Therapy for High-Functioning Anxiety in California
Anxiety therapy for high performers whose overthinking hides inside the habits that make them good at their job.
Everyone Thinks You Have It Handled.
You reread the email four times before you sent it.
Then you reread it once more in your sent folder, looking for the thing you missed.
You replayed the conversation from Tuesday on the drive home, and again at 2:00 a.m., and you have a fairly specific theory now about what the pause before their answer meant. You checked the document again even though you already checked it. You asked someone whether it was fine, they said it was fine, and the relief lasted about nine minutes.
Here is the part that makes this so hard to see for what it is: all of that is rewarded. Catching mistakes, anticipating problems, preparing for the difficult question before anyone asks it. You aren’t anxious in spite of being good at your job. Some of what you call being good at your job is the anxiety doing overtime.
This is what people mean by high-functioning anxiety. Nothing has fallen apart. Your reviews are good, your work is solid, and privately you’re bracing at all times for something to go wrong.
What high-functioning anxiety looks like
Most anxiety descriptions were written for a version of anxiety that stops someone in their tracks. That version is real. It isn’t the version most of my clients arrive with.
What I see more often looks like this: constant low-level scanning for what could go wrong. Difficulty stopping work even when there is nothing urgent, because stopping means the thoughts have room. Reassurance seeking, which feels like diligence and functions like a compulsion, because the relief is temporary and the need comes back stronger. Physical symptoms nobody connects to anxiety: jaw tension, chest tightness, stomach problems, a resting heart rate that is higher than it should be. Sleep that will not start because the brain has finally been left alone with itself.
And underneath it, quite often, a private conviction that you are one mistake away from everyone finding out you aren’t as capable as they think.
Sometimes this arrives instead as panic. A sudden surge of physical symptoms with no obvious trigger, often mistaken for a cardiac event the first time, followed by a persistent fear of the next one. Panic is treatable and it’s treatable quite reliably, which I say plainly because the fear of it tends to be worse than the thing itself.
Why “high-functioning” doesn’t mean “not serious”
I want to address the thing that keeps people from booking, because I hear it in almost every consultation call.
You’re functioning. Therefore, you assume this doesn’t count, or that you would be taking a slot from someone who needs it more, or that you should be able to manage something that isn’t actually stopping you from doing anything.
The ability to function isn’t evidence against an anxiety disorder. It’s evidence of a high tolerance for discomfort, which is a real strength and isn’t the same thing as treatment. People with high-functioning anxiety often carry more distress than people whose anxiety is visible, precisely because nobody around them has any idea, and so nobody is adjusting anything.
You don’t have to be failing at something to benefit from help with it.
How I work with anxiety
I use cognitive behavioral therapy as a foundation, and for anxiety specifically, that means the work has structure to it.
We start by getting concrete. Anxiety is famously bad at being specific, and describing it as “I’m just anxious all the time” is accurate but not workable. So we find out when it spikes, what it does to your body, what you do in response, and what happens next. That last part matters more than it sounds.
Because the central mechanism of anxiety is this: the things you do to reduce it in the moment are what keep it going. Checking, rehearsing, over-preparing, seeking reassurance, avoiding the meeting, mentally running through the disaster to feel ready for it. Each one produces a genuine drop in discomfort. Each one teaches your brain that the threat was real and that you narrowly escaped it. That is why anxiety tends to grow in the exact places where you are working hardest to manage it.
So a lot of the work is identifying those behaviors and deliberately, gradually, doing less of them. Sending the email after two reads instead of five. Not asking for the reassurance. Sitting with the discomfort long enough for your nervous system to learn something new, which it cannot do when you keep rescuing it.
Alongside that, we do the cognitive work, which isn’t positive thinking. It’s examining what you actually predict will happen, testing whether it does, and getting more accurate rather than optimistic. And we address sleep, because anxiety and insomnia reinforce each other and neither one settles while the other is running.
If panic is in the picture, we use exposure, which means deliberately and safely producing the physical sensations you’re afraid of so they stop being alarming. It sounds unpleasant, and it’s remarkably effective.
Why I see so much of this
I’m a former attorney. I passed the California Bar, practiced employment defense litigation, and then became a therapist, and a large part of my practice is lawyers and other high-achieving professionals.
Anxiety is close to structural in that population. The training itself selects for it and then sharpens it. You are taught to identify every way a thing could fail, to prepare for the worst version of the question, to never be caught unprepared. That isn’t a bug in a litigator; it’s the job. The trouble is that the same cognitive machinery doesn’t distinguish between a deposition and a text message from a friend that just says “can we talk.”
Add an environment where any admission of struggle feels professionally risky, and you get a lot of very anxious people who have never said so out loud to anyone.
You don’t have to be a lawyer for this page to be about you. Anxiety works the same way in physicians, founders, academics, and anyone else whose competence is their identity.
What I don’t do
I don’t do vague, open-ended anxiety therapy that consists of talking about how the week went without direction. I don’t hand out relaxation techniques alone as a treatment plan.
I do not prescribe medication. I am not a physician. Medication helps a great many people with anxiety, and if it seems worth exploring, I will say so and coordinate with your prescriber or help you find one. The research on combining CBT with medication is good, and it is genuinely your call.
Getting started
All sessions are by secure video for clients located in California, Washington, D.C., and Virginia. Sessions are also available in Spanish. Evening availability exists.
The first step is a short consultation call. We talk about what the anxiety looks like for you, how long it has been going on, and what you want to be different. There is no pressure attached to it, and if I’m not the right fit, I will tell you and point you toward someone who is.
Frequently Asked Questions
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Stress is a response to a specific demand and it resolves when the demand does. Anxiety persists past the trigger, generalizes to things that are not threatening, and produces behaviors designed to manage it that end up organizing your life. If you are still scanning for problems on a quiet Saturday afternoon, that’s worth noticing.
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Only to the extent it’s useful. My approach is present-focused and practical. Sometimes understanding where a pattern started helps it loosen, in which case we go there. I’m not going to spend a year on it as a matter of principle.
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Yes. Panic has one of the strongest evidence bases in all of psychotherapy and responds well to a specific CBT protocol. Most people are surprised by how treatable it is.
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That is most of my practice. Anxiety that doesn’t impair your performance is still anxiety, and it often costs more privately than the visible kind, precisely because nobody around you has any idea. You don’t need to be failing at something to benefit from help with it.
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Yes. A large part of my practice is attorneys because of my background, but I work with high achieving professionals across many fields. The anxiety pattern is very consistent regardless of industry.