High-Functioning Anxiety: Polished on the Outside, Panicking on the Inside

Picture this. It is nine at night. The presentation is finished, the lunches are packed, the cupcakes for the school fundraiser are cooling, and you have answered the class WhatsApp group twice. You sit down at last, and within a minute you are back on your feet, because sitting still feels wrong.

From the outside, your life looks impressively under control. On the inside, it feels as if you are one dropped ball away from disaster.

What high-functioning anxiety is

High-functioning anxiety is not a formal diagnosis. It is a description of people who live with a great deal of anxiety while continuing to perform well, often very well. Because nothing is visibly falling apart, nobody thinks to ask how they are, and they seldom ask for help.

It is often described in capable, conscientious women, though of course not only in women. It often looks like this:

• Over-preparing for everything and still expecting to be caught out
• Saying yes when you are already stretched, then resenting it quietly
• Lying awake going over the day's conversations and tomorrow's list
• Feeling guilty or restless when you try to rest
• Being praised for being "so organised" when it is really fear doing the organising
• Headaches, a tight jaw, an unsettled stomach or a racing heart for no clear reason

The achievements are real. What is hidden is the cost. Much of the drive comes from fear: of letting someone down, of being judged, of being found not good enough. That overlaps with what we describe in our article on imposter syndrome.

Why your brain cannot switch off

Your nervous system has two main settings. One is for action and alertness, sometimes called fight or flight. The other is for rest, digestion and repair. A healthy system moves between the two many times a day.

In high-functioning anxiety, it can be as though the action setting has been switched on for so long that it has become the default. The brain may have learned that being busy and vigilant keeps bad things from happening. Each time the worry "works", because the meeting went well or nothing was forgotten, it is taken as proof and the pattern repeats.

Brain cells communicate through electrical rhythms called brainwaves. Fast rhythms known as beta are linked with focus and problem-solving, and the fastest of these, high-beta, with tension and racing thoughts. A slower rhythm called alpha appears when you are awake but at ease. In a brain that is always on duty, there may be plenty of fast activity and not much of the restful kind. Stillness can then feel unfamiliar, even unsafe, and so you get up and wipe a counter that is already clean.

Rest is not a reward for finishing the list. It is something your brain needs in order to keep going.

Over years, this pattern can wear a person down. Sleep may become lighter and the body may start to complain. If you are already waking in the small hours with a busy mind, our article on being wired but tired looks at that. Left long enough, constant overdrive can end in the kind of collapse we describe in executive burnout.

How neurofeedback may help

Neurofeedback is a non-invasive form of brain training. Sensors on your scalp read your brain's electrical activity, and a computer gives feedback through sound or images whenever your brain shifts towards a calmer, more balanced pattern. The sensors only read. Nothing is sent into your brain.

One thing that may appeal to a high achiever is that it is not about effort. You cannot do it "well" by trying harder. The idea is that the brain learns from the feedback, and over time it may become more familiar with a settled state and more able to return to it.

The aims are quite ordinary and quite welcome: falling asleep more easily, being able to sit through a film without reaching for the phone, feeling less rattled by a last-minute change of plan, and saying no with less guilt. The aim is not to take away your ambition or your standards. The hope is that they are driven a little less by fear. Results vary, and no particular outcome can be promised.

Neurofeedback is complementary. If your anxiety is severe, if your mood is low, or if you have physical symptoms such as palpitations, please see your doctor first, as thyroid and hormonal changes can produce similar feelings. If you take medication, continue as prescribed and discuss any changes only with your prescribing doctor. Therapy with a psychologist is often valuable for the beliefs underneath the busyness.

What training looks like

At Fix Your Brain in Krugersdorp, every client starts with a 19-channel brain map, which takes about an hour and a half. A brain map is a recording of your brain's electrical activity, taken from 19 points on the scalp.

Training sessions are 45 to 60 minutes and begin with a short check-in on how you are feeling. After that, the sensors read your brain's activity while you sit. Our what to expect page takes you through it step by step.

Common questions

Is high-functioning anxiety a real condition?

It is a widely used description, not a formal medical diagnosis. It refers to people who experience significant anxiety while still coping outwardly, often very successfully. The anxiety is real even if no one else can see it. A doctor or psychologist can assess whether it meets the criteria for an anxiety disorder and advise on treatment.

Will calming my brain make me less driven or productive?

That is a common worry. The aim of training is balance, not sedation. The hope is clearer thinking with less tension, since most of us concentrate better rested than frightened. Results vary, and no particular outcome can be promised.

I have very little time. How much is involved?

After the initial brain map, which takes about an hour and a half, training sessions are 45 to 60 minutes each. How often you would come, and for how long, is something to ask when you contact the practice.

You have spent a long time looking after everyone and everything else. If you would like to find out whether neurofeedback could help you rest without guilt, you are welcome to get in touch with Irine.