High-functioning anxiety: signs, patterns, and support

Written By: Christine Sheppard, MA, LCPC

There’s never been a more complex and demanding time to be a human on this planet- we engage with multiple systems daily that we depend on to run our lives efficiently. From refrigerators talking to our phones to traffic lights and video calls, we expect things to run smoothly, especially if we have money or time invested. Is it any wonder we’re all dealing with more anxiety than ever? The World Health Organization estimates that, since the pandemic, reports of anxiety difficulties have increased worldwide by a staggering 25%. 

But what are the symptoms of anxiety, and how could we be suffering from anxiety if we keep going to work and meeting family and social expectations? Even if we’re “high functioning,” we want to be looking for a set of symptoms that might sound familiar: trouble sleeping (getting to sleep or staying asleep), difficulty concentrating, feeling more irritable, and experiencing worries that are hard to control. Anxiety tends to focus on the future and forecast troubles in quantities or qualities for which there seem to be few solutions.  

Children can be affected by anxiety as much as adults, but may not know how to describe their emotions, complaining instead of stomach problems or headaches. It’s important to help children build an emotional vocabulary so that they can share their experiences with trusted adults and build coping skills. Children may be excelling at school, sports, and interpersonal relationships while also experiencing out-of-control worries.

Notice that characteristics of anxiety are different from depression symptoms, which center on regrets about past events and leave us feeling sluggish, with reduced enjoyment in activities that used to make us happy, and increased feelings of hopelessness or helplessness. We could have both anxiety and depression simultaneously, where we feel anxious but have trouble coping skillfully with it because of depressive symptoms.

Some anxiety is natural to feel when we’re contemplating going to an event in unfamiliar surroundings or with unfamiliar people, but social anxiety pushes us into a sense that we must endure that event. Some symptoms associated with social anxiety include a dread of being perceived in public, seen making a mistake or embarrassing ourselves, and then being judged and shunned by others. It’s normal to feel the need to recharge our batteries at home after being out in a group, but social anxiety can escalate into problems leaving home in the first place. 

With high-functioning anxiety, we’re suffering from general anxiety or social anxiety, yet pushing through with our work, social, and domestic tasks. It’s not unknown to be struggling with anxiety but meeting expectations and not really noticing we’re uncomfortable until our bodies start to show signs of strain, like migraines or stomach problems. In addition, if we’re unaware that we’re suffering from excess anxiety, we might not make common sense changes like cutting back or eliminating caffeine. 

We might be ignoring or masking our Anxiety because we feel pressure to do it all: be best at sports, as parents or grandparents, to excel academically, and above all, to make (or save!) lots of money. It can be hard to notice when we’re feeling overwhelmed and allow ourselves to take a day off to recuperate without calculating the monetary costs of self-care. It may be true for many of us that we can’t afford to take a day off when we’re not physically ill- we might be saving up our sick time for when our kids are sick! Maybe we work for an hourly wage and can’t afford groceries if we don’t keep working. 

How can we ask for help from a professional when we can hardly stop to take a breath? And what can a professional counselor or psychotherapist do to help us with high-functioning anxiety? Taking an hour out of the week to engage purposefully in reflection can sound challenging, but a therapist will work with us to identify what’s giving us the most trouble while also giving our struggles context. Different therapists will have different ways of supporting clients who show up for everyone else while suffering from anxious symptoms. It can be helpful to learn about mindfulness and meditation, engage physically, or just talk out difficult situations in session. 

Some of us find that we need to check in with our doctors about anxiety. Therapists are trained to work in cooperation with medical professionals to support clients fully. Most therapists are willing to support simultaneous work with non-Western practitioners like acupuncturists or Reiki specialists.

Many therapists are trained in Cognitive Behavioral Therapy (CBT) where we notice how our thoughts and feelings interact with our behaviors. Changes to any one of these will cause changes in the other two. A CBT exercise could help us notice how our feelings change when we manage our behavior differently: do we function better after a good night’s sleep? What can we do to ensure a good night’s sleep? Also, a CBT-oriented therapist will help us question some of our thinking: is it true that if I stop driving my child to practice, I will be a bad parent?

Other therapists are trained in Dialectical Behavioral Therapy (DBT) which offers a set of coping skills for emotional regulation. For instance, Opposite Action tells us that when we feel fearful or anxious, we can approach what scares us instead of retreating. Rather than letting a difficult future event gain power in our minds by pushing it away, we embrace it and develop a plan for coping with it beforehand. 

Client-centered therapy is classic talk therapy, where a therapist meets us with unconditional positive regard, intrinsically accepts how we manage our lives and helps us express and process uncomfortable emotions. A client-centered therapist will refrain from expressing opinions and advice but rather help us come to our own conclusions about what will help us handle our emotions and generate change. If we are struggling with high-functioning anxiety, a client-centered therapist can help us feel seen and heard and evolve organically in our thinking and feeling with their support. 

These are just three examples of how therapists can help us with high-functioning anxiety. It can be hard to contemplate change, let alone make plans to talk to a stranger about our troubles! It’s a good idea to talk to more than one therapist before you make a choice and ask them about their approach to anxiety. Some of us may find that it’s crucial to our comfort to find a therapist similar to ourselves in gender expression or cultural background. 

However we choose to acknowledge and cope with high-functioning anxiety, it’s important to recognize we’re subject to conditions beyond our control. We didn’t ask to feel anxious, and we didn’t invent the systems that increase pressures on us to excel. Stepping back and noticing that we’re overwhelmed is the first step towards making our lives more manageable. 

Cleveland Clinic. “Anxiety vs. Depression: Which Do I Have (or Is It Both)?” Cleveland Clinic,

Cleveland Clinic, 4 Jan. 2024, health.clevelandclinic.org/anxiety-vs-depression-which-do-i-have-or-both.

Kingsmith, A. T. (2023). The hidden problem of high-functioning anxiety. Canada Watch, 11–12. https://www.yorku.ca/research/robarts/wp-content/uploads/sites/466/2023/01/CW-Fall-2023.pdf#page=11

Yao, L., & Kabir, R. (2023). Person-Centered Therapy (Rogerian Therapy). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589708/

Saari, C. (2025, April 15). You Don’t Have to Power Through It: Yoga for High Functioning Anxiety. Yoga Therapy Associates. https://yogatherapyassociates.com/yoga-therapy-for-high-functioning-anxiety/

World Health Organization. (2022, March 2). COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. World Health Organization; World Health Organization. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide