High-Functioning Anxiety:
Understanding, Balancing, and Shifting Your Perception | Amority Health
By: Rachel Cooper, MS, LPC-Associate
Supervised by Amber Quaranta Leech, PHD, LPC-S
For: Amority Health - Blog - Shifting Perceptions
Introduction
High-achieving adults often carry a type of anxiety that is less visible but profoundly impactful: high-functioning anxiety. Unlike more obvious forms of anxiety, it can appear as competence, productivity, and resilience, but under the surface, it often comes with persistent tension.
In this post, we’ll define high-functioning anxiety, explore its benefits and risks, and discuss steps toward a healthier relationship with it. We'll also highlight how Cognitive Behavioral Therapy (CBT) can help transform anxiety from a burden into a guide.
What Is High-Functioning Anxiety?
High-functioning anxiety is a form of anxiety in which individuals manage to perform well in their personal and professional lives despite experiencing significant internal stress. People with high-functioning anxiety may:
- Overprepare or overthink decisions
- Strive for perfection
- Feel restless or “on edge” despite outward success
- Experience difficulty relaxing
- Seek reassurance or validation to manage internal pressure
Unlike generalized anxiety disorder, high-functioning anxiety often does not disrupt daily responsibilities outwardly, making it hard to recognize for both the individual and others (Newman et al., 2013).
Think of high-functioning anxiety as a car engine constantly revving: it moves you forward efficiently, but if left unchecked, it risks overheating.
The Benefits of High-Functioning Anxiety
Despite its challenges, high-functioning anxiety is not all bad. Many people with this pattern:
- Excel under pressure: Anxiety fuels diligence, preparation, and conscientiousness.
- Notice details others miss: Hyper-awareness can enhance performance and interpersonal sensitivity.
- Set and achieve ambitious goals: Motivation often comes from a desire to maintain control and succeed.
In this sense, high-functioning anxiety can act as a hidden compass, pointing toward growth, excellence, and personal responsibility. When managed consciously, it can become a source of structured energy and focus.
Risks and Concerns
Even with its benefits, prolonged high-functioning anxiety carries potential risks:
- Burnout: Constant internal pressure can lead to exhaustion and emotional depletion (Burnout Therapy).
- Sleep disruption: Racing thoughts or difficulty shutting down may interfere with restorative rest.
- Perfectionism and procrastination: High standards can paradoxically slow progress or cause self-criticism (Perfectionism Therapy).
- Difficulty forming authentic relationships: Anxiety may drive people-pleasing or avoidance of conflict (People-Pleasing Therapy).
Left unchecked, the traits that help high-achievers thrive can become double-edged swords (Kertz et al., 2017).
From Unhealthy to Healthy: Shifting Your Perception
The first step toward managing high-functioning anxiety is awareness. Recognize that anxiety is a signal, not a flaw. The goal is not to eliminate anxiety completely but to shift it from a controlling force to a guiding one.
Cognitive Behavioral Therapy (CBT) is an evidence-based approach that helps high-achievers:
- Identify unhelpful thought patterns: Recognize perfectionistic or catastrophic thinking.
- Challenge cognitive distortions: Question beliefs like “I must do everything perfectly to be valued.”
- Develop coping strategies: Structured problem-solving, relaxation, and mindfulness.
- Gradually adjust behavior: Practicing self-compassion and realistic goal-setting to reduce internal pressure.
CBT reframes anxiety as a messenger, not an enemy, transforming the mental “revving engine” into a steering wheel that guides toward intentional action.
How to Begin
If you recognize yourself in these patterns, starting is simpler than it may feel:
- Self-reflection: Keep a journal of anxious thoughts and behaviors to spot patterns.
- Mindful awareness: Notice the physical sensations of anxiety without judgment.
- Small behavioral experiments: Practice saying “no,” delegating tasks, or letting minor imperfections go.
- Professional support: A therapist practicing CBT and experienced with high-achieving adults can provide structure, accountability, and individualized strategies (High-Functioning Anxiety Therapy).
By taking intentional steps, you can harness the strengths of high-functioning anxiety while reducing its burden, creating more balance, calm, and clarity.
Shifting Perceptions
High-functioning anxiety is often misunderstood. Shifting your perception, from viewing anxiety as a flaw to seeing it as a signal, can empower you to navigate life with awareness, intention, and self-compassion.
Explore other posts in our “Shifting Perceptions” series to discover more ways to align ambition with well-being.
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Each post offers insights and practical tools to help high-achieving adults navigate challenges with clarity, balance, and self-compassion.
Written by Rachel Cooper, a therapist specializing in burnout, perfectionism, and life transitions. Learn more about therapy for high achievers at Amority Health.
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References
Kertz, S. J., Bigda-Peyton, J. S., & Bjorgvinsson, T. (2017). Development and initial validation of the Worry Behaviors Inventory. Journal of Anxiety Disorders, 49, 1–9. https://doi.org/10.1016/j.janxdis.2017.02.001
Newman, M. G., Llera, S. J., Erickson, T. M., Przeworski, A., & Castonguay, L. G. (2013). Worry and generalized anxiety disorder: A review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annual Review of Clinical Psychology, 9, 275–297. https://doi.org/10.1146/annurev-clinpsy-050212-185544
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