Not everyone who suffers from anxiety looks like they’re suffering. Some anxiety sufferers might seem outwardly calm, deal competently with whatever life throws at them—and even be quite successful. Yet inside, they’re just barely keeping a grip on their fears and worries.

These people have high-functioning anxiety. Their suffering is not as obvious as the paralyzing version—but it’s just as damaging. The term “high-functioning anxiety” is relatively new and not currently recognized as a mental-health diagnosis. One reason may be that a diagnosis of anxiety disorder has to meet the criteria that symptoms (such as fear, worry, sleep problems, stress) impair functioning at work, at school or in other critical areas of life. 

People with high-functioning anxiety are functioning fine—even brilliantly. But their functioning is at great cost. Constantly suppressing their inner turmoil takes a toll on joy. And the stresses that might stay suppressed (at least for a while) in one area, such as work, tend to pop up somewhere else, such as with family and friends. Also, not dealing with it now can turn anxiety into a full-fledged disorder down the road…and even increase risk for other health issues, such as dementia and heart disease. 

How to Find Your Zen

If you or someone you know fits the description of high-functioning anxiety, here are the strategies that can help…

• Cognitive behavioral therapy (CBT). This form of psychotherapy is effective for breaking the cycle of negative thoughts that leads to anxious feelings. Treatment is usually short-term and focuses on learning self-calming skills that challenge negative thoughts.  

• Belly breathing. Slowing your breathing tells your brain that you’re safe. Inhale slowly through your nose, letting the air move down into your abdomen so that your belly expands with your breath. Then let your belly deflate as you exhale slowly through your mouth.

• Mindfulness meditation. Mindfulness combines belly breathing with focusing thoughts on the present—rather than dwelling on problems from the past or worries about the future. Mindfulness meditation has been shown to relieve not just anxiety but also depression and pain. 

• Muscle relaxation. Physical tension is a hallmark of anxiety. Tensing and then relaxing specific muscle groups trains you to notice when your muscles are tight—and how to release the tension in your muscles, which releases mental tension as well.

• Yoga. An ancient mind-body practice that combines deep breathing, physical movement and meditation, yoga stretches and strengthens muscles while improving mental well-being. 

• Healthy lifestyle. Don’t underestimate the anxiety-reducing benefits of regular exercise, proper sleep, limiting caffeine and alcohol, and eating a healthful, balanced diet.

• Medication. If the above steps don’t give you relief, you may benefit from medication. Certain drugs, such as selective serotonin reuptake inhibitor (SSRI) antidepressants, including fluoxetine (Prozac) and sertraline (Zoloft), can help ease anxiety.  

Finally, bear in mind that some anxiety can be good—if it’s not excessive, it can spur you to reach a desired goal!