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Therapists are seeing patients who exhibit a paralyzing fear of being publicly shamed and ostracized.

The very same evolutionary foundations that explain cancel anxiety also explain cancel culture.

Existing treatments can help, though clinicians must consider social realities of exposure treatments.

If you have ever hesitated before hitting post, reread a message five times, or felt your stomach drop at a notification, you already know the feeling: What if this goes badly? What if people turn on me?

That fear is modern in its details but ancient in its design. Anxiety disorders already affect roughly 20 percent of Americans in any given year, but now therapists are noticing a distinct new pattern: a persistent, sometimes paralyzing fear of being publicly shamed and ostracized. In a recent issue of Open Inquiry in Mental Health, one expert, Dean McKay, has proposed a name for it: akyronophobia, from the ancient Greek meaning “to nullify.”

This isn't ordinary social anxiety. It's the dread that your career, relationships, and reputation could be destroyed overnight because of a joke, an old social media post, or a political opinion. In an informal poll of 187 anxiety experts, 147 reported treating patients with intense fears of being cancelled.

For most of human evolutionary history, your survival depended on what others thought of you. Our ancestors lived in small groups where reputation was currency. If others valued you, they'd share food, defend you, and choose you as an ally. If they devalued you, you faced exclusion from the cooperative networks that meant life or death.

This created a powerful selection pressure for psychological systems that track and protect reputation. Shame, for instance, isn't just an unpleasant feeling: It's sophisticated mental machinery designed to minimize........

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