EMDR for High-Functioning Anxiety
Everything’s working right? You handled what you said you would and you followed through with whatever complicated things other people brought you because they knew you’d take care of it. Nobody knows that you were up till 2 in the morning thinking about the one awkward thing you think you said the previous day or that your shoulders have been up your ears like a turtle since last Tuesday.
Anxiety like this can go untreated for years because it often isn’t impacting anything that anyone else can see, just you on the inside. It costs you sleep, patience, and the ability to sit through a movie without picking up your phone. EMDR is one of the approaches that can help address it.
What high-functioning anxiety feels like from the inside
Wired and worn out at the same time. You move fast all day, and by evening you're too tired to enjoy anything and too keyed up to fall asleep. Rest feels like something you have to earn. And by the way, you’re never going to feel like you’ve earned it.
There’s a running commentary goes along with it. You should have caught that sooner. Everyone else is dealing with this better. If you slow down, they'll find out that you’ve just been faking it. None of that ever gets said out loud, and most of the people around you, even the ones that care the most, may never know what’s going on inside your head.
It’s going to show up in your body before it shows up anywhere else: a jaw that’s hurting by afternoon because you’re grinding your teeth, sleep that hasn’t been restful in months, a nauseous feeling in your stomach that is there before you’ve even noticed there’s an issue. What makes this so hard to treat is that the anxiety works. It’s gotten results your whole life, so trying to get it to go away or at least be less, feels like self-sabotage.
Why simply understanding the pattern doesn't change it
By the time someone comes to therapy dealing with something like this, they can usually explain the whole mechanism and processes themselves. They've read about perfectionism, they can give details where it started, and they know their reaction to a short text that says "can we talk later" is well out of proportion to the text. None of that knowledge has changed what happens internally when that message comes through.
The anxiety alarm lives deeper in the nervous system than what most people’s language can reach. It’s often formed in infancy, before we have any sort of ability to deeply understand our feelings much less express them effectively. Insight gets to move through the thinking and logical part of the brain, while the threat response gets sent through the older wiring where it learned to react through experience.
Somewhere in that system, it learned that even the tiniest slip can have dramatic consequences. Maybe a parent got excessively angry about a grade on your report card. Maybe you were the kid who had to keep the house calm so nothing escalated into something dangerous. Were you possibly the one who noticed when something was about to go wrong, and being able to be right about it kept everyone safe? Those seemingly small moments got stored, and your nervous system has drawn some conclusions from them: stay ahead of it and you’ll be ok. Decades later, the conclusion is still active, and no amount of reasoning has been able to talk it down.
What EMDR is, in plain terms
EMDR stands for Eye Movement Desensitization and Reprocessing. Psychologist Francine Shapiro developed it in the late 1980s, and it has since become one of the most studied treatments for PTSD, with endorsements from the World Health Organization and the American Psychological Association.
In session, you bring up a specific memory as well as the emotions, beliefs, and thoughts that go with it while focusing on something like the therapist's hand or a dot on the screen, sometimes through tapping from one side of the body to the other, which we call bilateral stimulation or dual attention stimulus. The back-and-forth attention, paired with the memory, appears to let the brain finish processing something it filed away while it was unfinished.
The memory doesn’t disappear; you still remember the event afterward. What changes is the charge or intensity attached to it. People describe recalling the same moment without the drop in the stomach or terror that used to show up.
"But I don't have trauma"
This is one of the most common objections to doing EMDR. It usually is because the definition of trauma that someone has heard is too narrow. EMDR doesn't require one catastrophic event to work with. It also works on an accumulation of things: the years of being noticed only when you “produced” or did something big to make someone proud, the household where anger showed up unpredictably, the stretch of months when every crisis in your family was put through you and nobody thought to ask how you were holding up.
Those experiences may sound unremarkable just talking about them, and maybe not many people would call them trauma around the dinner table. But they still taught your body about what happens when you’re not ahead of things, and unfortunately that still gets activated every time you sit down to rest.
Choosing what to target
EMDR works best on specific memories, which raises a fair question when the anxiety has no obvious starting point, at least one doesn’t jump out at you. Almost nobody comes to therapy able to name the moment they learned to stay ahead of everything. So, we can start from the present instead, with a recent moment when the anxiety spiked hard: the text that said, "can we talk later," the pause after you asked for something, the hour you lost to a conversation that ended fine.
From there your therapist works backward. You hold that present-day reaction in mind and follow the feeling to earlier moments where your body did the same thing. What surfaces is usually undramatic and often surprising, a specific afternoon or the look on somebody's face or a sentence someone said once and they had forgotten about by dinner. Whatever arrives tends to hold the beginnings of the belief sitting underneath the anxiety, some version of I'm only okay when I'm ahead of it, or something bad happens when I stop being on guard.
The belief is what gets processed. Patterns like this are usually held up by a handful of memories, so reprocessing a few of the anchors tends to loosen the whole set, and a course of EMDR for anxiety with no single obvious event often runs shorter than people expect. The step-by-step of how a session itself is structured is covered on our EMDR page.
What actually changes
Through EMDR, and therapy more generally, your personal standards don't disappear, and neither does your ambition. People who finish EMDR for high-functioning anxiety usually still care a great deal about doing things well, and they still hold themselves to a high bar. What changes is how much pain and suffering they experience maintaining that standard.
The two-in-the-morning replays slow down, Sunday evening loses some of its dread, and somebody else's bad mood stops feeling like your problem to solve. The change tends to show up in small places first, in things people notice before they can explain them: staying present through dinner, sleeping straight through the night, taking a Saturday off without the guilt that used to make rest feel like something they were getting away with.
Other Suggested Blog Posts: The Trauma Spectrum, The Unexpected Signs of Trauma, Hyper-independence as a trauma response
Written by Hunter Cook, MSML, LPC/MHSP (S), LPC, LCMHC
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