Therapy for High-Functioning Anxiety
… to settle your busy, spiralling mind so you can actually live your life, rather than worry about it
High-functioning anxiety therapy based on CBT, ACT, and mindfulness - with me, Carina, an experienced & accredited but very warm & genuine CBT therapist. Online all over the UK and internationally (with some exceptions).
The high-functioning anxiety dilemma
Moment of honesty - I’m not a big fan of the term “high-functioning anxiety”…
Because it can invalidate the experience - who decides what “high-functioning” means when you feel like you're barely holding it together?
Because it might oversimplify the experience - we need context and nuance so we don’t miss important details and focus on the wrong things
Because it’s become a buzzword people use to try and sell you quick fixes
But for all intents and purposes, if you…
Find that your mind is always full of ‘what if’s
Worry and catastrophise about every little detail of life
Feel the need to have control over everything, and set impossibly high standards
Can never really switch off from your constantly busy and spiralling mind
Find it difficult to focus
Procrastinate or approach things inefficiently
Often feel tense, restless, even panicky, heart pounding, difficulty breathing - and exhausted
Try to get rid of your worries or your physical symptoms of anxiety - by distracting yourself or trying hard to calm down
Attempt to stay busy, always cover all your bases, stick to familiar things, people-please
You’re in the right place, and things can change.
Cognitive Behavioural Therapy for Anxiety
, I’m Carina, an accredited and experienced, but very human therapist, and I help those whose minds and bodies are exhausted from not only the constant worry and tension, but also from trying to hide them from the world and appear in complete control.
In CBT for high-functioning anxiety, we work with the worrying and the beliefs behind it, the physical anxiety symptoms and how you relate to them, and the things you (understandably) do to try and feel safer (which may or may be keeping you stuck). Bit by bit, we get you to a point where you worry less, understand your mind and body better, and feel more settled and balanced.
My main training is in CBT (Cognitive Behavioural Therapy), but I'm the therapist for those who've tried CBT for anxiety (or anything else), and it hasn't worked - as my blend of CBT is actually more Acceptance and Commitment Therapy (ACT) and mindfulness, plus neurodivergent-friendly and trauma-informed.
Stop living in constant urgency, and learn to relate to your mind and body in a wiser, kinder way.
There’s a link between high-functioning anxiety, fear of failure, and being a high-achiever
I’ve already exposed myself as someone who thinks that the label of “high-functioning anxiety” may not always be helpful - and one of the main reasons is that it lacks the context and nuance that’s needed when we talk about anything mental health-related. In fact, high-functioning anxiety rarely exists in isolation - it often overlaps with low self-esteem or OCD, which are all touched on in therapy for high-achievers.
So, I’ll try my best to explain, clearly and simply, what may be going on for you if you relate to what you’ve read so far. All of us humans go through certain experiences as we grow up - and these experiences massively influence how we see ourselves, other people, and the world (even if we’re not aware of it). These are our ‘core beliefs’, and alongside them, we also develop some general ‘rules’ we create for ourselves to feel safe in some way or another.
Because we’re never really taught to question the role of our beliefs and rules, we tend to buy into them and hold onto them pretty tightly - so, they paint the way we operate in the world - in big and small ways.
How high-functioning anxiety might manifest itself
Beliefs such as…
“I’m a failure”
“Other people are unpredictable”
“The world is dangerous”
“Worrying ensures I am always prepared and in control”
“Anxiety is the driving force behind my success”
Patterns of thinking and behaving such as…
Worrying a lot
Spending a lot of time planning and preparing
Refusing to delegate
Saying yes to everything
Procrastinating and avoiding doing things because you don’t know where to start and won’t get them done perfectly
Avoiding thinking about things because it’s too difficult
Trying to get rid of your difficult thoughts or feelings by staying busy and distracting yourself
Rules such as…
“If I don’t achieve, I am not worthy”
“If I express my needs, others will judge me”
“If I don’t do it, it won’t get done right”
“If I stop, everything will crumble and I’ll be exposed”
“If I don’t get everything done perfectly, my life will fall apart”
All this makes you utterly exhausted.
What therapy for high-functioning anxiety might look like
I’ll start by saying this is not about relaxing, emptying your mind, or calming down. It’s also not (only) a space to unload, vent, and explore. We do all of this, of course - we explore your experiences and beliefs, and we then also work on these in a way that honours them, not diminishes them, but also gently helps you get to a point where they don’t have as big an impact.
Cognitive behavioural therapy for anxiety involves discovering your beliefs and rules, understanding how they influence every facet of your life, and learning to break the vicious cycles that keep you stuck.
However, my specific blend of CBT leans heavily on ACT and mindfulness. Where ‘classic’ CBT may be at times be a little rigid in attempting to help you challenge your thoughts and beliefs by gathering evidence to the contrary, I’ll often approach things a little differently:
I might suggest we explore your values - the kind of person you want to be, and the kind of life you want to live - so that they can act as a compass (instead of the rigid rules you may have understandably developed and been living by).
I might get you to slow down and really start noticing what your mind comes up with moment by moment, and how you respond to it (instead of continuing to engage in worry spirals or acting in line with your rigid rules) - using mindfulness practices.
I might get you to understand your body and how your high-functioning anxiety shows up more deeply - so you know that it’s natural to feel anxious, you’re not in danger, and you don’t have to get rid of anxiety or continue to entertain it in order to do all the things that make your life meaningful.
Instead of engaging in debates about whether your thoughts and beliefs are true or not, I might help you zoom out, and give you tools to learn how to handle your thoughts and emotions more wisely - so you can discern what is truly helpful and what isn’t, and change your behaviour accordingly.
High-functioning anxiety therapy can help you…
Catch your mind worrying and not engage with it
Feel whatever emotion or sensation comes up without being terrified of it
Do things as best as you can and that be good enough (and trust others to as well)
Untangle your worth from your achievements and productivity (without compromising on your ambition)
Be present in your life and enjoy the little moments
Have more understanding and compassion for yourself
So that you can have…
Days with less urgency and rushing - taking things more slowly, taking breaks, truly resting
Relationships where you can express your needs, and trust others to do things
Projects and tasks you approach with consistency rather than procrastination and last-minute scrambling before deadlines
An identity beyond your achievements and productivity
A life in which you dedicate time do what really matters, and are fully present
Your High-Functioning Anxiety Therapist’s Values & Approach
Here’s the thing: I’m a former senior cognitive behavioural therapist in the NHS, a university supervisor, a mindfulness teacher, and I’ve worked in lots of different mental health services for many years, and also in academic research and healthtech. I also have 4 degrees (BSc Psychology, MSc Clinical Neuroscience, PGDip Psychological Intervention CBT, MSc Psychological Therapy).
But I think that all of that means squat if you don’t feel safe, heard, and understood by me. So, here’s what you can expect:
I use evidence-based, trauma-informed, affirming and inclusive approaches - CBT for anxiety; ACT, and mindfulness - no BS, airy-fairy stuff, and no cluelessness as to the systems, culture, dynamics, and trauma that shape the way humans operate
I have an understanding of good research - I’ll know when old approaches have been disproven, or when new exciting discoveries have been made
I have practised mindfulness personally since 2015, and have had my own therapy, mostly based on Acceptance and Commitment Therapy (ACT) - so I know what it’s like to be on both sides
Humanity (I’ll never pretend to have it all figured out)
Imperfection (because no one is, and those who try probably make terrible therapists)
Openness (about what’s working and what isn’t, about what’s really going on, about… everything)
Silly sense of humour (because sometimes that’s the only thing that makes sense)
Interested in working together? I’m so glad!
You deserve a life that feels like yours.
Having said that, I know reaching out can be a bit of a nerve-racking (and also amazing) step. So, because everyone’s different, here are your options to get started (and a more detailed overview below):
If you feel most comfortable starting in writing, contact me via this form
If you’d like to see if we click live, book a free 15-min consultation
If you’ve decided you want to go straight for an initial session to explore things in a bit more depth, book it below
Therapy sessions: £125/session
Book in week by week
How cognitive behavioural therapy for anxiety with me works…
(Optional): Reach out in writing OR have a free 15-minute intro call
Everyone’s different - some people prefer to get a feel in writing first, others want to see if they connect with someone live. Or you might even be ready to try a first session directly. Choose what feels right for you!
1
Initial session (up to 60 minutes), during which we’ll discuss:
Current difficulties, some background and history, & impact on your daily life
Goals & previous experiences of therapy (if any) - what was helpful and what wasn’t
How this all may link together & how ACT/CBT could help
What you need to make this work best for you
Your first between-sessions task
2
Ongoing sessions (45-50 minutes), during which we will:
Go deeper on our shared understanding of what may have led to development of your high-functioning anxiety, and what may be keeping it going (called a ‘formulation’), to use as a basis for your treatment plan
Use a variety of interventions (ACT/CBT/mindfulness) to support you in achieving your goals
Set a plan / agenda at the start of each session to keep us on track (but this is not fixed and we can adapt according to your needs)
3
Ending therapy (which we both agree on):
We will discuss ending therapy a few sessions before the final one (and we will of course agree on this)
It’s natural to feel a little apprehensive about ending, so we really think together if it’s ‘just’ this, or if we’ve actually missed anything
During this final session, or perhaps last two sessions, we will work together to produce a summary of important points and a plan for the future
FAQs
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It may be for you if you:
Worry and catastrophise about every little detail of life
Feel the need to have control over everything, and set impossibly high standards
Can never really switch off from your constantly busy and spiralling mind
Find it difficult to focus; procrastinate or approach things inefficiently
Often feel tense, restless, even panicky, heart pounding, difficulty breathing - and exhausted
Attempt to stay busy, always cover all your bases, stick to familiar things, people-please
Are tired of brushing it off or trying everything under the sun without anything changing
You’ve tried other approaches and they’ve left you feeling invalidated, confused, or stuck
You want a therapist who, while always being on your side, will sometimes gently call you up on your BS to help you move forward - using evidence-based approaches such as CBT, ACT, and mindfulness
You want to live more authentically and are willing to put in some work for this to happen
(and also, you can reach out in writing or book a free 15-min intro call to ‘vibe’-check :-)
It may not be for you if:
You want an open, explorative space with no structure, practical skills, exercises, or things to do between sessions
You want to get rid of your difficult thoughts and feelings altogether and only experience positives
You want an uber-’professional’, blank-slate kind of therapist who will nod in agreement to everything you say and never challenge you
You want a quick fix or expect that things will change by you attending a session a week and continuing as you are outside of it
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Short answer - almost. The only limitation is that I can’t offer therapy to clients based in the US or Canada due to licensing (and please note I work under UK jurisdiction, as I’m based and accredited in the UK).
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I’m online-based only at the moment - so all sessions take place on Zoom. I love online therapy as research shows it’s just as effective as in-person therapy, but we can work together even if we live miles apart, and you get the comfort and flexibility that comes with it. As long as we both have good cameras and microphones, we can recreate most, if not all, of what we would do in a therapy room. You get high-quality therapy AND you can show up in a familiar, comfy space, with a hot drink.
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ACT/CBT are goal-oriented and a therapy episode is usually completed in 3-6 months of weekly therapy sessions, but some people carry on for longer (we’re all different!)
The recommended frequency of therapy sessions is weekly - this is the ‘sweet spot’ frequency to allow for momentum to build but also allow for enough time for information to consolidate and skills to be practised between sessions
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My speciality is working with adult (18+) high-achievers whose fear of failure shows up as low self-esteem, fear of failure, self-doubt (as well as overthinking, anxiety, or OCD), and keeps them from living as their real, authentic selves.
I also have a particular interest and knowledge in working with people who are neurodivergent or LGBTQIA+.
And I also specialise in working with dog phobia - see here.
Having said that, I am highly trained in working with a range of mental health difficulties, including stress, depression, generalised anxiety disorder, panic disorder, health anxiety, social anxiety, low self-esteem, perfectionism, phobias, and post-traumatic stress disorder (PTSD).
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I generally do not work with people who present with severe and enduring mental health difficulties, including, for example, active symptoms of psychosis, or severe difficulties with emotional regulation - this is because such difficulties are best addressed in specialist services which consist of multi-disciplinary teams of clinicians.
Importantly and relatedly, I also do not work with people who are presenting with concerns related to their own safety or that of others - as in private practice I do not have access to professionals and facilities which would support managing such concerns, and therefore, it would be unsafe and unprofessional.
Finally, if I feel like your difficulties require a different kind of support than I can provide, I will always be honest with you and try to help you find the right support elsewhere.
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I am not set up to provide crisis support, so I am not able to respond to any urgent queries between sessions, nor am I able to work with people who have concerns about their own safety or that of others.
If you are having such difficulties and are in the UK, please call 999 or go to A&E. You can also contact your GP or local NHS mental health service for urgent support, contact the Samaritans on 116 123, text Shout to 85258, or use the Stay Alive mobile app.
If you are outside of the UK, please contact your local emergency services.
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I have quite a few, bit of a nerd here :-) The most relevant ones are my PgDip in Psychological Intervention (CBT) from the University of Surrey, which I then topped up with an MSc in Psychological Therapies from the University of Exeter, and my accreditation with the BABCP (British Association for Behavioural and Cognitive Psychotherapies) as both therapist and supervisor. I also completed the Mindfulness Teacher Training Pathway with The Mindfulness Network/University of Bangor.
But I also hold a BSc (Hons) in Psychology from the University of York, an MSc in Clinical Neuroscience from UCL, and plenty of experience - read more about me here
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The type of therapy I offer is evidence-based and structured, goals-oriented, and forward-focused.
We’ll do the in-the-moment stuff. But we’ll also go deeper, exploring both:
Beliefs (your fear of failure, vulnerability, proving yourself, or being your true self and not being accepted)
Wider context (the systems, culture, dynamics, and trauma that shape the way you’ve learned to cope)
We’ll spend time both exploring and using active interventions to help you unhook from the “I overthink everything” loop, so your true self has space to emerge and bloom.
Read more about ACT here.
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You’re definitely not alone! Talking to a complete stranger about your deepest thoughts and feelings can feel quite daunting when you think about it, and I really get that - and many clients tell me the same thing.
That’s why I offer a few options so you feel as comfortable as possible:
… and breathe. You may just have found a way to go from being constantly exhausted by your busy mind and attempts to appear in control to a life where you can dedicate time to what truly matters, beyond your productivity and achievements.
I’m here when you’re ready.