8 min read
Updated: Oct 8
Introduction: The New Silence in the Therapy Room
Therapists are increasingly encountering a clinical pattern that I have termed cancellation anxiety—the quiet fear of being socially punished, mischaracterized, or ostracized for expressing a viewpoint.
Cancellation anxiety doesn’t always begin in the headlines—it often begins in personal relationships, where people start to silence themselves out of fear of conflict or rejection. Therapy clients today are describing fractured relationships, tiptoeing through conversations, and worrying about being misunderstood or cut off entirely. They’re telling me their brother won’t return their texts after a disagreement, or that Thanksgiving dinner has turned into a minefield of nodding and smiling while avoiding “dangerous” opinions. Some have lost relationships to what I call the “Six Ds”: defriending, divorcing, declining to date, disinviting, decreasing time, and outright dropping contact due to political or social views.
While this pattern of cancellation anxiety is not confined to one political side, polling data show that all six of the Six Ds skew heavily leftward: Liberals are statistically more likely than conservatives to cut off contact over political differences—whether through ending friendships, marriages, or even family ties (Mitchell et al. 2014); (Cox 2021); (PRRI 2024); (Abrams 2022); (Wakefield Research 2017); (Brown 2020). That asymmetry adds another psychological wrinkle: many clients who hold more centrist or conservative views feel they must self-censor not only to avoid conflict, but to avoid losing relationships altogether. Even liberal-leaning clients sometimes report a quiet fear of being ostracized by their own ideological community if they question or hesitate to endorse their party's latest political norms. Many liberals cite what would be very good reasons for many of their ostracising behaviors, if their beliefs were accurate: for example, 78% of Democrats believe the Republican party has been taken over by racists (PRRI 2020).
This is unfolding amid what the U.S. Surgeon General has called an epidemic of loneliness—a public health crisis tied to anxiety, depression, and even early death (U.S. Department of Health and Human Services 2021). Perhaps the epidemic is being partially facilitated by people muting themselves out of a fear of cancellation.
More and more, clients arrive in therapy burdened not by hidden traumas or unresolved childhood wounds, but by the fear of simply speaking their minds. They report censoring themselves at work, in social settings, and even with loved ones. Not necessarily because they believe their views are harmful, but because they fear being labeled, excluded, or punished. The result is a rising form of cancellation anxiety that isn’t rooted in traditional public speaking fears, but in social and ideological pressure. As a clinical psychologist, I’ve watched this modern form of self-censorship quietly erode mental well-being, fueling anxiety, depression, and disconnection. It’s time we name it for what it is: a mental health concern worthy of therapeutic attention.
Background: Why Language Matters for Mental Health
In mental health, the distinction between speech and violence is clear. Psychologists are legally and ethically required to break confidentiality only if a client threatens serious physical harm to themselves or others. But if a client says they plan to insult someone—even cruelly—we are legally prohibited from breaking confidentiality. The distinction is clear: threats of physical violence and verbal offenses are absolutely not the same. Words can sting, but they are nothing like a threat to physical safety. Conflating the two erodes psychological clarity and contributes to the confusion and anxiety many clients now experience when trying to express themselves honestly, or even hearing someone else say something they dislike.
Human language isn’t just a communication tool—it’s a hardwired, primal feature of our brains. As psycholinguist Steven Pinker has noted in The Language Instinct (Pinker 1994), just as spiders are born with the ability to spin webs, humans seem biologically driven to speak and connect. Babies instinctively babble and learn language, regardless of culture, and even across the globe, similar sounds like “mama” emerge to identify primary caregivers. This suggests that language is more than cultural—it’s biological. Suppressing our ability to speak doesn’t just stifle communication; it disrupts a fundamental neurological process.
Research supports this. Language allows us to organize our inner lives, label emotions, and reflect on our thoughts. Without it, we risk losing access to self-awareness and problem-solving (Lieberman et al. 2007), (Wetzstein & Hacker 2004). In fact, limiting access to meaningful language—whether through internal fear or external pressure—can result in a kind of intellectual and emotional malnourishment. We aren’t just quiet; we become fragmented.
In our current cultural climate, the idea that "words are violence" has taken hold in many circles. This well-intentioned but misleading notion has created a chilling effect, where the stakes of verbal missteps are perceived as existential. A 2022 New York Times/Siena College poll found that 84% of Americans believe self-censorship due to fear of retaliation is a serious problem. From college students to seasoned professionals, people are stifling their true thoughts not only in public but even in intimate settings. The fallout from this cancellation anxiety includes diminished self-expression, increased emotional repression, and growing social isolation. Clients often tell me they feel lonely despite being surrounded by others—a symptom closely tied to the inability to express one's authentic self.
Research has shown that labeling emotions through speech can reduce emotional intensity by calming the brain’s threat center, the amygdala (Lieberman et al. 2007). This affect labeling not only facilitates interpersonal communication but also enhances emotional regulation, which is why speech suppression can be so costly.
How It Shows Up in Mental Health Treatment
Cancellation anxiety rooted in social fear manifests in therapy in subtle but damaging ways. Clients describe withholding their opinions on sensitive topics, even from their therapists, for fear of judgment. Others share that they nod along in conversations where they feel uncomfortable, repressing discomfort in order to maintain social harmony. Over time, this pattern of self-silencing can erode self-efficacy and self-esteem.
Clinical research underscores the psychological toll of chronic self-silencing. For example, research on reflective verbalization suggests that articulating thoughts—even privately through journaling—can significantly enhance insight and problem-solving (Wetzstein & Hacker 2004). Conversely, habitual suppression of one’s views in social interactions can lead to emotional numbing and diminished self-efficacy. Research also shows that emotionally charged conversations—such as those involving politics, which are common sources of personal strain for many clients—can activate automatic emotional responses, making it harder to process information rationally (Morris et al. 2003). This helps explain why many clients fear such discussions or freeze in moments of disagreement. The longer clients suppress their true thoughts and emotions, the harder it becomes to locate and express them authentically.
One client, Mark, discovered through frank therapeutic conversation and journaling that his years of "going along to get along" at work had numbed his ability to name his own goals. Journaling, as supported by research on reflective verbalization, can improve insight and solution-building by requiring the speaker to articulate and question their thoughts (Wetzstein & Hacker 2004). Another client, Olivia, felt fraudulent in her relationship with a beloved aunt because she hid her political views to avoid conflict. Both found relief not only through open speech but through the acknowledgment that their silence had been costing them emotionally and cognitively.
Therapeutic Solutions: The WAIT Test and Say Your Line
Helping clients navigate cancellation anxiety requires more than telling them to "speak up." Many already want to; they just feel paralyzed. That’s where structured, step-by-step tools come in. Two of the most effective techniques I’ve created and used in clinical practice are the WAIT Test and Say Your Line.
The WAIT Test
WAIT stands for Want, Appropriate, Inoculate, Trust. It helps clients think through whether, when, and how to speak up.
W – Want: Ask yourself, “Do I really want to speak up?” Not every situation requires a response. For instance, if you're tired and drained at the end of a long day, it might be okay to let a comment slide. But if you feel your silence is eating at you later, that’s a sign that your authentic self wants to be heard.
A – Appropriate: Is this the right time and place? If you're about to bring up a politically charged topic with your new partner, it may be better to do it over a quiet dinner than at a noisy gathering. Choose a setting that allows space for a meaningful exchange.
I – Inoculate: Give the other person a small dose of what you want to say before you go all in. This might sound like, “Hey, I’d like to share something that may be a little different than what you’re used to hearing, but I’m hoping we can talk about it openly.” This primes them to receive your point without feeling blindsided and gives you a chance to see how they react to you sharing a little bit before you dive in deeper.
T – Trust: Ask yourself: “Do I trust this person—or at least trust myself to handle the fallout if the conversation doesn’t go well?” You may not be able to control how others respond, but you can decide that even if it’s hard, you’ll have your own back.
Using the WAIT test before entering a difficult conversation helps reduce impulsive speech driven by frustration or anxiety. It also builds confidence by showing clients they have a plan.
Say Your Line
Sometimes the hardest part of speaking up is just getting started. The "Say Your Line" technique helps clients overcome that first hurdle by focusing only on the opening sentence or two of a difficult conversation. It draws on the cognitive-behavioral therapy tool of cognitive rehearsal—but zeroes in on the moment of initiation.
Here's how to do it step-by-step:
Choose Your Line: Think about what you want to say, then craft one or two simple sentences that express it clearly and calmly. For example: “Actually, I see it differently—would you like to know why?” or “There’s something I’ve been meaning to say that’s a little sensitive, but important to me.”
Imagine You’re an Actor: Instead of emotionally gearing up for a high-stakes confrontation, shift your mindset. Pretend you’re an actor whose only job is to deliver a line. This can help remove the emotional weight and make it easier to simply speak.
Practice Out Loud: Say the line aloud a few times in a neutral tone, like you're rehearsing a part. This builds familiarity and reduces pressure.
Deliver It: When the moment comes, don’t try to think through the entire conversation. Just take a breath and say your line. Once you've begun, you can move naturally into the rest of the dialogue.
“Say Your Line” is ideal for clients who already feel reasonably prepared, but who freeze up at the starting gate. It offers a quick on-ramp into dialogue without needing to map out every possible outcome. For clients who have done deeper work (e.g., using the WAIT Test), this technique helps put their preparation into motion.
Conclusion: Reclaiming Speech as a Mental Health Imperative
Speech is more than communication; it’s a cognitive and emotional lifeline. When we silence ourselves, especially habitually and around deeply held values, we risk compromising our mental health. Therapists have a role to play in naming this issue and offering tools to help clients reclaim their voices. Encouraging open dialogue, practicing self-awareness, and equipping clients with techniques I’ve created like the WAIT Test and Say Your Line can foster both personal growth and relational healing.
In a time when many feel they must choose between silence and exile, reclaiming our voice isn’t just a therapeutic task—it’s a cultural imperative. Whether you’re in the therapy room or across the dinner table, the ability to speak openly—without fear of exile—is essential for personal well-being and for a resilient society. This cultural silencing may also be one hidden contributor to the loneliness epidemic that public health leaders, including the U.S. Surgeon General, are urgently working to address.
Dr. Chloe Carmichael is a clinical psychologist and USA Today bestselling author. Her new book, Can I Say That? Why Free Speech Matters and How to Use It Fearlessly unpacks the psychology of free speech; and provides practical techniques to speak freely and listen resiliently.
