Thriving Under Pressure: 7 Proven Strategies High Performers

Introduction – Anxiety

Whether you’re a high level executive, pro athletes or C-suite executive, if you are dealing with anxiety and stress, you’re not alone. The same qualities that have fueled your success can also make you more vulnerable to chronic stress and self-imposed pressure.

There are proven treatments that not only reduce anxiety but also improve performance, emotional clarity, and long-term resilience.

In this article, you’ll learn how anxiety shows up in professionals, why generic solutions often don’t work, and the most effective, research-based treatments tailored for people like you.

Anxiety in high-achieving professionals often hides behind productivity. It can show up in ways that look like dedication or ambition, but underneath, there’s often:

• Constant overthinking or second-guessing
• Trouble turning off your mind, even on weekends
• Difficulty relaxing or sleeping
• Fear of failure or letting others down
• Irritability, restlessness, or a short fuse
• Physical symptoms like fatigue, jaw clenching, unease, or muscle tension

This type of anxiety is often linked to deeply held beliefs like:

• “If I slow down, I’ll fall behind.”
• “I can’t show weakness.”
• “I’m only as good as my last win.”

These thoughts may drive short-term performance but often lead to burnout, disconnection, and emotional exhaustion over time.

Why Typical Anxiety Advice Falls Short

Has anyone every said to you “just relax,” “take a break,” “meditate”, “don’t stress?? This misses the mark for professionals who operate in high-stakes environments.

You don’t want to step away from your career. You want to show up more effectively and with more clarity. That’s why the best treatment isn’t just about stress relief. It’s about helping you operate from a place of strength rather than survival.

What Actually Works for Anxiety: A Targeted Approach for Highly Successful Professionals

Here’s what effective anxiety treatment looks like for professionals in leadership, tech, finance, medicine, law, the arts, professional sports or entrepreneurship:

1. Cognitive Behavioral Therapy (CBT)

CBT is the gold standard for anxiety treatment. It helps you recognize and change unhelpful thought patterns that fuel worry and perfectionism. In treatment, you’ll learn to:

• Identify anxiety-driven beliefs
• Challenge assumptions like “I must always be in control” or “I need the stress”
• Reframe your thinking to reduce reactivity and build mental flexibility

CBT is active and collaborative. So many people who come to my office say they have been in therapy off and on for years. However, they got frustrated. They just talked. However, with structured CBT, you don’t just “talk”, but you learn tools and strategies for thriving and feeling better. 

2. Schema-Focused Therapy

High achievers often develop early and long-standing patterns called schemas. Schemas are the ways that we view ourselves and the world. And, can be very challenging to change. However, with the right treatment, your schemas can improve. Schemas shape adult behaviors. These might include:

• Unrelenting standards: Feeling you must always do more or do better
• Defectiveness: A belief that you’re fundamentally flawed and must hide it
• Emotional inhibition: Struggling to show vulnerability or ask for support

Schema therapy works by identifying and reshaping these lifelong patterns. This deeper work can lead to lasting change, especially for those who feel stuck despite success.

3. Performance Coaching

Many professionals benefit from integrating coaching with therapy. Coaching provides:

• Structure and accountability
• Executive function strategies
• Communication tools
• A bridge between insight and action

Performance coaching is about applying what you learn to real-time challenges at work and in life.

4. Mindfulness and Grounding Techniques

Techniques like breathwork, box breathing (used by Navy SEALs), and present-moment awareness are essential tools for calming the nervous system.

One simple and proven method I often teach is counting the breath: Close your eyes and, on each exhale, imagine a number drifting outward. Exhale longer than you inhale. Count from 1 to 10, and if your mind wanders, start again at 1. Practicing this for even five minutes a day can improve clarity and reduce reactivity.

These tools help in the moment—before meetings, presentations, or high-pressure decisions.

5. Anxiety Medication (When Appropriate)

Often, medication can play a key role. This is especially true if anxiety is chronic, interfering with sleep, or causing physical symptoms. Medications like SSRIs, SNRIs, or beta-blockers may be considered depending on the situation. The goal is never to “numb out,” but to reduce symptoms enough to engage fully in therapy and in life. Anxiety medications are also often called anti-anxiety drugs or anti-anxiety meds.

When I prescribe medication, I do so carefully and collaboratively, always considering your lifestyle, goals, and potential interactions with work demands.

Case Example*

David*, a 43-year-old finance executive, came to treatment after a colleague noticed his irritability and lack of focus. At home, he felt emotionally distant. At work, he was successful but anxious all the time. Through a combination of CBT and schema therapy, he uncovered a core belief: “If I’m not perfect, I’ll lose everything.”

We worked to challenge that belief, build emotional awareness, and practice performance-grounding techniques. Over time, David felt more focused, engaged, and capable of responding rather than reacting. He learned how to relax without feeling guilty and lead without carrying the world on his shoulders.

Final Thoughts on Anxiety: You Don’t Have to Choose Between Excellence and Peace

Anxiety doesn’t have to be the tradeoff for achievement. The best treatment for high-performing professionals is one that combines insight, strategy, neuroscience, and performance coaching. Comprehensive treatment can help you thrive with the stress of your high-powered career.

I work with professionals in such fields as finance, technology, entrepreneurs, professional athletes, C-suite executives, and engineers across New York and New Jersey offering integrated treatment that includes therapy, coaching, and when appropriate, medication. Whether you’re seeking clarity, control, or greater fulfillment, we’ll work together to create a plan that fits your life.

Visit scottshapiromd.com to learn more or schedule a confidential consultation.

Frequently Asked Questions about Anxiety (FAQ)

What kind of anxiety do high level executives experience?

Most experience a mix of performance anxiety, perfectionism, fear of failure, and chronic stress. It often shows up as racing thoughts, overworking, irritability, insomnia, or feeling emotionally distant—even during periods of success.

Can anxiety affect my professional performance?

Yes. Anxiety can make it harder to focus, make decisions, collaborate effectively, and maintain creativity or long-term motivation. Left unaddressed, it can lead to burnout or missed opportunities.

What treatments work best for high-achieving professionals?

The most effective treatment combines:

• Cognitive Behavioral Therapy Anxiety Disorders for reducing anxious thought patterns
• Schema-focused therapy to address deeper patterns
• Performance coaching for executive functioning and leadership
• Mindfulness and grounding tools
• Medication (anxiety pills), when needed

This tailored approach not only reduces anxiety but enhances clarity and performance.

Will therapy interfere with my work schedule?

Treatment can be adapted to fit a busy lifestyle. Many professionals find that even one focused session a week leads to noticeable improvement in decision-making, stress tolerance, and overall well-being.

What’s the first step if I want help?

Start with a consultation. I offer evaluations and treatment for professionals throughout New York and New Jersey. You’ll leave the first session with insight and a clear plan forward.

Contact me at scott@scottshapiromd.com or 212-631-8010.

*Disclaimer:

This article is for informational purposes only and is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. The case example above is fictionalized to protect confidentiality. Always consult a licensed professional for questions about your specific situation.