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When high performance masks anxiety

Outward success can sometimes mask inner turmoil. High performing, or functioning, anxiety, is a mental health challenge which has been recognised only relatively recently — but it can lead to significant levels of distress.

The hallmark of this often severe mental health challenge is that people who are affected continue to function effectively, and are able to mask their symptoms from colleagues and family. And because they have developed extensive coping mechanisms, their productivity and work performance often places them among the top performers in an organisation.

There is evidence of some advantages to anxiety. Researchers at the French Institute of Health and Medical Research found that anxious people process threats more quickly and differently, using regions of the brain responsible for action — which could, theoretically, give them an edge in business.1

Unprecedented stress

As the Bupa Global Executive Wellbeing Index shows, the pandemic has been a tipping point for many executives and Dr Humber says, “There is no doubt that the fallout from the pandemic has been disproportionately felt, with some managers coping with immeasurable and unprecedented amounts of stress and pressure.

“They have been forced to make decisions at pace, on a day-to-day basis, while working around the clock. And many senior managers have also had to make major personnel and structural changes which are, in and of themselves, hugely stressful.”

Supporting the mental health and wellbeing of their teams has been a priority, but Dr Humber says many executives are failing to protect their own mental health — and this is undermining their ability to maintain prolonged peak performance.

Strengths can be vulnerabilities

As the Bupa Global Executive Wellbeing Index confirmed, many executives are attuned to these personal mental health challenges and take positive steps to manage their psychological wellbeing. More than a third (36%) have sought professional help, 44% have explored relaxation techniques and a third (33%) have practised mindfulness and meditation.4

But, to some extent, it is the qualities which make them strong leaders which also make senior executives vulnerable to mental health issues. Dr Humber explains, “They are often perfectionists, who set high standards for themselves, and when they notice a few red flags going up in relation to their mental health they see that as part and parcel of the job.

“If they feel any sense of anxiety or symptoms of mental ill-health, they often put their foot on the gas and push themselves even harder. Work becomes an unhealthy coping strategy.”

Importance of trust

There are also very few people around senior executives who have experience of the pressures they face and knowledge of specific business challenges. “Trust is also a factor. Who can they trust with this very sensitive and personal information?”


Dr Humber suggests developing discrete packages of resilience monitoring and input from different professionals who are trusted, and able to recognise any individualised warning signs, triggers, risk and need.


Important components of this could be mental wellness resources such as Healthy Minds — a 24/7 confidential telephone support line providing access to a counsellor who is trained to listen and provide on a range of issues that can go beyond work. There are also anonymised services such as Silvercloud — evidence-based online support which can easily fit into frenetic work schedules.

She believes business can also learn from competitive sport. As Liz Nicholl, the former CEO of UK Sport and President of World Netball, says, “High performance cultures have a reputation for being ruthless in their drive for top results, but getting the culture right is key to getting the best performance from people.”5

Dr Humber agrees, “It's not only about mental health, it's about resilient performance by keeping agile and fresh.”

Supporting You


2 Bupa Global Executive Wellbeing Index, UK data

3 Bupa Global Executive Wellbeing Index, UK data

4 Bupa Global Executive Wellbeing Index, UK data

5 Bupa Wellbeing Edit 2017

Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales No. 3956433. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Arranged and administered by Bupa Insurance Services Limited, which is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales No. 3829851. Registered office: 1 Angel Court, London EC2R 7HJ

Bupa Health Trusts are administered by Bupa Insurance Services Limited. Registered in England and Wales No. 3829851. Registered office: 1 Angel Court, London EC2R 7HJ © Bupa 2024

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