ANXIETY | June 1

Recognizing High-Functioning Anxiety

And How to Manage It 

Brianna Valleskey  

High-functioning anxiety is random. It can be easily disguised. It can express itself in many different forms, which is why I didn’t realize it had been my constant companion for at least a decade until recently.

For me, high-functioning anxiety took the form of nail chewing, knuckle cracking, and cuticle picking. Having a plan for almost every hour of every day just made sense to me (and any departure from that plan was a crisis). Going to bed without neurotically making sure every single inch of my apartment was clean was impossible. And any work I did was always my best work. Always.

These are physical symptoms of high-functioning anxiety, as I’ve come to understand. Others have called it perfectionism, neuroticism, or overly active ambition. There are plenty of successful, driven people who live with anxiety - and what a relief it was to learn that I am not alone.

Beforehand, it never occurred to me that what I experienced every day was common, let alone manageable. Understanding how to manage anxiety gave me hope. And our goal at Stigma is to do the same for you.

Where Does Anxiety Come From?

The simple answer? Anxiety is a result of a perceived a threat in your immediate environment. The threat can be very real, Psychology Life Well director Dr. Michelle Barton explained to me, or simple a perceived threat in your mind.

Perceived threats can be anything from a tenth grade chemistry exam to a terror attack, and everything in between. Regardless, that anxiety triggers a “Fight or Flight” response in your nervous system to optimize functioning and help you navigate a stressful situation successfully. Even if the threat is only perceived and no danger is within your immediate environment, the anxiety response persists.  

Dr. Barton went on to say that during activation of the fight or flight response, there are thirty different hormones and several neurotransmitters released - a jarring physical experience.  

“The system is designed to work quickly to remove you from danger and return your body to normal functioning. Unfortunately, with the case of anxiety, that never happens so your body stays in the fight or flight mode until all of your hormones, neurotransmitters, and systems are depleted (usually causing exhaustion, lethargy, or even depression if it continues),” she said.  

The symptoms of high-functioning anxiety occur on a continuum of intensity, and can express themselves differently depending on the individual and situation. According to Dr. Barton, common symptoms include increased heart rate, shallow quick or infrequent breathing, hormone and neurotransmitter changes, lowered body temperature, and slowed or speeded digestion.

Failure to acknowledge these early signs of anxiety, she warned, can lead to increased intensity, as your body is trying to tell you something important and you aren't listening. That’s why managing anxiety on a daily basis requires gaining insight into your individual symptoms.

How to Manage High-functioning Anxiety on a Day-to-Day Basis

Because these symptoms can be very difficult to identify and have so many different expressions, Dr. Barton recommends consulting a doctor or psychologist to help determine which symptoms you need to target.

Many of you are probably already very aware of your anxiety-induced symptoms. If that’s the case, here are a few strategies and tools recommended by health professionals to manage the associated changes resulting from anxiety.

1) How to Manage Anxiety: Increased heart rate, shallow quick or infrequent breathing.

What it may feel like:

  • “ … I get the physical symptoms, like dizziness, trouble breathing, hyperventilating, numbness, etc. when something triggers me.” 
  • “I feel like someone is standing on my chest and I can't get enough air and have heart palpitations.” 
  • “I have a slight sensation that I can't catch my breath. Sort of like this intense dread I'd sometimes get as a kid when I'd be dicking around underwater for too long in the deep end and not feeling like I could reach the surface in time to take a breath.”

What to do about it:

Breathe deeply. Intentionally. Diaphragmatically. Rachel Baker, a clinical social worker, explained to me that as babies, we naturally breathe with our bellies. As we grow into adulthood, however, we start taking short breaths from our chest - which is only exacerbated by anxiety.

To breathe deeply, place your hands on your belly. Take a few, slow, smooth breathes while feeling your abdomen expand and contract. For some, it helps to inhale for five seconds, hold for five seconds, then exhale steadily for five-to-ten seconds. This not only helps your body bring in much more oxygen, Baker said, but your diaphragm presses on the vagus nerve that sends a signal telling the brain to release serotonin, which instantly calms down the mid-part of the brain (where anxiety lives).

Dr. Barton, and many others, also endorsed the benefits of diaphragmatic breathing: “Deep breathing exercises are fantastic for addressing anxiety in the moment and long-term,” she said. “They serve to help the body return to normal functioning allowing reduction in sensations associated with the physiological changes of anxiety.”

2) How to Manage Anxiety: Hormone and neurotransmitter changes.

What it may feel like:

  • “My heart/brain feels like it's running from a tiger while all my muscles lock up tight with an elephant on my chest, then it's like trying to think through mud, like being drugged while you're drowning and sucking for air. Trying to find words to ask for help, but the words don't come. Then I feel like I'm going to pass out and my legs eventually stop.” 
  • “I think the best way to explain how it feels for me is that every function of the sympathetic nervous system goes off at the same time. I feel super cold, and also super warm and sweaty. I feel like I want to throw up. I'm extremely aware of my circulation and my breathing. Sometimes my heart is racing or pounding, but not always. I almost always feel light-headed, and I feel like I need to lie down and stay in one place. I feel like I'm about to burst, and also like I'm shrinking into myself. When it's really bad, my vision starts to be tinted red; that's when I know I'm going to pass out.” 
  • “Suffocation, everything tense, disconnected from reality, uncontrollable shaking, panic, paranoia, tension headaches that last up to two weeks. I also clench my jaw on and off until it's noticeably very sore, and get nauseous and distracted/confused very easily. Most importantly is the suffocation, which intensifies everything else, though pretty much everything feeds into everything else.”

What to do about it:

NY- and NJ-based clinical social worker Maureen Clancy suggests that you should first get out of your head by getting into your body. Do something physical: Go to the gym, for a walk, a bike ride, a swim or have a solo dance party in your kitchen.  

“This has a wonderful grounding effect, deepens your breathing and interrupts the anxiety alarm in your brain,” Clancy explained.

She also recommended smelling something you love. Grab something with a scent you enjoy, hold it a few inches from your nose and inhale deeply. Do this a few times, Clancy said, because it also deepens your breathing and turns off the fear-based anxiety signal in the amygdala part of your brain. You can also simply search for something to distract yourself, such as a new movie, good book, baking cookies or even cleaning your bathroom - something to immerse yourself in fully and give yourself a break.

3) How to Manage Anxiety: Lowered body temperature or slowed/speeded digestion.

What it may feel like:

  • “I always sweat cold. Palms always sweaty. Sometimes I feel hot and cold at the same time and I simply cannot get comfortable.” 
  • “Like many with anxiety I suffer from IBS [irritable bowel syndrome] and basically just have a completely unpredictable gut. I can feel great Monday, have horrible diarrhea on Tuesday and be badly constipated on Wednesday. Recently lost about 100 pounds thanks to this.”
  • “My heart starts to race, I break out in a cold sweat, and I sometimes begin hyperventilating.” 
  • “Very often, it doesn’t feel like anxiety or how you’d imagine an anxiety attack to feel. It can feel like being light-headed. Breaking out in a cold sweat. Feeling shaky, nauseous, like your guys are clenching. It can even causes the immediate need to go to the bathroom. 

What to do about it:

Dr. Barton emphasized that awareness of small changes in your body and intervention can help prevent the anxiety from taking over the day.

“Eating a balanced diet, sleeping well, and exercising consistently all help more than anything else including medication and psychotherapy,” she said. “If you start the day by taking care of the most basic bodily needs, it makes a huge difference in the ability to regulate anxiety levels throughout the day, and I strongly believe it also improves self-esteem.”

Dr. Charlotte Howard, a TX-based psychotherapist, says to notice the way you talk to yourself. When you start to feel anxious, talk to yourself with a loving, nurturing tone to calm down -- just as you would soothe a baby in distress. People often talk to themselves in a judgmental and pressured way that would make anyone anxious, she explained, but loving and caring for yourself is the foundation of a peaceful center that will make you resilient and robust in a world with many stressors.

How to Manage Anxiety on a Long-Term Basis

According to Dr. Barton, the best strategy for anxiety management over the long term is being consistent on developing and maintaining the habits that help you manage anxiety on a day-to-day basis. This sounds easy, but routines often dismantle slowly. What starts as skipping the gym once a week can quickly turn into a couple of days the next week and so on. Before you know it, the feelings of anxiety start to creep back in.

When that happens, Dr. Barton recommends examining what made you defer from your wellness routine in the first place: What changed? Why? And how can we get back to that routine in order to maintain reduced anxiety, promoting wellness? Be flexible with yourself. If you’ve found that the first routine you try doesn’t work, try again. And again. And again, until you find something that both fits your lifestyle and promotes overall health and wellbeing.

Here are a few additional tools that will help you learn how to manage anxiety on a long-term basis.

1. Mindfulness and Meditation

Dr. Howard advocates for mindfulness: a non-judgmental awareness of what you are experiencing. She said mindfulness is one of the most researched and proven ways to combat anxiety. You can practice mindfulness daily through meditation or through the practice of noticing and accepting your present sensations as you go about your day.

“Mindfulness, particularly, helps in protecting you from becoming anxious about your anxiety,” she said. “Instead of creating a vicious cycle, you embrace your anxiety and all its sensations through mindfulness.”

Another meditative practice to try is something that sports psychologist Meg Waldron uses with her athletes - mindful visualization. During this exercise, you think of a word of phrase (like a mantra) that you can use to reach a calm place when you need it most.

“One athlete I worked with used the phrase, ‘fuzzy blanket,’ to remind herself of a childhood blanket and the feeling of safety,” Waldron explained. “Another athlete used a hand motion of turning down a dial before a race to mimic ‘dialing down’ his anxiety, so he could better direct his energy to the task at hand.”

2. Consistency and Acceptance

Consistency and continued self-regulation is the best way for individuals with anxiety to focus on living a healthy and fulfilling life, Dr. Barton explained.  


“As much as many of us don't like to believe it, the only thing we can control in this entire world is ourselves, and that's on a good day,” - Dr. Michelle Barton 

Be realistic about the things you can and cannot control. Reality check yourself. Make a list of everything that is causing you anxiety in a given situation, then cross out everything that is not directly within your control. Channel problem-solving efforts on what you can control, and accept the things you cannot (such as the behavior of your family members or coworkers).

Focus on eating consistently, exercising consistently, maintaining hygiene, and managing your sleep in a consistent fashion, so that other variables are much less likely to throw you off our game and create anxiety.

3. Reach Out and Connect With Others

In addition to also advocating for mindfulness exercises, Clancy recommends getting into therapy with an expert to help manage your anxiety. “I’m in the business, so I can vouch for this. Working with someone to help you manage anxiety (and heal the underpinnings of it) has resounding beneficial effects on your life,” Clancy said. Cognitive Behavioral Therapy (CBT) was also suggested by Dr. Barton, as it sets very clear-cut goals for managing anxiety and provides tools to use from long-term maintenance.

Unfortunately, more than half of Americans who do not receive mental health treatment can not afford the cost. Alternatively, Dr. Barton said that merely reading about anxiety and the struggles of others who have successfully overcome it can be very motivating. It can also provide you with some real tools for successfully managing anxiety that you wouldn’t have otherwise thought of.

One place you can do this is with a free support resource like Stigma. Hundreds of thousands of people use the app-based community to share their struggles with mental health and receive thoughtful and caring peer support via digital penpals and support groups.

Stigma anonymously matches you with a small group of compassionate and supportive peers close to your age. In these support groups, users message each other and respond to thoughtful prompts. For one-on-one peer support, you can browse and match with PenPals to have more intimate discussions. You can also track how new routines and anxiety-reducing activities affect your mood over time with a color-coded weekly graph and monthly calendar.

Remember that the keys to long-term happiness and anxiety-management success require prioritizing and maintaining the strategies we covered above. Stigma is merely one easy-to-use tool that helps you do that.