By Carissa Weber
We see it all the time. That one ambitious person working late in the commercials, always in the office building with every light off but in their own cubicle space. We also see it in our favorite bingable series; that one character who is always pushing to get everything done. Many people applaud that crazy go getter, sometimes even wishing they could be like them.
We have also seen at our favorite shows that one person who always avoids responsibility. Even in our favorite kid movies when there is a crisis, we see one person usually hiding in the corner, while the rest are running around like chickens with their heads cut off. That person (or animal if you think about some kids movies) tends to invoke a sympathy response for them. What if I told you that both of these cases demonstrate the sheer flexibility of anxiety?
As outlined in my last post, What Anxiety Really is: A map of Distress to Nowhere, we talked about why our anxious brains do what they do. This post is looking at the many masks and features that anxiety has as well as some ways to address the amped up anxiety and the shutdown anxiety.
Let’s start off with talking about amped up anxiety. Some of you may have already heard the term high functioning anxiety, a term that is fairly new in the therapy world. Why have you heard it? Believe it or not, it is because the stigma of mental health is changing in a positive way (Yippee!!!). High functioning anxiety shares similarities with ” regular” anxiety (like feeling worried all the time, overthinking situations, feeling overwhelmed, and having some of the physical symptoms that come with anxiety). The difference is that people who have high functioning anxiety have adapted to it and function well, almost flawlessly, to the untrained eye.
People with amped up or high functioning anxiety often appear outgoing, driven, and ambitious. These crazy cats are always punctual and putting in long hours to achieve their goals. They demonstrate (on the outside) they are on top of things and use several organizational tools to help them remember what is going on. People with high functioning anxiety come across as passionate, educated, and natural born leaders. In essence, people with high functioning anxiety come across as type A personalities.
There is a dark side to high functioning anxiety:
- the mask of passion and leadership are hiding the obsession to be perfect
- Working hard to gain acceptance from their peers (better known as people pleasing behavior)
- Struggle to say no due to their fear of rejection
- Increases in anxiety and nervousness bring sleepless nights and ruminating thoughts (and a decreased ability to relax)
- Nail biting, playing with their hair along with an increase in irritability getting lost in tasks
- A Unhealthy self-esteem level that stems from setting unrealistic goals and not meeting them (I think I just called myself out).
- All of this is done kind of in an attempt to avoid the feelings that come with anxiety
High functioning anxiety is a type of anxiety that isn’t actually a diagnosis, yet. Some of you may be scratching your head at that, let me explain why. In the diagnostic Bible for therapists, the DSM-5, it covers a category called anxiety disorders, which include generalized anxiety disorder, panic disorder, agoraphobia (and other phobias), social anxiety, separation anxiety, and obsessive compulsive disorder (OCD). From OCD to social anxiety, amped up anxiety takes a little bit from each diagnostic category to make it’s own little cocktail. I love the quote from psychologist Elizabeth Cohen “[High functioning anxiety] has the people-pleasing that usually comes with social anxiety, the physical responses and ‘waiting for the other shoe to drop’ component of GAD, and the rumination of obsessive-compulsive disorder (OCD).” With that said, people with high functioning anxiety often don’t meet all the criteria needed for one specific anxiety diagnosis. Hopefully, that will change in the future.
Does high functioning anxiety work differently in the brain than “normal” anxiety? I wish there was a clear answer there for you. As science researches it more, many of us therapists recognize high functioning anxiety as a specific coping mechanism for anxiety symptoms as it follows the same pathway as “regular” anxiety (check out last week’s post, What Anxiety Really is: A map of Distress to Nowhere to revisit the anxiety pathway) . Your darn amygdala so happens to be the fighters from the triple F response (Wahoo!).
“People who have high functioning anxiety have adapted to it and function well, almost flawlessly, to the untrained eye.”– Carissa Weber
What about “regular” anxiety? Is that called low functioning anxiety because we are unable to cope with the emotions? It is not. “Regular” anxiety is broadly known as generalized anxiety disorder (GAD for short). The DSM-5 looks at the following symptoms to diagnose GAD:
- The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least six months and is clearly excessive.
- The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another.
- The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (In children, only one of these symptoms is necessary for a diagnosis of GAD):
- Edginess or restlessness
- Tiring easily; more fatigued than usual
- Impaired concentration or feeling as though the mind goes blank
- Irritability (which may or may not be observable to others)
- Increased muscle aches or soreness
- Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)
How many of these symptoms do you have at any given time? If you have been keeping up with the journaling discussed in the last post, What Anxiety Really is: A map of Distress to Nowhere, you may have picked up on a few of these. Some other things not listed by the DSM-5: avoiding things that make us feel anxious, and forgetfulness ( a lot of forgetfulness).
No matter what anxiety style we struggle with (amped up or shut down), one thing is common: that darn amygdala tricks us into thinking things that are not true. That darn amygdala knows the way of triggering our hippocampus and hypothalamus into focusing on the negative things happening in our life and puts the positive things on the back burner (or forget them completely). As a survival mechanism, this is great! It keeps you on alert and prepared for when things go wrong. Do things go wrong all the time? Of course not! There’s a technical name for when that darn amygdala does this. It is called cognitive distortions.
Cognitive distortions operate a lot like a pair of sunglasses. When cognitive distortions are operating, they filter what we can. Unfortunately, what we see tends to be negative thing that gives that darn amygdala a louder voice. Everyone uses captive distortions in their life. This is something, when used in moderation, helps us prepare for future stress and keep us safe. Below, you will find the most common cognitive distortions that darn amygdala uses to keep us stressed and anxious:
- Seeing the worst thing possible
- “I got a C on my exam, the world is over!”
- Experiences aren’t important
- “It was just a little fender bender, not a big deal”
- A single event will always happen
- “I stubbed my toe on the table, I’m such a clutz!”
- Magical Thinking
- Acts influence unrelated situations
- “Why am I getting dumped on by the boss? I’m a good worker!”
- Being responsible for things outside of your control
- “If I made dinner more maybe my wife wouldn’t be so cranky”
- Mind Reading
- Interpreting what people are thinking
- “Why is everyone looking at me? Am I really that ugly?”
- Fortune Telling
- Predicting the future without all the facts
- “They are going to call me in on my day off, I know it!”
- Emotional Reasoning
- Assuming emotions reflect what is happening
- “Today is shitty because I feel shitty”
- Disqualifying the positive
- Only focusing on the negative
- “Everyone liked my new shoes except for Amy G. Dala (see what I did there?). My shoes must be bad if she doesn’t like them.”
- “Should” statements
- Believing things should be a certain way
- “I should get this done, I should get that done.”
- Thinking in absolutes
- “I always have to be my best.” “I am never good enough.”
How many of these look and sound familiar? I bet more than a few. Sometimes we use these cognitive distortions without even recognizing it (even several at one time). It is important to identify which cognitive distortions we are using before we are able to challenge them. Once we know what we are facing, we can use some of the challenges below.
Challenging cognitive distortions helps anxiety and the brain in several ways. First, it allows the prefrontal cortex to get in on the conversation the amygdala is trying to bulldoze. Second, it allows for the release of those calming neurotransmitters, GABA and serotonin, to be released physically calming us down. Third, it releases glutamate into the hippocampus to help recall memories to further help release the neurotransmitters serotonin and GABA. The time it takes from the moment we recognize the cognitive distortion in use, to feeling relief can be up to 15 minutes. But in that 15 minutes, we are strengthening the connection between the prefrontal cortex and that darn amygdala to help prevent future hostage situations where that darn amygdala is running the show. Isn’t science fun?
Coping Skills Alert!
In order to challenge the cognitive distortion, we must first identify the thought that is giving fuel to the cognitive distortion. Once that thought is identified, we have to identify and explore all the facts surrounding that thought. Facts that support the thought or are against the thought. Once that step is complete, explore if any of these are true objective facts that anyone could prove or if they are feelings and emotions you are experiencing. Here comes the tricky step: we have to ask ourselves if there are other ways to interpret that thought. For example, if we are focused on stress eating that pound of chocolate (like in the post http://thatdarnamygdala.com/2021/04/04/easter-and-the-brain-why-we-cant-get-enough-chocolate/) if we are truly hungry, trying to eat sweets without our kids noticing, if we are stress eating, or if we’re trying to reward our brain for sticking to our meal plan for the week. Now for all of you who catastrophize situations (like me), we need to ask ourselves that nagging question: is this a realistic thought or a worst-case scenario kind of thought?
Another effective coping skill for anxiety is the use of mindfulness. As outlined in one of my previous posts, Stress and the Brain: Happy Stress Awareness Month, it can provide a release of serotonin that calms the body down. For those with shutdown anxiety, it can help improve their frustration tolerance. One of my favorite mindfulness exercises is deep breathing. This is something that you can do when you are out in public or in the privacy of your own home. Even though I have outlined it already, let me take some time to outline deep breathing exercises one more time:
- sit in a comfortable position
- Slowly inhale through your nose and into your diaphragm ( to make it simple, breathing so that your belly expands) for 6 seconds
- Hold that process in your belly for two seconds
- Slowly exhale out of your mouth for eight seconds, or until you feel like you have no breath left
- Repeat this pattern of breathing for 3 to 5 minutes (or however long it takes for you to feel calm).
- If you want evidence the deep breathing is working, take your heart rate before you start the deep breathing. After each minute of practicing the breathing, take your heart rate again. Your heart rate will go down!
I want to thank you for taking time to read about high functioning anxiety and shut down anxiety today. I know it is a lot of information, a lot of skills, and a lot of science, but you are worth knowing how all of this works in your brain! In next week’s post, I am going to go over mindfulness more in depth. Mindfulness is a group of healthy coping skills that allow us to control our anxiety through controlling our bodies physical responses. I cannot wait to share mindfulness with you all!
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- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Astorino, D.M. (2020). What is High Functioning Anxiety? Retrieved from What Is High-Functioning Anxiety? Symptoms and Treatment | Shape
- Author Unknown (2020). High Functioning Anxiety. Retrieved from High-Functioning Anxiety – Bridges to Recovery
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY, US: Guilford Press. Retrieved from Cognitive Distortions (Worksheet) | Therapist Aid
- Clark, G. I., & Egan, S. J. (2015). The Socratic method in cognitive behavioural therapy: A narrative review. Cognitive Therapy and Research, 39(6), 863-879. Retrieved from Cognitive Restructuring: Socratic Questions (Worksheet) | Therapist Aid
- Cuncic, Arlin (2020). The Characteristics of High Functioning Anxiety. Retrieved from The Characteristics of High Functioning Anxiety (verywellmind.com)
- Home – SAMHSA Behavioral Health Treatment Services Locator