Matthew Sexton, LCSW — Telehealth in NY, FL & ME
Therapy for High-Functioning Anxiety
You look like you are crushing it. You are white-knuckling every day.
You are the one everyone counts on. The one who always delivers, always answers the email, always looks like they have it together. And privately — you cannot sleep, you cannot sit still, your stomach is a mess, and the word “relax” has started to feel like a language you do not speak. High-functioning anxiety is a real clinical pattern, and it is treatable.
Telehealth available in New York, Florida, and Maine
The Clinical Picture
High-Functioning Anxiety Is Not a Personality Trait
“High-functioning anxiety” is not a formal DSM diagnosis — but clinicians who work with high-achievers see the pattern constantly. It most often maps to generalized anxiety disorder, adjustment disorder, or chronic occupational burnout, showing up in people whose external functioning keeps the internal distress hidden from everyone, often including themselves.
The catch is that the anxiety and the achievement are tangled together. The same vigilance that drives your performance is also what will not let you sleep. The same perfectionism that got you praised is also what leaves you exhausted at 10 PM rewriting a presentation nobody asked you to revise. Treating one without addressing the other usually does not hold.
“You can be good at your life and still not be okay inside it. Both things can be true at the same time, and the second one deserves treatment even when the first one is still intact.”
How It Actually Shows Up
The Patterns of High-Functioning Anxiety
The presentation is consistent enough to recognize. If several of these feel uncomfortably familiar, you are not imagining it and you are not alone in it.
Chronic Perfectionism
The standard is never quite met. Good enough feels like failure. You re-read the email four times, rework the deck at midnight, and treat every small mistake as evidence of a larger problem with you. Perfectionism is a coping strategy that eventually becomes the source of the distress.
The Inability to Delegate
You cannot hand things off. Not because you do not trust your team — because letting go of the task feels like letting go of the thing that keeps you safe. The workload is unsustainable and you are the reason it stays that way.
Somatic Symptoms
Stomach issues that no GI workup can explain. Clenched jaw, tension headaches, chest tightness, shallow breathing, a body that will not fully unclench even when nothing is wrong. The anxiety is not only in your head — it is living in your nervous system.
Sleep Dysregulation
You fall asleep fine and wake at 3 AM with your mind already running the day. Or you cannot wind down at all, scrolling past midnight, waking exhausted, pouring coffee into the deficit. Sleep becomes another performance you are failing at.
The Praise and Exhaustion Loop
People keep telling you how impressive you are. How reliable, how capable, how together. The praise is real — and it lands on someone who is privately running on fumes. The gap between how you look and how you feel becomes its own form of loneliness.
Social Masking
You perform fine at the dinner, the meeting, the family event. You say the right things, laugh at the right times, and drive home with your shoulders at your ears. The mask is so practiced you are not always sure what is underneath it anymore.
The Clinical Work
How We Actually Treat It
Nervous System Mapping
Before we change anything, we learn what your nervous system is actually doing. When it revs up, what it is defending against, which situations drop you into fight, flight, freeze, or fawn. You cannot regulate a system you cannot read.
Dropping the Productivity-as-Identity Loop
High-functioning anxiety is often held in place by a single belief — that your worth is your output. Therapy gently surfaces that belief, traces where it came from, and helps you build a self-concept that does not require constant achievement to stay intact.
Somatic Regulation
Insight alone does not calm a body that has been on alert for years. We work with breath, posture, interoception, and titrated rest — practical skills for actually downshifting, not just understanding why you should. The goal is a body that knows how to stand down.
Cognitive Defusion from Achievement Narratives
Drawing on ACT and cognitive therapy for anxiety, we create space between you and the relentless achievement story in your head. You do not have to delete the drive — you get to stop being driven by it. There is a meaningful difference.
Who This Practice Serves
The “Everyone Says I Have It Together” Demographic
High-functioning anxiety does not discriminate by industry, income, or gender — but it clusters in the people who were rewarded early for being responsible, competent, and easy to rely on. If the list below reads like a description of your week, this page is for you.
Your Therapist
Matthew Sexton, LCSW
Licensed Clinical Social Worker · High-Achiever Anxiety & Burnout
Matthew Sexton is a Licensed Clinical Social Worker in private practice. His work focuses on high-complexity clinical presentations in people who are functioning well externally — including high-functioning anxiety, achievement-driven burnout, perfectionism, and the kind of chronic overfunctioning that does not show up until the body forces the issue.
Sessions are available via telehealth to clients located in New York, Florida, or Maine at the time of service. Private pay — a SuperBill is provided on request for out-of-network reimbursement.
Common Questions
Objections We Hear All the Time
If I am still functioning, do I really need therapy?
Yes, and arguably sooner than someone whose functioning has already collapsed. Waiting until you cannot get out of bed is a strategy — it is just a very expensive one. Treating high-functioning anxiety while you are still functioning is how you avoid the version of this where you are not.
Will therapy take away my drive?
No. The goal is not to make you ambitionless. The goal is to separate your ambition from the anxiety that has been fueling it, so you can keep the parts of your drive that feel like you and lose the parts that are running you into the ground.
How do I rest without falling apart?
That is one of the core questions of this work. If your nervous system has been on for years, rest can initially feel like danger — and that is clinical information, not a character flaw. We work on tolerating rest in titrated, manageable doses before we ask your body to trust it.
I do not look anxious. Are you sure this is it?
High-functioning anxiety is specifically the version that does not look like it. The textbook picture is a pacing, visibly-distressed person. The more common picture is the composed one at the conference table whose stomach is in knots. Looking fine is part of the diagnosis, not evidence against it.
Getting Started
Begin the Work
Reach Out
Use the contact form or send a direct message. Matthew responds personally — no intake coordinators, no answering services.
Free Consultation
A 15-minute call to understand what is actually going on, answer your questions, and confirm we are a good fit before committing to anything.
Start Sessions
Telehealth via secure video. Weekly to start. Private pay — SuperBill available on request for out-of-network reimbursement.
Clinical Foundations
The Work Is Grounded in the Literature
The approach on this page draws on established clinical and research traditions for anxiety, burnout, perfectionism, and the relationship between achievement and exhaustion. A short, non-exhaustive list of foundational sources:
- Maslach, C., & Leiter, M. P. Work on the three-component model of burnout (emotional exhaustion, depersonalization, reduced personal accomplishment) and the occupational conditions that produce it.
- Schaufeli, W. B., and colleagues. Research on work engagement, workaholism, and the relationship between high engagement and exhaustion in high-performing populations.
- Bandura, A. Foundational work on self-efficacy and how achievement-contingent self-concept shapes stress responses.
- Hayes, S. C., and colleagues. Acceptance and Commitment Therapy (ACT), including cognitive defusion and values-based action as treatment for experiential avoidance.
- Beck, A. T., and the cognitive tradition. Identification and modification of cognitive distortions in anxiety disorders.
This list is informational only and does not constitute an endorsement by the cited authors of any individual clinician or practice. Treatment decisions should be made with a qualified provider who can evaluate your specific situation.
Mental Wealth Solutions provides individual psychotherapy and mental health consulting. This page is for informational purposes and does not constitute medical advice. Matthew Sexton, LCSW is licensed in New York, Florida, and Maine. Telehealth services are provided to clients located in those states at the time of service.