The Down Low On High Functioning Anxiety From an Anxiety Therapist

As a clinician I don’t love anything that’s coined “high functioning” if I’m being honest. For me that reads that you have adapted to your circumstances really well and you can mask your symptoms and suffering a little too well.

High functioning anxiety (HFA) is a catch-all term used to describe those who experience anxiety but continue to function quite well in their daily lives. Unlike some other forms of anxiety that are more obvious, high functioning anxiety can be less noticeable to others, as those affected often excel in their responsibilities and appear outwardly successful.

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Key Characteristics of High Functioning Anxiety:

1. Overthinking: You tend to overanalyze situations, events, and your own actions. This constant overthinking can lead to feelings of self-doubt and a fear of making mistakes.

2. Perfectionism: There is a strong desire to achieve perfection in various aspects of life. This drive for perfection is a source of stress and there is an intense pressure to meet your exceptionally high standards.

3. Fear of Failure: There is a persistent fear of failure, and you may go to great lengths to avoid making mistakes or falling short of expectations. This fear can be a powerful motivator but can also contribute to heightened stress levels.

4. Difficulty Relaxing: Even during moments of leisure, you may find it challenging to fully relax. Your mind races with thoughts and concerns, preventing you from fully enjoying downtime.

5. Physical Symptoms: While not always as pronounced as in other anxiety disorders, HFA can still manifest physical symptoms such as tension, GI issues, restlessness, fatigue, and difficulty sleeping.

6. Masking: You’re likely very good at concealing your inner struggles from others. You may present a composed and put-together exterior, making it challenging for others to recognize the internal turmoil they may be experiencing. A hallmark sign is that your internal experience does not match at all what you present on the outside (see below).

It's important to recognize that mental health and fitness exists on a spectrum, and individuals with HFA still benefit from support and understanding even though it isn’t an official diagnosis. Using more accurate and comprehensive language to describe the challenges individuals with anxiety face can help them to feel less alone and articulate their needs better. Last year I wrote about how to support a woman with high functioning anxiety, which you can read here.

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Steps to Improve Your Symptoms:

Improving high functioning anxiety involves several strategies. When a client comes to me and their umbrella complaints are “stress” “anxiety” and “overwhelm” those are typically cover problems. Or if you think of an iceburg, those are just the top of it, or the part we can see. In order to improve those things, we need to figure out what’s going on under the water.

If I’m generalizing, what I uncover is usually a massive lack of boundaries in this person’s life, both personally and professionally. They can’t (or won’t) say “no”, struggle with self awareness despite thinking they’re very self aware, struggle with emotional regulation, have no tools to help them relax or recharge, feel responsible for everything, cannot manage their time well, struggle to take care of their physical self, and have unreasonable expectations of themselves.

If you read that and thought “yeah that sounds like me!” then you’re on to something. Breaking it down, here are some bit sized steps I would consider to improve your experience of HFA.

1. Self-Awareness:

   • Acknowledge and accept that run anxious: You can’t manage it effectively if you don’t accept it.

   • Identify triggers: Recognize situations, thoughts, people and activities that tend to exacerbate your anxiety.

2. Relaxation & Downtime Habits:

   • Practice some kind of habit or hobby that allows you to decompress and disengage. This doesn’t have to be meditation but it can be. It can be anything that brings you joy and allows you to get a break from your regular life roles and duties. Prioritize self-care: Dedicate time for activities that bring you joy and relaxation.

   • Deep breathing exercises: Incorporate deep breathing exercises to help calm the nervous system and reduce physical tension. Mediation, exercise, walking, etc are all good options.

3. Establish Healthy Boundaries:

   • Learn to say no without guilt: Set realistic limits on your commitments to avoid overwhelming yourself.

   • Internal boundaries with yourself and external boundaries with others are the key to reducing your anxiety. Limits that are communicated and enforced by you cut down on overwhelm and stress.

   • You cannot improve HFA until you start identifying your needs and creating boundaries around protecting those needs. Typically when your boundary practice gets healthier, your HFA starts to decline.

4. Effective Time Management:

   • Break tasks into smaller steps: Divide larger tasks into more manageable components to prevent feeling overwhelmed.

   • Prioritize & triage tasks: Focus on the most important tasks first and avoid spreading yourself too thin. Always assume something will take longer than you think.

5. Stop Isolating:

   • Talk to someone: You aren’t an island-share your feelings with friends, family, or a therapist. Connection is key because it gets you out of your own head. with others can provide valuable support.

   • Ask someone for help and delegate. People want to help you.

6. Take Care of Your Physical Well-Being:

   • Regular exercise: Engaging in any kind of physical activity that you enjoy releases built-up tension and negative feelings from your body and nervous system. This helps you to feel BETTER.

   • Healthier lifestyle: Consider that your overall lifestyle impacts your anxiety and eating a more balanced diet of things you like, getting enough rest for your body, and drinking water will all help to improve your anxiety.

7. Mindful Information Consumption:

   • Limit exposure to stressors: Be aware of the information and stimuli you consume and allow yourself to be exposed to. Boundaries around the news and social media will reduce your anxiety almost immediately.

   • Don’t underestimate that consuming your friends’ and families’ social media posts can absolutely impact your anxiety.

   • Take breaks from screens: Unplugging periodically is good for your brain (i.e. dopamine levels) and setting limits around your screen consumption close to bedtime will also impact your anxiety positively.

A parting note-

Most self help books and resources (just like this post) place the burden on the individual to regulate their own nervous system rather than acknowledge that high functioning anxiety is in part due to people crushing under the weight of broken systems and structures that only value what we produce without complaining. Telling you how to fix your symptoms is just one more thing to do and you already have a lot going on. I’m just one person and I can’t fix all of the screwed up societal structures and messaging that have conditioned us to be this way, but it feels wrong to at least not acknowledge it.

Stopping the Worry Domino Effect

Do you ever feel nervous that you aren't feeling more nervous? Wonder why you aren’t feeling more stressed than you think you should be? If you experience anxiety on a daily basis this is probably a common occurrence for you. When worry is a constant companion and you’re used to being triggered by all kinds of things, it can feel like a line of dominos when your worries get triggered. One worry gets knocked down and before you know it they’re all getting knocked down one by one.

We tend to think of our worries like as conscious or intentional thoughts since we can identify them and verbalize them (i.e. “crowds make me anxious” “people looking at me makes me nervous” “I have health anxiety”). But what if I told you that, while these worries are conscious, the way your unconscious brain works can contribute to the ongoing loop of worries? There is a simple two step process that, if practiced regularly, can do wonders to help you keep those worries at bay.  Sounds good right?

Step 1:  Download Your Thoughts & Schedule Worry Time

Downloading your thoughts means that you’ll pick a period of time, maybe 2 minutes every hour and essentially download your worrisome thoughts. You can do this in a journal, in the notes section of your phone or in a document on your laptop...wherever you like. You are going to write out every worry that is plaguing you but you can only do it for the set amount of time that you have assigned, then you put it aside. After that you stop and go on with your day. You have to do this consistently throughout  the day because your brain is constantly coming up with worrisome thoughts, so it is essential to keep downloading these thoughts as the day goes on. Think of your brain like a server, you don’t want those worries storied on your server so you download them!  

Then you can pick a time of day, just once a day, that you are allowed to go through that list and spend as much time worrying about those things as you'd like. This might sound counterintuitive but it’s actually based on the psychological concept of cognitive defusion which means we are separating ourselves from our worries and disconnecting us from our worrisome thoughts. This practice also gives us permission to worry and do it intentionally. Instead of the worry taking over we can do it in a way that is intentional and helps us to feel in control. 

So literally schedule in your calendar when you will pull out your thought download and get to worrying :) Remember that we actually have a good reason for why we worry. We mostly worry about things that can harm us or change our lives. We like to believe that if we worry about we can somehow be prepared for it. It’s almost as if not worrying about becomes stressful because then how in the world will be prepared for it if it actually happens? Worrying feels like we have some sort of control so when we try to tell ourselves “don’t worry!” it feels nearly impossible.  This is why scheduling worry is a much better alternative and instead of dismissing your feelings you are validating them, but without letting them take over. 

Step 2: Practice Mindfulness

Once you get into the habit of practicing a Thought Download and scheduling worry, try incorporating a brief mindfulness or grounding practice to help anchor you to the moment. Things such as breath work, progressive muscle relaxation and guided meditation can help us detach from our worrisome thoughts and keep us in the here and now. We tend to play out worries over and over in our head because they are events that typically don’t actually occur, so there is no closure. It’s unfinished business. So we worry about one thing, which leads to the next, and so on and so on just like a stack of dominos. You started off worrying about how you’ll make time to get groceries tomorrow and before you know it you’re worrying about your retirement plan. Worries escalate quickly! 

A mindfulness practice can anchor you in your senses (smell, sight, touch, feel, sound) and keep you in the moment. Like anything this takes practice and effort and committing to this even when you don’t want to. But find a mindfulness practice that works for you can be key in helping you get ahead of the domino effect of worrisome thoughts. New habits take time to form and remember you’ve likely been thinking the way you think for a very long time. Your thought patterns are so automated you don’t even realize you think that way! Learning a new way of thinking takes effort but with enough practice can eventually become automated and almost like second nature. Don’t give up!