Part One of When Capable Women Cannot Switch Off
She arrives on time. She has completed the intake forms carefully. She can describe the problem clearly and may already have read several books, listened to podcasts, tried meditation, and learned how anxiety works.
She is successful at work, attentive to her family, and often the person others depend upon. From the outside, she appears to be coping well.
Yet she cannot switch off.
Her mind reviews conversations, anticipates problems, and prepares for every possible outcome. Her body remains tense even when nothing is immediately wrong. She may fall asleep from exhaustion but awaken in the early hours with her thoughts already moving. When people suggest that she slow down, she replies that she does not know how.
This is a common presentation among the high-performing women I see in my hypnotherapy practice.
High performance is not the absence of distress
“High-functioning anxiety” is not a formal clinical diagnosis. Nevertheless, the phrase describes an important experience: A person can remain highly productive while living with considerable internal anxiety.
Some behaviours associated with anxiety may initially contribute to achievement. Hypervigilance can look like excellent preparation. Fear of disappointing others can look like reliability. Perfectionism can produce meticulous work. Difficulty delegating may be interpreted as commitment.
These behaviours are often rewarded, making it difficult for the client—or those around her—to recognize their cost.
Over time, competence can become less of a freely chosen strength and more of a protective strategy. The person is no longer preparing simply because preparation is useful. She is preparing because not preparing feels unsafe. Rest becomes uncomfortable because vigilance has become familiar.
Why insight may not be enough
Many high-performing clients understand their anxiety very well. They know their fear may be disproportionate to the situation. They can identify unhelpful thoughts and may be able to offer themselves a more rational interpretation.
Yet anxiety is not created by conscious thought alone.
One contemporary neuroscience model describes anxiety in terms of an altered relationship between top-down and bottom-up processing. Top-down processes include reflection, planning, interpretation, and conscious regulation. Bottom-up processes include sensory information, bodily arousal, emotional responses, and rapid threat detection (LeDuke et al., 2023).
In a well-regulated system, these forms of processing work together flexibly. Under persistent anxiety, however, threat-related bodily and emotional signals may become so compelling that rational reassurance cannot fully settle them. The client may think, “I know I am safe,” while her body continues to respond as though something must be managed immediately.
This helps explain why telling an anxious person to think positively, stop worrying, or simply relax is rarely sufficient.
What hypnosis offers
The American Psychological Association’s Division 30 defines hypnosis as a state of consciousness involving focused attention, reduced peripheral awareness, and an enhanced capacity to respond to suggestion. Hypnotherapy refers to the therapeutic application of hypnosis to a medical or psychological concern (Elkins et al., 2015).
For the capable client who already understands her anxiety intellectually, hypnosis offers something different from further explanation. It creates an opportunity to experience calm, competence, uncertainty, and choice differently.
The research supporting hypnosis for anxiety is encouraging. Valentine et al. (2019) reviewed 17 controlled trials and found a mean weighted effect size of 0.79 at the end of treatment. In practical terms, the average participant receiving hypnosis experienced more anxiety reduction than approximately 79% of control participants. In the seven trials that included longer-term follow-up, the mean effect size increased to 0.99.
The researchers also found that hypnosis was more effective when combined with other psychological interventions than when used as a stand-alone treatment. This supports an integrative approach in which hypnosis complements rather than necessarily replaces other appropriate forms of care (Valentine et al., 2019).
A broader review of 49 meta-analyses also concluded that hypnosis has the potential to improve a range of mental and physical health outcomes. At the same time, the authors noted considerable differences in study quality and emphasized the need for stronger research into who benefits most, which treatment components are most important, and who may not benefit (Rosendahl et al., 2024).
Creating a different experience
During hypnosis, a client might rehearse completing a task without repeatedly checking it. She might imagine allowing someone else to help without experiencing that as a failure. She may notice the first signs of anxiety and respond with curiosity rather than immediately moving into problem-solving.
She might experience herself as prepared enough rather than perfectly prepared.
These are not merely new thoughts. They are imagined, emotional, and embodied experiences. The client has an opportunity to discover how it feels to respond differently before she is asked to do so in everyday life.
Hypnosis may also help the practitioner use the client’s existing strengths. The same ability to focus deeply, imagine future possibilities, notice subtle details, and become absorbed in a task can be directed toward therapeutic change.
The qualities that have contributed to anxiety may also become resources for healing.
From automatic competence to flexible competence
The goal is not to take away the qualities that have helped the client succeed. Her intelligence, conscientiousness, empathy, and ability to anticipate difficulties are genuine strengths.
The therapeutic task is to help those strengths become more flexible.
Preparation can remain available without becoming compulsive. Caring for others can coexist with receiving care. Achievement can be satisfying without determining worth. Rest can become a legitimate human need rather than something that must continually be earned.
For many high-performing women, healing does not mean becoming less capable. It means discovering that capability no longer has to be maintained through fear.
References
Elkins, G. R., Barabasz, A. F., Council, J. R., & Spiegel, D. (2015). Advancing research and practice: The revised APA Division 30 definition of hypnosis. International Journal of Clinical and Experimental Hypnosis, 63(1), 1–9. https://doi.org/10.1080/00207144.2014.961870
LeDuke, D. O., Borio, M., Miranda, R., & Tye, K. M. (2023). Anxiety and depression: A top-down, bottom-up model of circuit function. Annals of the New York Academy of Sciences, 1525(1), 70–87. https://doi.org/10.1111/nyas.14997
Rosendahl, J., Alldredge, C. T., & Haddenhorst, A. (2024). Meta-analytic evidence on the efficacy of hypnosis for mental and somatic health issues: A 20-year perspective. Frontiers in Psychology, 14, Article 1330238. https://doi.org/10.3389/fpsyg.2023.1330238
Valentine, K. E., Milling, L. S., Clark, L. J., & Moriarty, C. L. (2019). The efficacy of hypnosis as a treatment for anxiety: A meta-analysis. International Journal of Clinical and Experimental Hypnosis, 67(3), 336–363. https://doi.org/10.1080/00207144.2019.1613863