Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
Troubleshoot High-Functioning Anxiety Symptoms With Lifestyle Changes That Can Help
High-functioning anxiety isn’t a diagnosed mental health condition; rather, it’s a description of symptoms such as racing thoughts, overthinking, perfectionism, fear of failure, and insomnia (generally to a degree that is not debilitating) [1, 2].
Although high functioning anxiety is not necessarily a diagnosed condition, the symptoms can certainly interfere with daily life and deserve to be addressed.
Brain retraining with CBT or a form of limbic system retraining have shown good improvements in anxiety.
In terms of lifestyle changes that can help, an improved diet plus probiotics is a great combination.
Are you driven, a high-achiever at work or school, but you also struggle with racing thoughts, fear of failure, and feel a lot of pressure to always be the best? Is that getting exhausting? You may have high-functioning anxiety symptoms. With a few simple changes, you could improve the factors that cause you to feel under pressure all the time, while still achieving what you want in life.
Symptoms of High-Functioning Anxiety
High-functioning anxiety isn’t a medical diagnosis, but rather a term that many mental health professionals and patients use to describe people with anxiety (diagnosed or self-identified) who can still maintain the majority of their life roles and responsibilities, without experiencing a severe loss of quality of life. While people can maintain their life roles, that doesn’t mean they should have to live with feelings of being overwhelmed and anxious. We want to help you find ways to improve the negative symptoms of high-functioning anxiety.
The Anxiety and Depression Association of America (ADAA) and other mental health professionals describe high-functioning anxiety symptoms as the experience of having racing thoughts, overthinking, being driven by perfectionism and a fear of failure, and sometimes losing sleep [1, 2]. In some people, they also feel that these symptoms promote being an overachiever and high performance.
High-functioning anxiety is most often considered “subclinical” anxiety, meaning that it doesn’t necessarily fit the criteria for diagnosis of a mental illness. Still, that doesn’t mean the symptoms aren’t real or worthy of being addressed.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)deems anxiety a disorder when the symptoms are bad enough that they cause significant distress or significantly impair social, personal care, educational, or occupational abilities for at least six months . In high-functioning anxiety, you’re generally still able to perform (and maybe even excel) at work, and to take care of your personal life. Still, many of us understand the feeling of succeeding on the outside, but struggling on the inside; this may be high-functioning anxiety.
In general, if many of the following emotional and physical symptoms fit you, you may be struggling with high-functioning anxiety [1, 2, 4]:
Perfectionism that drives work and life
Fear of failure that drives you to perfectionism
Racing heart rate
Pit in your stomach
Insomnia, often due to overthinking and racing thoughts
Chronic fear over health-related issues
People are often surprised that three of the most-commonly described symptoms of high-functioning anxiety are high work performance, being extremely organized, and being very disciplined in life.
While these are all things that help you be successful in life and get things done, in some people they’re also signs that anxiety may be driving these behaviors. In these cases, you may also have a very hard time coping when a work project doesn’t go well, when everything isn’t organized perfectly, or you just feel an underlying sense of pressure and being overwhelmed. This can be exhausting and stressful.
In resolving high-functioning anxiety symptoms, we’re looking to keep all the good parts and improve the stress and pressure so you can live better. Let’s look at anxiety in general to get a better idea of where high-functioning anxiety symptoms might be coming from.
What Is Anxiety?
Anxiety is an umbrella term that includes many types of anxiety, panic, and phobia disorders. There are different levels of anxiety depending on which mental health disorder a person has.
Anxiety is a future-oriented mood state focused on fear, basically making the brain always vigilant in a fear state and ready to react to possible danger at all times. Fear is not inherently bad; in fact, it’s the needed automatic emotional state of alarm that creates an impulse to fight, freeze, or flee when faced with danger . Fear keeps us safe and helps us make quick decisions in emergencies.
Anxiety, simply, is when that fear is chronic and the brain sees most things in life as present or possible danger, so we keep responding with fight, freeze, or flee in non-emergency situations.
There are quite a few different forms of anxiety that fall under the umbrella. This chart summarizes a few of the more common ones and their corresponding symptoms .
Type of Anxiety Disorder
Generalized Anxiety Disorder
Constantly worrying too much about daily life, like work and school performance, which feel hard to control. This constant worry can cause restlessness, edginess, fatigue, difficulty concentrating, irritability, muscle tension, and sleep problems.
Fear and anxiety about situations like using public transportation, being in open spaces, being in busy enclosed spaces like theaters, standing in line or being in crowds, or being alone outside of the home.
The experience of repeated panic attacks and resulting fear of having more panic attacks, which are surges of intense fear or extreme discomfort. Panic attack symptoms include palpitations, sweating, hyperventilation, fear of going crazy or fear of dying, which reach a peak within minutes and cause sufferers to avoid situations that could provoke another attack.
Social Anxiety Disorder
An intense fear or anxiety about social situations that pose the threat of scrutiny by others, and the resulting embarrassment, rejection, humiliation, or potential of offending others.
Separation Anxiety Disorder
Persistent anxiety and fear related to the possibility of losing attachment figures through harm, death, or other methods of separation.
In high-functioning anxiety, an overactivation of fear is still going on in the brain, just not to a level where you can’t handle daily life. Just because you can navigate daily life — meaning you can get things done — it doesn’t mean you have to live with the constant feelings of fear and being overwhelmed.
Improving High-Functioning Anxiety Symptoms
For high-functioning anxiety there are a few things we can do in our day-to-day life that can improve symptoms, such as diet changes, probiotics, and brain retraining.
Let’s take a look at a few of the most successful forms of brain retraining and lifestyle interventions that can help improve high-functioning anxiety symptoms.
Brain retraining is anything that changes the actual structure or function of the brain so that you have better well-being, cognition, and emotional and behavioral regulation. This happens through neuroplasticity, the brain’s ability to change itself, both structurally and functionally . Occupational therapy after a brain injury is a form of brain retraining, as is cognitive behavioral therapy (CBT).
In the treatment of anxiety disorders, cognitive behavioral therapy and a few forms of limbic retraining have been found to be helpful forms of brain retraining. These therapies seek to retrain the brain to decrease fearful negative thoughts in order to calm the fear center of the brain, or calm the limbic system directly to decrease fear reactions.
CBT for Anxiety Relief
By far, we have the most research around CBT, or cognitive behavioral therapy, and treatment of anxiety disorders. In CBT, a clinician works with patients on how to more correctly assess risk by investigating and resolving the fearful negative thoughts that lead to an amygdala response .
Some forms of CBT also work to help people process the bodily sensations that come with anxiety and decrease the fear response when you get, for example, a racing heart beat, sweaty palms, or a pit in your stomach . Rather than calming the amygdala directly, CBT uses talk therapy to target the prefrontal cortex, which is responsible for reason and decision-making . When the prefrontal cortex is working well, not only can we assess risk more realistically, but it inhibits over-activation of the amygdala.
Cognitive behavioral therapy is the most studied type of psychotherapy, and ample evidence has shown individual or group CBT is a moderately to highly effective treatment for panic disorder [6, 8, 9, 10, 11]. In comparing CBT to pharmaceuticals only, research doesn’t show that either CBT or medication is significantly better in treating anxiety [12, 13, 14]. Many people prefer CBT due to the side effects from medication.
Limbic System Retraining and EMDR
The limbic system is the part of the brain that houses the amygdala, and is responsible for assessing safety and triggers our fight, flight, or freeze response . An overactive or highly sensitive amygdala can contribute to anxiety because it’s like your fight-or-flight response is always on, rather than only on when needed .
Anything that trains the brain to calm this response can fall under the category of limbic system retraining, including direct training of the amygdala and limbic system, such as in Gupta Program Brain Retraining™ and EMDR (Eye Movement Desensitization and Reprocessing), and even mindfulness and breathing techniques.
We don’t have as many research studies on the various forms of limbic system retraining and anxiety as we do with CBT and anxiety, but the research we have so far is promising, and we’ve seen good results in our clinic with limbic system retraining as well.
Early evidence suggests that limbic retraining has helped fibromyalgia patients reduce their anxiety [17, 18]. In fact, one study found that eight months of mindfulness plus amygdala and insula retraining (MAIR) led to not only less functional impairment, anxiety, and depression, but also significantly less pain catastrophizing and psychological rigidity, even three months after the study was over .
At the clinic, we’ve seen good improvements in anxiety with the Gupta Program Brain Retraining™. One study on this type of amygdala retraining techniques (ART) for chronic fatigue syndrome (CFS) found that ART interventions achieved greater improvements in CFS than other interventions, with 93% of participants subjectively reporting better functioning .
Eye Movement Desensitization and Reprocessing (EMDR) has become increasingly popular as a clinical intervention for anxiety disorders. In EMDR, the clinician asks the patient to recall distressing thoughts or events and then has the patient engage in bilateral stimulation, such as side-to-side eye movements or tapping on opposite sides of the body. This process is used to interrupt the repetitive negative pattern in the limbic system that triggers fear and rewire those connections.
A 2020 meta analysis of 17 randomized control trials showed that EMDR moderately improved anxiety and panic, and had a smaller positive effect on phobias .
Diet and Probiotics
The gut and brain are linked in multiple important ways, and we know that inflammation in the gut can cause inflammation in the brain.
We don’t know what comes first — if a gut imbalance causes anxiety or if anxiety causes gut issues — but the back-and-forth communication of the brain-gut connection suggests it’s both. In our clinical practice, we find that manypeople who have gut issues (whether or not they know about it) develop anxiety, and that healing the gut often leads to improvements in anxiety.
Both diet and probiotics help improve gut health and decrease inflammation in the gut, and can help improve mental health issues such as depression and anxiety [21, 22, 23, 24, 25]. Randomized clinical trials have found that probiotics can improve anxiety, anger, and depression, as well as decrease stress-hormone levels .
Probiotics may be able to help reduce anxiety because they improve leaky gut . The bacterial toxins that enter the bloodstream from leaky gut have shown to contribute to symptoms of anxiety and depression . Diets that improve leaky gut may also improve anxiety symptoms for the same reason.
The combination of improved diet and probiotics have been found to be the most beneficial at improving anxiety .
A few different types of diets have been studied, one of them being low-FODMAP, which is a diet low in fermentable oligosaccharides, disaccharides, and monosaccharides and polyols . We’ve seen good improvements in anxiety for our clients on a low-FODMAP diet.
As far as adding in a probiotic with your diet goes, though most studies of probiotics and anxiety use Lactobacillus-based probiotics, in general gut health improves the best on a multi-strain probiotic. For this reason, and since there are minimal adverse side effects, try a multi-strain probiotic with your dietary changes.
Besides the brain retraining and lifestyle interventions mentioned, there are also a few common forms of pharmaceutical treatment used for anxiety disorders . Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are considered first-line treatment for all anxiety disorders. Benzodiazepines are another common form of medication and are good for short-term anxiety management and panic attacks or phobias. However, long-term use of benzodiazepines comes with a high risk for dependence.
Chronic Illness and Heightened Anxiety
One high-functioning anxiety symptom that we often see in the clinic is with people who have had chronic health issues and have started to heal. When you have lived with chronic illness for a long time, your limbic system (the area in the brain that houses the amygdala, which helps regulate anxiety) may be primed to react with strong fear every time you feel a change in your body, no matter how slight. This is understandable because this vigilance kept you safe in the past by helping you know what foods or environmental toxins might be irritating to you.
However, as we heal, this heightened sense of fear related to any feelings in the body can lead to feeling generally anxious and unwell, even though your health is improving. For example, a little bit of stomach bloating at times is normal even after your gut has healed. But if you’ve dealt with symptoms for a long time, your limbic system may lead you to be overly anxious and afraid because of past experience with chronic bloating. You may also remain chronically anxious about eating out, trying new foods, being outside in allergy season, or that anything could set off your chronic illness again.
Fortunately, we’ve found the limbic system retraining discussed earlier to be very effective for this kind of anxiety, and this is often the missing piece for those who have seemingly healed many of their physical symptoms but still feel unwell.
Daily Interventions for Better Well-Being
Mental health issues can affect all of us at times, even without a diagnosed mental illness. This is especially true with high-functioning anxiety because to the outside world everything seems great — you excel at work and can take care of all of your responsibilities at home — but on the inside you’re a bundle of stress and pressure.
Remember, anxiety is a future-oriented mood state where the brain experiences fear when it feels you can’t control the future. This is why high-functioning anxiety symptoms include being organized and having a good work ethic, because your brain tries to control the future by being highly perfectionistic. This is great because you get stuff done, and you do it well! At the same time, it’s a struggle when things aren’t always in your control, so you then may have racing thoughts, racing heartbeat, sweaty palms, and a feeling of being overwhelmed most of the time.
Fortunately, you don’t have to get rid of the qualities of hard work and attention-to-detail in order to relieve the pressure. Try the strategies outlined above, like limbic system retraining, CBT, diet, and probiotics, in order to improve your mental health.
These interventions should help you relieve high-functioning anxiety symptoms and start feeling more calm, joyful, and able to enjoy your success, rather than feel pressure all the time to keep achieving. If you want more help or if you try these interventions and are still struggling, our clinic at the Ruscio Institute for Functional Medicine is open to new patients and we would be happy to help.
The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.
Chand SP, Marwaha R. Anxiety. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 29262212.
Puderbaugh M, Emmady PD. Neuroplasticity. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. DOI: 10.1007/978-1-908517-18-0. PMID: 32491743.
Pompoli A, Furukawa TA, Efthimiou O, Imai H, Tajika A, Salanti G. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med. 2018 Sep;48(12):1945–53. DOI: 10.1017/S0033291717003919. PMID: 29368665. PMCID: PMC6137372.
Craske MG, Tsao JCI. Assessment and treatment of nocturnal panic attacks. Sleep Med Rev. 2005 Jun;9(3):173–84. DOI: 10.1016/j.smrv.2004.11.003. PMID: 15893248.
van Dis EAM, van Veen SC, Hagenaars MA, Batelaan NM, Bockting CLH, van den Heuvel RM, et al. Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2020 Mar 1;77(3):265–73. DOI: 10.1001/jamapsychiatry.2019.3986. PMID: 31758858. PMCID: PMC6902232.
Barkowski S, Schwartze D, Strauss B, Burlingame GM, Rosendahl J. Efficacy of group psychotherapy for anxiety disorders: A systematic review and meta-analysis. Psychother Res. 2020 Nov;30(8):965–82. DOI: 10.1080/10503307.2020.1729440. PMID: 32093586.
Carpenter JK, Andrews LA, Witcraft SM, Powers MB, Smits JAJ, Hofmann SG. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018 Jun;35(6):502–14. DOI: 10.1002/da.22728. PMID: 29451967. PMCID: PMC5992015.
Bandelow B, Sagebiel A, Belz M, Görlich Y, Michaelis S, Wedekind D. Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies. Br J Psychiatry. 2018 Jun;212(6):333–8. DOI: 10.1192/bjp.2018.49. PMID: 29706139.
Bandelow B, Reitt M, Röver C, Michaelis S, Görlich Y, Wedekind D. Efficacy of treatments for anxiety disorders: A meta-analysis. Int Clin Psychopharmacol. 2015 Jul;30(4):183–92. DOI: 10.1097/YIC.0000000000000078. PMID: 25932596.
Imai H, Tajika A, Chen P, Pompoli A, Furukawa TA. Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database Syst Rev. 2016 Oct 12;10:CD011170. DOI: 10.1002/14651858.CD011170.pub2. PMID: 27730622. PMCID: PMC6457876.
Torrico TJ, Abdijadid S. Neuroanatomy, Limbic System. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 30860726.
Abuhasan Q, Siddiqui W. Neuroanatomy, Amygdala. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018. PMID: 30725787.
Sanabria-Mazo JP, Montero-Marin J, Feliu-Soler A, Gasión V, Navarro-Gil M, Morillo-Sarto H, et al. Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomized Controlled Trial. J Clin Med. 2020 Oct 11;9(10). DOI: 10.3390/jcm9103246. PMID: 33050630. PMCID: PMC7599726.
Goldway N, Ablin J, Lubin O, Zamir Y, Keynan JN, Or-Borichev A, et al. Volitional limbic neuromodulation exerts a beneficial clinical effect on Fibromyalgia. Neuroimage. 2019 Feb 1;186:758–70. DOI: 10.1016/j.neuroimage.2018.11.001. PMID: 30408596.
Yunitri N, Kao C-C, Chu H, Voss J, Chiu H-L, Liu D, et al. The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials. J Psychiatr Res. 2020 Apr;123:102–13. DOI: 10.1016/j.jpsychires.2020.01.005. PMID: 32058073.
Liu RT, Walsh RFL, Sheehan AE. Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials. Neurosci Biobehav Rev. 2019 Jul;102:13–23. DOI: 10.1016/j.neubiorev.2019.03.023. PMID: 31004628. PMCID: PMC6584030.
El Dib R, Periyasamy AG, de Barros JL, França CG, Senefonte FL, Vesentini G, et al. Probiotics for the treatment of depression and anxiety: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN. 2021 Oct;45:75–90. DOI: 10.1016/j.clnesp.2021.07.027. PMID: 34620373.
Firth J, Marx W, Dash S, Carney R, Teasdale SB, Solmi M, et al. The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019 Apr;81(3):265–80. DOI: 10.1097/PSY.0000000000000673. PMID: 30720698. PMCID: PMC6455094.
Lee HJ, Hong JK, Kim J-K, Kim D-H, Jang SW, Han S-W, et al. Effects of Probiotic NVP-1704 on Mental Health and Sleep in Healthy Adults: An 8-Week Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021 Jul 30;13(8). DOI: 10.3390/nu13082660. PMID: 34444820. PMCID: PMC8398773.
Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM, et al. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009 Mar 19;1(1):6. DOI: 10.1186/1757-4749-1-6. PMID: 19338686. PMCID: PMC2664325.
Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, et al. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr. 2011 Mar;105(5):755–64. DOI: 10.1017/S0007114510004319. PMID: 20974015.
Lamprecht M, Bogner S, Schippinger G, Steinbauer K, Fankhauser F, Hallstroem S, et al. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Int Soc Sports Nutr. 2012 Sep 20;9(1):45. DOI: 10.1186/1550-2783-9-45. PMID: 22992437. PMCID: PMC3465223.
Stevens BR, Goel R, Seungbum K, Richards EM, Holbert RC, Pepine CJ, et al. Increased human intestinal barrier permeability plasma biomarkers zonulin and FABP2 correlated with plasma LPS and altered gut microbiome in anxiety or depression. Gut. 2018 Aug;67(8):1555–7. DOI: 10.1136/gutjnl-2017-314759. PMID: 28814485. PMCID: PMC5851874.
Yang B, Wei J, Ju P, Chen J. Effects of regulating intestinal microbiota on anxiety symptoms: A systematic review. Gen Psych. 2019 May 17;32(2):e100056. DOI: 10.1136/gpsych-2019-100056. PMID: 31179435. PMCID: PMC6551444.
I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!
Transform your health
Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DC.