The following is based on a vignette of a high-functioning client from my private anxiety therapy practice in downtown Delray Beach. Names, gender, descriptions, and details have all been disguised to keep the person/persons described anonymous. Of course, some details may have been omitted or embellished to make a point. Any resemblance to actual persons, living or dead, or situations, past or present, is purely coincidental.

What Can High-Functioning Anxiety Look Like?

Brian stepped into my waiting room just as I was exiting the kitchen area after lunch. He was early for his 1 PM appointment, and when I turned after closing the door, I was struck by his appearance. “Urban Warrior” is a phrase that immediately leapt into my mind. His head was shaved. Clothed in military-style regalia complete with a pistol belt, Brian’s arms bulged from his tight sleeves, and he’d clearly been lifting weights just before coming.

At around 6 feet and 4 inches, his body shape was angular and very muscular, with a thin waist and excessive thickness in his thighs. His jaw was square and stood out prominently. A handsome man with dark hair, a full dark beard, and strong blue eyes, he greeted me with an overly firm handshake (my hand was actually uncomfortable) and turned away to sit. I felt that I was in the presence of an action figure who’d just stepped out of the pages of a graphic novel.

“I’ll need to ask you to put any weapons in your possession in your car during our meeting”, I told him. “Just policy. Nothing personal.” He left for a moment and returned minus the weapons belt. “Thanks”, I said. “I think we’ll be just fine without that.” At that moment, he abandoned his courteous stance and glared at me with a piercing look. “A man’s got to protect himself,” he said. “The world is a messed-up place, and you never know who you can trust”. “I understand,” I said. They say one should always pay rapt attention to the first statements your client makes. I didn’t miss a thing.

The Overlap of Physical and Mental Symptoms

“I’m here because my heart hurts,” he said. “I have a condition that is called Pericarditis, and it’s painful in the extreme”. “I’ve been hurting without relief for weeks this time, and I’m giving up hope. These pains come out of nowhere. I’m very discouraged and don’t know how long I can go on. Honestly, I’ve had thoughts of suicide. I’m not really there,” he said, “but it crosses my mind. I know I’m depressed. My friend has been seeing you and says you’ve helped him tremendously. He referred me. He felt it could help. I don’t know how, but I’m here”.

What Circumstances Can Lead to High-Functioning Anxiety?

Brian was a railroad security detective. He operated inside a law enforcement branch that, to him, felt a bit like special forces. Working primarily at night, it was Brian’s job to detect shipping breaches and apprehend the criminals who were costing the railroads millions in stolen goods. He was good at his job. He was known as a high-performing, special category enforcer who was not afraid of combative altercations.

When we talked about his social and emotional history, things were different. At 34, Brian had never had a long-term girlfriend. He preferred the company of prostitutes and had a lifelong mistrust of women and relationships.

“Women basically are un-trustworthy”, he proclaimed, almost hinting that I might dispute this. The loneliness that he’d lived with from birth had served as a self-reinforcing, self-protecting system of belief. “I’m not going to allow women to hurt me”, he’d said. “So why get close to them”?

Addressing Physical Symptoms

We circled back to the medical implications of Brian’s difficulty. When someone presents with physical symptoms like this pain he’d described, I always make sure that they are seeing a doctor, and if indicated, a specialist. Brian had seen his cardiologist recently for an outbreak of sharp chest pains and had been given a regimen of nonsteroidal anti-inflammatory drugs. He’d also advised Brian to slow down and rest. His doctor had advised him that pericarditis is a physical illness that can leave the nervous system in a heightened, reactive state. Strategies to calm and modulate could only help.

First things first. We began with a no-harm contract after he disclosed his thoughts about suicide. I am careful to offer this delicate discussion too early in the relationship, as it can be sensitive. But Brian was extremely tense. His anxiety was through the roof. His hands shook as we spoke, and so I carefully initiated a proposal that we’d agree to partner around any future thoughts he might have on harm.

No-Harm Contract

After talking about his friends and family briefly, he identified his mother as an important point of contact. Then, I introduced him to my standard no-harm contract, which contains the following blank spaces in which to name a contact person:

I, ____________, agree that I will refrain from harming myself. I promise not to participate in any activity that could result in intentionally causing myself harm or death. If I ever have thoughts of suicide, feel like I want to kill myself, and/or have the urge to cause harm to myself, I will remind myself that ___________ cares deeply for me and does not want me to harm myself. I’ll remind myself that when I do ___________ I feel a little better. I will contact the following safety person if I am feeling suicidal (list contact names). I know that _________ does not want me to hurt myself and cares about me very much.

He filled in and signed the document, and I gave him a copy. Then he sat back in his chair, took a long breath, and followed it with a long sigh. He looked tired and perplexed. “Thanks,” he said. “No one’s ever acted like they gave a damn if I even kept on living”.

Do Childhood Experiences Contribute to High-Functioning Anxiety?

I invited him to tell me more, especially about his childhood. Brian had been born significantly premature and had been taken from his mother and placed in a mechanical hospital incubator for several weeks after birth. He was separated from his mother and most other forms of warm, human contact for weeks. He remembered being told that he was “difficult” and colicky and coughed a lot. Several times, he nearly died before gradually gaining enough strength to be reunited with his mother. With little help from me, Brian seemed to place a lot of importance on this series of events. He seemed to intuit what science has told us about early maternal separation and the development of self-regulation.

In infancy, self-regulation happens through the caregiver’s body. Warmth, smell, heartbeat, voice, and touch help the newborn’s nervous system settle. When separation happens, even briefly, the infant may rely more on self-protective physiological responses rather than co-regulation. This does not mean conscious memory or blame; it is about the early patterning of stress responses.

Separation and Abandonment

Later in life, some people with early separation histories may show tendencies such as heightened vigilance, difficulty settling proper boundaries when distressed, strong reactions to abandonment or loss, or a deep drive toward self-reliance. These were the symptoms Brian struggled with the most, and though high-functioning, he lived a very lonely life because of it. The presence or absence of later attuned caregiving matters far more than the separation itself, but Brian felt he had none. He reported that his mother seemed disconnected and frustrated by him throughout his childhood, as if he were a nuisance.

Hypercritical and impatient, he reported that he often felt like a “bad employee” of his mother and could never please her no matter what he did. His father was more distant. Traveling the world as a sales representative, his father was rarely at home, and when he was, he kept his distance. Brian began to form caustic and destructive self-limiting beliefs, and his early life sadness and depression morphed into harshness, anger, and cruelty.

How We See Ourselves As a Result

Sadly, his anxiety changed the way he saw himself. He believed he was no good andwas not lovable. He believed he had no control over his life. “I’d kick anyone’s ass”, he told me. “If someone even looked at me wrong, I’d punch them in the face”. Brian had considerable learning difficulties throughout school, which is not uncommon in someone as dysregulated as he’d become. Diagnosed with ADHD early on, he’d been prescribed just about every available medication, especially Ritalin and Adderall.

“I felt like a fuck-up”, he said. “Like I didn’t belong anywhere. They put me in a “special class” because of my behavior and treated me like a problem. I became venomous and spiteful, especially to my teachers. I hated them.”

What are Holistic Solutions for High-Functioning Anxiety?

Brian and I took our time. Many of our sessions occurred on Zoom. He traveled. By and by, he began to report a shift in his thinking. His thoughts of suicide seemed to wane and disappear. He was more and more receptive in our talks. We’d relied mostly on cognitive behavioral therapy to help Brian uncover some of his distortions and radical thinking. I encouraged him to experiment socially, and he went on a few dates. He seemed to enjoy himself as he took on a new way of viewing himself. After a few months, his symptoms of pericarditis and the pain it brought seemed to abate. Of course, he remains in the care of his doctor.

The Hakomi Method

Much of our therapy was informed by a method and framework I’ve used for many years called The Hakomi Method, originated by Ron Kertz, an extraordinary healer, therapist, and author.

There is no other body of work and frame that informs my work with clients in my Delray Beach anxiety therapy practice. Hakomi rests on several core principles:

• – Mindfulness is central. Clients are guided into present-moment, inwardly focused states where subtle emotions, sensations, impulses, and memories can be observed without judgment. These states allow unconscious material to surface safely.
• – Organicity means the psyche naturally moves toward healing when conditions are supportive. The therapist follows rather than directs, trusting the client’s inner organization.
• – Nonviolence emphasizes gentleness, respect, and pacing. Nothing is forced. Brian had learned to force the world around him to accept him and cooperate. We treated his resistance as protective intelligence, not something meant to be broken through.
• – Unity reflects the idea that mind, body, emotions, and relationships are inseparable. Symptoms are understood in context, not in isolation.
• – Mind-body holism recognizes that beliefs and emotional learnings are encoded somatically—in posture, tension, breath, and reflexes—not just in thoughts.

How Hakomi Works

In practice, Hakomi works experientially. The therapist observes body cues (changes in breathing, posture, facial expression). An experienced anxiety therapist may offer experiments—such as a gentle statement (“You don’t have to do this alone”) or a small physical prompt—to evoke implicit beliefs. The client’s spontaneous responses reveal core organizing themes, often formed early in life.

A key goal is core belief transformation. Once an implicit belief (for example, “I’m on my own” or “My needs are too much”) becomes conscious, new experiences—called missing experiences—are offered to allow the nervous system to update.

Hakomi is especially useful for complex and developmental trauma, attachment wounds, chronic or high-functioning anxiety, shame, and relational patterns. The focus is on deep structural change through awareness of sensations in the body and the emotions and thoughts that follow.

In short: Hakomi helps people discover how they learned to be the way they are and then offers the nervous system a chance to learn something new—safely and gently.

I’ve had remarkable results with holistic, body/mindfulness approaches like Hakomi. While Brian and I are still working together, it has been fascinating to observe his growth and the differences that have occurred in his thinking and behavior since we began. He remains a warrior, just not so much with himself. His sense of humor has emerged.

High-Functioning Anxiety Doesn’t Have to Define You: Final Thoughts

If you or someone you love is struggling with high-functioning anxiety, get help. Even if that someone is a high performer and seems successful from all outward appearances, it can be liberating to ask for help. Especially with the presence of loneliness, poor social adjustment, and isolation.

Anxiety therapy can create new paths to satisfying adult health and bring fresh success to difficult relationships. It’s a wise investment and may take time, but the payoff can be priceless.

I would love to help. Call or text me at 561-213-8030 or email me at jdlmhc@gmail.com for a consultation.

Explore Holistic Solutions Through High-Functioning Anxiety Therapy in Delray Beach

High-functioning anxiety often looks like success on the outside while stress, overthinking, and pressure build internally. Anxiety therapy can help you slow the constant mental drive, calm your nervous system, and feel more at ease, without losing your motivation, competence, or sense of purpose.

When high-functioning anxiety goes untreated, it can quietly shape how you relate to others, set boundaries, and respond under pressure. Therapy offers a supportive space to understand the patterns that keep anxiety running in the background and to develop healthier ways of coping that don’t rely on self-criticism or constant productivity. At my counseling practice in Delray Beach, FL, I help clients replace anxiety-fueled habits with practical, holistic tools that promote emotional balance, clarity, and sustainable well-being.

Here’s how anxiety therapy can support you:

• 1. Identify the underlying thought patterns and nervous system responses that drive high-functioning anxiety in a calm, judgment-free setting. Schedule a consultation to get started.
• 2. Learn evidence-based strategies to manage overthinking, perfectionism, and chronic stress while building emotional regulation with an experienced anxiety therapist in Delray Beach, FL.
• 3. Create a more grounded, fulfilling life, where calm, confidence, and self-compassion can coexist with ambition and success.

Other Services John Davis Counseling Provides in Delray Beach, Florida

Anxiety therapy can help you step out of constant overdrive and develop healthier ways to manage stress, overthinking, and internal pressure. With the right therapeutic support, many clients begin to feel more grounded, emotionally balanced, and better equipped to handle daily demands, without relying on perfectionism or pushing through exhaustion.

High-functioning anxiety often overlaps with other concerns, which is why treatment is most effective when it considers the whole person. In addition to anxiety therapy, my Delray Beach practice offers trauma-informed counseling, relationship therapy, couples therapy, grief support, addiction treatment, and care for individuals navigating ADHD/ADD, impulse-control challenges, spiritual concerns, and narcissistic personality dynamics.

Each treatment plan is thoughtfully customized to reflect your personal history, stress patterns, and long-term goals. I use an integrative, evidence-based approach that may include CBT, EMDR, Gestalt therapy, mindfulness-based strategies, psychodrama, or clinical hypnosis—selected to calm the nervous system, reduce anxiety-driven habits, and support lasting emotional resilience.

My goal is to help you build sustainable coping strategies, strengthen emotional flexibility, and reclaim a greater sense of calm and stability in your everyday life. I invite you to explore my blog for additional mental health resources or contact my Delray Beach office to schedule a consultation when you’re ready to begin therapy.

About the Author

John Davis, LMHC, is an experienced anxiety therapist in Delray Beach, FL, who specializes in helping individuals recognize and manage anxiety. Especially forms like high-functioning anxiety that can quietly impact daily life. With a clinical background in child and family therapy, John brings a lifespan perspective to his work, understanding how anxiety patterns develop early and continue to influence emotional regulation, confidence, decision-making, and productivity in adulthood.

John practices from a trauma-informed, integrative framework, using various evidence-based approaches. His focus is on helping clients uncover the underlying drivers of anxiety, shift entrenched patterns of overthinking or avoidance, and develop practical skills that support clarity, calm, and sustainable well-being. In addition to his clinical work, John serves as Executive Director of the Mental Health Counselors’ Association of Palm Beach, has received the Outstanding Community Service Award, and is featured as an expert therapist on StayMarriedFlorida.com. Through his practice, John remains committed to helping clients build more grounded, resilient lives—one session and one skill at a time.