WHAT IS HIGH FUNCTIONING ANXIETY? “High functioning anxiety” is the kind of anxiety that is usually well concealed. One client described it as “anxiety hidden behind a smile and the outward picture of success.” It is the person who may appear calm, successful and very well put together on the surface, but internally they are in significant distress. It is common for it to be the type of anxiety that can be channeled into propelling individuals toward career and financial success and can be associated with several positive characteristics. However, while it may look like ambition is the driving force, it is actually usually crippling fears of failure, of disappointing others or making a mistake or “impostor syndrome” that is driving the achievement. The unfortunate consequence then becomes that no amount of success is rewarding or lowers the anxiety. If you don’t address the underlying distorted beliefs, then no amount of outward achievement will resolve the inner feelings of distress, anxiety and seeking of external validation. Individuals with high functioning anxiety are often objectively successful on paper but may tend to feel empty, overwhelmed and constantly worried and preoccupied. Essentially it is hard to ever feel satisfied or to slow down.
HOW AND WITH WHOM IT MANIFESTS We see a huge subset of high achieving and successful professionals in demanding and stressful fields (physicians, other mental health professionals, lawyers etc.) who may be successful in their careers but internally feel chronically anxious, overwhelmed and generally dissatisfied with their lives. These are often individuals who might be diagnosed with Generalized Anxiety Disorder (GAD). The formal diagnostic symptoms of GAD include restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances and intrusive thoughts. For others the symptoms may even be subclinical and not reach a diagnosis but still have a tremendous impact on their quality of life. In practical terms, the way this tends to play out for professionals and those with high functioning anxiety is in overthinking, rumination and chronic worry about mistakes and excessive focus on judgement and how others are viewing you. Common behavioral patterns are people pleasing, difficulty saying no, nervous habits, needing reassurance, being early and over-preparing. It can lead to a tendency to become excessively emotional or irritable when things don’t go as planned and feeling yourself be over-reactive to small changes and disruptions. It often involves excessive self critical reactions to any mistakes. The solution to feeling better becomes doing more and excelling higher and identity and sense of self become completely tied into these external validations. It then becomes difficult to slow down or enjoy relaxation or personal time because the thoughts continue to race and these individuals find it hard to ever shift out of work and achievement mode Essentially they use achievement as a way to manage the anxiety. Therefore, when not in the mode of achieving or staying excessively busy they are left with their thoughts and feelings of emptiness that they keep running from. Often this is the person who ends up needing to stay “busy” in attempts to avoid underlying anxious feelings. There is also a tendency to overthink and overanalyze social interactions and a need to put up a façade and show in social situations, thus making it hard to feel natural, present and connected in relationships. Over time it can lead the body to be so stressed and over-taxed that it can lead to excessive fatigue but difficulty sleeping and then can shift to feelings of emptiness and depression.
CAUSES & MECHANISMS UNDERLYING HIGH FUNCTIONING ANXIETY There are two main underlying mechanisms to this cycle. The first set are cognitive in nature and have to do with unhealthy and distorted thinking patterns and belief systems. The most common pattern and themes I recurrently see are underlying perfectionistic expectations and belief systems. Perfectionists often set excessively high goals, feel most things are not good enough, have excessive concerns about making a “mistake” and chronically doubt themselves.
The other mechanism has to do with how anxiety and stress works physiologically in the brain and body. When we are constantly feeling anxious, our bodies are in a chronic state of mild fight or flight reactivity or diffuse physiological arousal. Put simply, the body is always in a “stress reactive mode” where the stress hormones are pumping through. This leads to several different emotional and physical consequences, especially the longer that it goes on. It is hard to slow the mind down when the body is constantly in stress mode or high alarm. Another underlying mechanism to this cycle, has to do with what we call the fight or flight response. This has to do with the impact that this low level but chronic and constant stress and anxiety have on our bodies. This can then affect sleep which in turn affects the increased anxiety level in a vicious cycle of reactivity. People find themselves staying excessively busy because it is a way to drive their nervous and anxious energy towards a goal and then they don’t notice the underlying feelings and bodily signals of anxiety and stress.
OUR APPROACH TO TREATMENT OF HIGH FUNCTIONING ANXIETY When you come to counseling for anxiety, our clinical psychologists will do a mental health assessment to get to know you as an individual. They will try to first understand your anxiety, your mental health history and how your anxiety is impacting your life right now. They will then help you come up with an individual treatment plan.
But all of that is pretty broad, so you are still wondering exactly how we will treat your anxiety, right? Our therapists most often use mindfulness techniques and cognitive behavioral therapy techniques in counseling sessions for anxiety. Our clinical psychologists will help you identify triggers for your anxiety, be more present in the moment (mindfulness), learn coping skills for when anxiety comes and help you reframe how you look at your anxiety. In therapy, you can spend time working on relaxation skills, mindfulness and meditation skills and various ways of slowing down and learning to cope with and respond to the discomfort that surfaces when slowing down. Additionally, in therapy, you can attempt to challenge and re-program the perfectionistic belief systems that drive this type of anxiety.
It's important to note that each of our therapists will approach anxiety treatment slightly differently. Each of us is a doctoral level psychologist. However, we've attended different trainingS, have had different client experiences and bring our unique personality to sessions. You can read an overview of all our psychologists or look at our individual pages for more in depth information.