Neuro magnifico! An exploratory study critically reviewing news text reporting of anxiety-related work performance strengths,challenges and support measures

Abstract

BACKGROUND:

Progressive workplaces should be aware of emerging neurodiversity related issues. People are sharing their narratives of high functioning anxiety in a variety of forums. Despite news text reporting upon this phenomenon, the concept has managed to escape a research spotlight.

OBJECTIVE:

To critically investigate the evidence base of news article reporting of anxiety-related work performance strengths, challenges and support measures.

METHODS:

Thematic analysis was applied to news texts derived from CrossSearch database and internet enquiries and journal articles obtained from Scopus, Medline and Science Direct databases.

RESULTS:

The analysis of eight news texts and 36 journal articles produced evidence-based themes including those of work performance strengths (quality, quantity, creativity) challenges (overreaching, perfectionism, overthinking, communication) and support measures (medical, cognitive, physical, flexibility).

CONCLUSION:

This investigative review reveals that anxiety-related work performance strengths, challenges and support measures as identified within news text reporting of the high functioning anxiety concept have at least some basis in the literature. It might therefore be the case that organizations who invest in supporting employees who identify with high functioning dimensions of their anxiety disorders are the ones who are ultimately rewarded with work performance advantages.

Keywords

Neurodiversity anxiety disorders thematic analysis high functioning anxiety

1 Introduction

The officially acknowledged spectrum of anxiety disorders is wide-ranging. Murrough, Yaqubi, Sayed and Charney [1] note that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes generalized anxiety disorder, panic disorder, separation anxiety disorder, agoraphobia, specific phobia and selective mutism (among others). Work related issues associated with anxiety disorder diagnosis are widely reported within the literature. These issues include an elevated risk of reduced work outcomes [2], treatment expenses [3] and lowered attendance [4]. Plaisier et al. [5] also suggest that employees who have anxiety illnesses face a greater risk of lowered work function. Iancu et al. [6] too see anxiety disorders as being linked to major functional limitations. In addition, Hilton et al. [7] indicate that a lessening of mental illness symptoms is related to improved worker productivity. Honey [8] suggests that persons once experiencing mental ill health tend to completely re-examine their work capability. Helping to explain how anxiety might negatively influence performance, Vytal, Cornwell, Arkin and Grillon [9] comment that anxiety can harm the capacity to think and focus. Hence, mental wellbeing and productivity in the work environment are said to be closely aligned [10].

Notwithstanding academic reporting of mental illness-related work issues, it is important that employers do not accept such risks uniformly or unquestioningly and proceed to automatically dismiss potential neurodiversity aligned work performance strengths. In this regard, anxiety disorders are described as less restricting than mental illnesses of a mood or psychotic nature as persons with anxiety disorders retain an awareness of reality [11]. Crucially, progressive workplaces need to be aware of developments in the field of neurodiversity. Hughes [12, p.3] defines neurodiversity as “an umbrella term that encompasses neurocognitive differences such as autism, attention deficit hyperactivity disorder (ADHD), dyslexia, Tourette’s syndrome, anxiety, obsessive-compulsive disorder, depression, intellectual disability, and schizophrenia as well as ‘normal’ neurocognitive functioning, or neurotypicality.” Dalton [13] makes the point that additional disorders may be incorporated into the neurodiversity community with the evolution of knowledge. As the brain functions of persons who are neurodiverse vary from the neurotypical [12], it is fitting to consider what these variations might mean in terms of work performance benefits. Morris, Begel and Wiedermann [14] describe neurodiverse staff as reporting distinctive cognitive approaches that include pattern and detail awareness. A capacity to grasp detail should be welcomed in a range of occupational roles including those of policy officer, accountant and systems analyst. Austin and Pisano [15] also recognise variances in how neurodiverse persons are wired in comparison to neurotypicals might entice fresh viewpoints. Illustrating this potential, a Hewlett Packard Enterprise (HPE) client has benefited from HPE neurodiverse software testers’ intolerance of disorderliness with these staff members successfully challenging the client’s seeming acceptance of such issues within their projects prior to their launch [15]. Employers should therefore remain open minded about the potential work performance contributions of mentally diverse team members as aspects of neurodiversity (intolerance of disorder in this instance) can support positive work outcomes.

Aligning with neurodiversity driven work performance is the concept of high functioning anxiety (HFA). Patel [16] reports that the HFA concept is not currently to be found within the DSM-5 nor has it acquired explicit research attention. Hence, according to Patel [16], a formal medical definition for this concept does not currently exist. Nevertheless, this reported lack of official recognition and scholarly enquiry has not stopped people from identifying with the term or writing about it within news texts. Mistry [17, n.p.] remarks, “high-functioning anxiety, is the term coined by writer Sarah Schuster, for the nagging feeling that no matter how much you do, it will never be enough.” A person who identifies with HFA may experience a range of anxiety-related symptoms and yet manage to function [18]. Moreover, as the term suggests, the possibility exists that these persons might not only survive in terms of their work performance but actually thrive in consistently attaining a standard of excellence. High functioning persons are frequently smart, ambitious and successful individuals who outwardly shine in professional and private spheres [19]. Indeed, anxiety can mean such achievements as attaining consecutive A’s, receiving internships and being included on the Dean’s honor list [20]. Patel [16] notes that video footage of a female describing her lived experiences with HFA attracted 58 million viewings. Others are also sharing their narratives of high functioning neurodiversity across a variety of forums. In this regard, Sian [19, n.p.] comments, “most recently, it has been gaining more and more attention in the public eye due to personal accounts of living with high functioning mental disorders being written about on high profile blogs, social media magazines, and editorial columns of prominent online news websites.” Furthermore, Patel [16] suggests that the HFA term has generated a feeling of community among individuals who consider themselves as belonging to this category. Following on, this study aims to critically investigate: a) news reported claims of the HFA concept lacking explicit research attention; and b) the evidence base of HFA news article reporting of anxiety-related work performance strengths, challenges and support measures.

2 Method

Two searches were applied to produce a purposive sample comprised of HFA news text reporting upon anxiety-related work performance. The first of these searches was applied to the CrossSearch database and incorporated the following inclusion criteria: search term = “high functioning anxiety”; year range = 2000–2017; no duplicates permitted; document type = news text; text is accessible; and HFA text covers anxiety-related work performance influences (i.e. strengths, challenges and/or support measures). The CrossSearch database was selected for its coverage of materials spanning library collections, while inclusion criteria were purposefully designed to promote the availability of a meaningful news text sample. Complimenting this purposive sample, a supplementary internet (i.e. Google) enquiry applied the above inclusion criteria with the following minor adjustment: search term = “high functioning anxiety” AND “workplace” so as to target vocational-oriented news texts. Searches of Scopus, Medline, Science Direct, CINAHL, Springer Link and Sage Journals Online databases applying the inclusion criteria of: search term “high functioning anxiety”; years = all years; fields = all fields; and document type = article was conducted to test the news text reported claim of a lack research explicitly covering the HFA concept. To allow for the possibility of scholarly research referring to the concept of high functioning anxiety under different terms (while also helping to critically investigate whether HFA news text reporting is evidence based) queries of the Scopus, Medline and Science Direct scholarly databases were executed using the search term of: (“anxiety” AND NOT “autism”) AND (“high functioning” OR “high function”) and applying the following inclusion criteria: years = 2000 to 2018; abstract = yes; document type = journal article; no duplicates; article is accessible; and article covers instances of news text reported anxiety-related performance strengths, challenges and/or anxiety management support measures. Assisting this critical examination of news text reporting on anxiety-related performance, supplementary queries of the three scholarly databases were also undertaken utilising the search term of: “anxiety disorders” AND “work performance” with the above-mentioned inclusion criteria again applied. Relevant articles were determined through a two-stage assessment process. In the first stage, abstracts were reviewed in order to determine the journal article’s potential to meet inclusion criteria. In a second pass, potentially relevant articles were retrieved and reviewed in detail. Those articles meeting all inclusion criteria were then deemed to be relevant. Finally, assessment of all relevant documents (i.e. news texts and journal articles) principally followed the Braun and Clarke [21] proposed approach to performing thematic analysis. This qualitative analytical procedure involved phases of: reading texts from the research sample; recording preliminary ideas; updating analytical tables that included theme identifiers, coding rules and exemplary quotations; and iteratively reviewing themes as informed by news texts in light of new data. This methodological approach of exploring the reliability of news text reporting through comparisons with scholarly evidence has been previously applied to diverse topics including those of climate change, genetic research and medication errors [22 –24].

3 Results

Populating a purposive sample of HFA news texts, the CrossSearch database enquiry produced 17 possibly relevant texts which were comprised of 13 newspapers, two references, one e-book and one web resource. Of these texts, four met with inclusion criteria and were considered to be relevant (i.e. HFA news texts reporting upon anxiety-related work performance) [20 , 25–27]. The supplementary internet search produced 66 possibly relevant texts. Of these texts, four matched with the targeted search criteria and were thus included among the results [16 , 29] giving a sample total of eight relevant news texts. Searches across Scopus, Medline, ScienceDirect, CINAHL, Springer Link and Sage Journals Online databases support a lack of explicit scholarly attention as directed towards the concept of high functioning anxiety (i.e. enquiries within each of these databases produced nil results). Assisting to investigate whether HFA news text reporting of anxiety-related work performance influences and management measures is evidence based, searches of Scopus, Medline and ScienceDirect databases using alternative terms for ‘high functioning anxiety’ delivered the following results: Science Direct = 9 possible, 1 relevant journal article; Scopus = 62 retrieved (7 duplicates), 55 possible, 3 relevant journal articles; and Medline = 33 retrieved (24 duplicates), 9 possible, 0 relevant journal articles. Supplementary scholarly database enquiries applying the search term of “anxiety disorders” AND “work performance” produced results as follows: Science Direct = 177 possible, 8 relevant journal articles; Scopus = 725 retrieved (16 duplicates), 709 possible, 24 relevant journal articles; and Medline = 17 retrieved (14 duplicates), 3 possible, 0 relevant journal articles. These supplementary enquiries thus produced 32 relevant journal articles. Combined with the HFA alternative terms database results, this paper is informed by a total of 36 scholarly articles. Thematic analysis of news texts produced several themes including those of work performance strengths (i.e. quality, quantity, creativity) challenges (overreaching, perfectionism, overthinking, communication) and support measures (i.e. medical, cognitive, physical, flexibility). These themes, their coding rules, as well as supporting quotations from corresponding news texts and journal articles are provided in Tables 1, 2 and 3.

Table 1
News text reported/literature supported anxiety-related work performance strengths

Strength theme: Quantity.

Coding rule: anxiety supported high volume workloads.

News text quotes: “It is the gnawing sense that if you don’t check off everything, you’re doomed to live a life of failures” [17, n.p.].

“However, a key difference between anxiety and depression is that anxiety can actually act as a motivator” [27, p.14].

“when controlled, my anxiety is also what pushes me to be diligent and hardworking” [28, n.p.].

“All the while, anxiety appears perfectly calm because most of us are always looking for a way to channel that never ending energy in the forms of tasks that continuously keeps us busy like writing, painting and meditating” [29, n.p.].

Journal quotes: “his anxiety about work leads him to feel guilty whenever he is not working, which has led him to give up on many of his personal hobbies” [30, p.274].

“I feel my disorder pushes me to exceed expectations in my work environment” [31, p.77].

“the increased sense of responsibility that OCPD can produce could result to individuals with this condition becoming “workaholics” [32, p.136] citing [58].

“None of the mental disorders included in this study were significantly associated with absence days” [40, p.142].

“People with depression and anxiety disorders are also at risk of over working” [59, p.260].

Strength theme: Quality.

Coding rule: HFA supported excellence.

News text quotes: “For people who label themselves with this term, it is described exactly what it sounds like: a high functioning person with anxiety who often doesn’t have any problems doing their job or socializing with others” [16, n.p].

“Anxiety means straight A’s. It means Editor-in-chief, internships and making the Dean’s list” [20, n.p.].

“she had achieved, and was still achieving much in life as an executive at a multinational firm” [27, p.14].

Journal quotes: “She recalls that the pressure to maintain a high standard developed after she won an achievement award for a particular project she led her team in” [36, p.14].

“Individuals with high levels of negative perfectionism would be expected to work toward the avoidance of failure and disappointment” [38, p.321].

“She reported a family history of OCD, with both her father and brother exhibiting symptoms involving meticulousness and checking tendencies” [39, p.243].

“On the other hand, generalized anxiety disorder (b = 0.8, 95% CI 0.3 to 1.3) and intermittent explosive disorder (IED) (b = 1.2, 95% CI 0.5 to 1.9) were associated with an increase in work performance” [40, p.142].

“It was unexpected that the 30-day prevalence of GAD and IED was associated with increased on-the-job work performance” [40, p.144].

“depression produced more self-reported impaired work performance than anxiety” [41, p.630].

“only 3.6% of those with anxiety and no employment restrictions reported reduced work accomplishment” [60, p.901].

Strength theme: Creativity.

Coding rule: HFA supported creative thinking.

News text quotes: “It doesn‘t matter how many times you tell me it will be fine – my brain has already formulated a million comebacks to tell you why it won‘t be” [26, n.p.].

“The 19th Century Danish philosopher Soren Kierkegaard said the more creative a person, the more potentially anxious he is” [27, p.14].

“more often than not, creative geniuses suffer from an anxiety disorder of some kind” [28, n.p.].

Journal quotes: “When William thinks about initiating an outing or working around the yard, he easily imagines all the options available to him (like where he could go for lunch, or which fertilizer is best), as well as all the possible consequences of making the wrong decision” [30, p.268].

“Some anxious people might be able to avoid possible triggers at work, by creating a predictable workplace or keeping away from crowded places or social situations, which therefore lead them to have a rather functional work environment” [43, p.204].

Table 2

News text reported/literature supported anxiety-related work performance challenges

Challenge theme:	Overreaching.
Coding rule:	Taking on too much work.
News text quotes:	“Bhatia says common symptoms of someone living with anxiety include worrying, panic attacks, constantly feeling guilty or bad for saying ‘no,’ and sometimes having difficulty saying no to people altogether” [16, n.p.].
	“It means late nights under the harsh glow of a computer screen. It means another cup of coffee. It means saying yes to writing a book as a full-time student with a full-time job” [20, n.p.].
	“I was constantly signing myself up for as many things as possible to avoid dealing with myself” [25, n.p.].
Journal quotes:	“individuals who are depressed and anxious deliberately decrease leisure and social activities in order to preserve their remaining capacity for work” [33, p.1709]
	“Most respondents believed that unmanageable workloads contributed to their anxiety and depression” [34, p.213].
	“several respondents stated that workplace bullying and/or excessive work and life demands contributed to their first panic attack” [35, p.261].
	“She maintains all her appointments and does not avoid situations she knows she will feel anxious in, but endures them with some distress and with the help of safety behaviours (e.g., rehearsing presentations, over-preparing and making excuses for her appearance and behaviour)” [36, p.14].
Challenge theme:	Perfectionism.
Coding rule:	Costs linked to perfectionism.
News text quotes:	“You will work your butt off and spend hours perfecting your work” [16, n.p.].
	“the amount of turmoil you feel on the inside when you get home is when you suffer” [16, n.p.].
	“The monster that is my anxiety first reared its ugly head in grade school. My mom gave it a name: perfectionist” [20, n.p.].
	“part of this and all anxiety is related to erroneous beliefs about your selfworth — so that even if you are achieving, you can’t quite believe it and instead you give more weight to all those messages you absorbed about yourself while growing up” [27, p.14].
Journal quotes:	“William frantically searches for the perfect solution, hoping to avoid the distress and regret that could accompany a wrong decision” [30, p.268].
	“She reported no anxiety in relation to being observed unless it was in the workplace where she felt pressure to appear flawless” [36. p.14].
	“In an attempt to avoid contact with negative emotions, self-critical thoughts, and opportunities for failure, the perfectionist may “give up” or become less likely to begin or complete tasks” [38, pp.322–23].
	“the perception that one must meet others’ high expectations may be perceived as being excessive and uncontrollable, and ultimately, lead to the development of an anxiety disorder” [42, p.1127].
Challenge theme:	Overthinking.
Coding rule:	Inflating negative thoughts.
News text quotes:	“Her condition causes her to overthink or over-worry about small things, become anxious about making the right impression and sometimes, she even vomits” [16, n.p.].
	“anxiety is best friends with both overthinking and insecurity” [28, n.p.].
	“High-functioning anxiety is when an individual notices one misstep in the way someone acts towards you, consequently dwelling on the scenario for days, by replaying the whole episode and wondering what could have been done in that moment to avoid the subsequent ill-feeling” [29, n.p.].
Journal quotes:	“Often individuals who experience generalized anxiety disorder (GAD) or chronic worry report that they are consumed by their worries in a way that leads them to miss out on their present experience” [30, p.264].
	“The anxiety Joe experiences is out of proportion to the actual threat” [36, p.14].
	“Severe cases of AG may result in the person being completely housebound or unable to leave home unaccompanied” [44, p.283].
	“anxiety disorders may impair activity due to intrusive and uncontrollable worries or fears that interfere with the ability to undertake tasks and the ability to leave the house” [45, 293].
	“The professionals emphasized that the capacity to work was fragmented by anxiety attacks as well as preoccupying thoughts of the next attack” [61, p.130].
Challenge theme:	Communication.
Coding rule:	Issues in communicating.
News text quotes:	“Since anxiety also messes with our ability to move facial muscles, it’s not surprising that anxiety can literally silence the people who struggle with it’ [28, n.p.].
	“The mind and body are connected, and if you’re an anxious person, that means your nerves can literally prevent you from speaking” [28, n.p.].
	“It is not knowing how to start a conversation with a person with ease – whether it’s at a local store, at work or in a college class” [29, n.p.].
	“It’s about forming sentences in your head before being able to say it out loud in order to not feel judged by the other person” [29, n.p.].
Journal quotes:	“More opportunities to participate and take a more active role in contributing to ideas and strategies. [said in reference to having options available to government ‘preferred’ face to face communication]” [31, p.76].
	“Both reported not answering the telephone when they felt really anxious, not wanting to communicate with anyone” [35, p.267].
	“he reported that he completely avoids any sort of performance situation as being asked to speak in front of others causes severe anxiety” [36, p.14].

Table 3

News text reported/literature supported anxiety management strategies

Medical:
Coding rule:	anxiety management encouraged through medication (with qualifiers).
News text quotes:	“If we could eliminate the stigma surrounding prescription medications, more people could make decisions that may ultimately lead them to living better lives” [25, n.p.].
	“It’s a choice that must be personal in order to be effective” [25, n.p.].
	“The small dose helped me tremendously to get through my day-to-day routine” [26, n.p.].
Journal quotes:	“Currently available first-line treatments for anxiety disorders include SSRI and SNRI medication, with benzodiazepines best suited for short-term and adjunctive anxiolytic treatment” [1, p.13].
	“At baseline, 68.9% of participants in the chronic anxiety disorder group received psychiatric treatment (antidepressants, benzodiazepines or psychological treatment; data not shown). Therefore, improvements during the 2-year follow-up were to be expected, at least in a subsample of this group” [6, p.601].
	“Non-compliance with medication was common, which may lead to poor control of symptoms and impaired work performance” [34, pp.212–13].
	“this naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder ... ” [46, p.372].
	“Accessible patient information, explaining the actions of the medication, potential impact on safety, and what patients should expect with regard to symptom improvement” [47, p.544].
	“In addition to compliance problems at the start of a course of medication, patients further on in their treatment tended to cease medication once they started to feel better, often due to concerns about addiction” [48, p.212].
	“Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for the treatment of depression and anxiety-related disorders” [62, p.60].
Cognitive:
Coding rule:	anxiety management encouraged through behavioural therapies.
News text quotes:	“Bhatia says if you are not seeking help from a professional (although he encourages you to) there are ways to manage anxiety at home” [16, n.p.].
	“the counseling helped with the severe OCD” [20, n.p.].
	“The more I came back to her office, the more I understood about myself and my needs” [25, n.p.].
Journal quotes:	“ABBT has shown significant promise in the treatment of GAD ... ” [30, p.279].
	“Efficacy of cognitive-behavioral therapy (CBT) for panic disorder had been established for several decades” [49, p.222].
	“Our findings provide support for the effectiveness of an ACT and mindfulness intervention in promoting emotional and psychological well-being by targeting the competence of psychological flexibility” [50, p.2377].
	“Overall, it appears that delivering ACT exercises online holds promise as an unguided, transdiagnostic approach to treating common mental health issues in Australia [51, p.147].
	“There is growing evidence supporting the efficacy of mindfulness and acceptance approaches for the treatment of SAD” [52, p.287].
	“Access to the stress management program resulted in lower levels of depression, anxiety and stress and an increase in comfort and enthusiasm post intervention that were largely maintained at follow-up” [53, p.10].
	“this meta-analysis indicates that ABMT shows promise as a novel treatment for anxiety disorders” [54, p.989].
	“Following the introduction of the mindful acceptance and other defusion exercises, clients began to struggle less with their thoughts and emotions” [63, p.382].
	“Findings from the CBT studies indicate that initial treatment response is largely maintained over time” [64, p.311].
	“nonjudgmental, present-moment awareness taught in mindfulness would putatively compete with the individual’s tendency to focus attention on potential catastrophes” [65, p.473].
Physical:
Coding rule:	anxiety management encouraged through physical activity and yoga.
News text quotes:	“It can feel like there is electricity pulsing through my veins and the only thing I can do to expel it is physical exertion, usually push-ups” [16, n.p.].
	“Two scientific reviews on yoga’s effects on anxiety found that yoga helps perceptions to stress” [17, n.p.].
	“exercise is pretty much the go-to treatment for anxiety” [28, n.p.].
	“One of the best benefits of yoga is how it helps a person manage stress which has overwhelming effects on the human body and mind” [29, n.p.].
Journal quotes:	“Contexts that can help support and maintain client change should also be identified; we encourage clients to pursue meditation, yoga, or other groups to support their ongoing practice when they leave treatment ... ” [30, p.279].
	“Park walking and relaxation exercises activities are fairly easy to learn and implement in an organizational setting, and may assist employees in replenishing the resources needed to perform well on the job during the working day” [55, p.26].
	“Future interventions aiming to promote outdoor breaks or walks amongst the workforce should therefore focus on encouraging people to spend meaningful amounts of time outdoors ... ” [56, p.39].
Flexibility:
Coding rule:	anxiety management encouraged through accommodating and flexible workplaces.
News text quotes:	“Don’t burden yourself to handle all of it on your own, especially when you live with anxiety, day in and day out, and in the throes of panic attacks” [17, n.p.].
	“Work-life balance has become a myth in our society” [17, n.p.].
	“recognize that their illness is as real as the flu you caught last winter” [20, n.p.].
Journal quotes:	“These responses nevertheless suggest that for some government employees with anxiety disorders, accommodations can help to improve work performance by lowering anxiety to a manageable level” [31, p.82].
	“Sustainable work participation can be feasible with better knowledge regarding the person, environment and occupation fit” [33, p.1710].
	“Participants felt that there needs to be increased awareness and understanding from managers” [34, p.211].
	“Changing workplace norms and supervisor attitude to allow workers to have more control over taking sick absence could be beneficial to workers with mental disorders and their employers ... ” [40, p.144].
	“Managers require guidance on maintaining people with anxiety and depression in the workplace, which may involve modifying workloads or the range of tasks workers are asked to undertake” [47, p.544].
	“By understanding essential aspects of the relationships between the clients’ individual characteristics, the rehabilitation context and the vocational outcomes, more appropriate and effective interventions may be offered to the individual client” [57, p.37].

4 Discussion

On the basis of searches conducted and informing the first of the research aims (i.e. to critically investigate news reported claims of the HFA concept lacking explicit research attention), this study confirms that the concept has yet to receive specific academic focus. However, this research also reveals that scholarly attention has been given to the HFA concept under different terms as well as via journal article coverage of anxiety disorder-related work performance. Informing the second study aim, this section will critically discuss HFA news text reporting of anxiety-related performance strengths, challenges and support measures in terms of their evidence base (i.e. where such news reporting is reflected within the scholarly literature) along with implications for future research wherever relevant.

4.1 Quantity and overreaching

News texts include worker productivity among the set of reported anxiety-related performance strengths. Upon the basis of these reports, managers should not assume anxious staff to be incapable of high work output. On the contrary, Williamson [27] suggests anxiety varies from depression in a fundamental way in that the former can motivate. Anxiety based motivation has been expressed in news text reporting in various ways. Anxiety can inspire the completion of activities so as to avoid failure [17]. Enochs [28] further explains, when kept under control, anxiety can drive a person to be both industrious and meticulous. Scholarly endorsement of news reports concerning anxiety as a driver of worker productivity can be found within the literature. Examples include: potential for anxiety to trigger feelings of guilt when one stops being productive, a drive to surpass work performance expectancies, as well as obsessive compulsive-oriented workaholism following elevated feelings of responsibility [30 –32]. Nevertheless, news texts also raise potential challenges associated with anxiety-centred enthusiasm of which workplace managers should be aware. In this regard, it can be somewhat offensive when anxiety is mistaken for self-discipline [28]. Indeed, it is possible that motivation may not be something that employees who identify with high functioning anxiety have to concentrate on developing or maintaining as this inclination towards elevated productivity might be built into their neuro profile. According to news coverage, it is also feasible that this energetic predisposition may influence responses to work requests. That is to say, anxious people might have problems responding with ‘no’ and subsequently find themselves taking on multiple projects and working long hours in order to avoid personal issues [16 , 25]. Future research is required to determine the extent to which some anxious individuals might have problems in refusing unreasonable requests while embracing work as a self-directed anxiety management strategy. News texts also indicate that the consequences of any predisposed willingness to indiscriminately take on work requests and ‘overreach’ can be significant. Williamson [27] acknowledges the capacity of anxiety to attain a level whereby function ceases over a period. Harden [25] describes this breaking point as an eruption of feelings whose impact can be energy sapping. News reporting of anxiety in the context of overcommitting and subsequent ill-effects is not without academic merit. To this end, the literature discusses anxiety in relation to persons reducing non-work activities, experiencing greater mental health issues following excessive workloads, and being overly prepared [33 –36]. Subsequently, while workplaces may experience short term productivity gains by overloading their anxious staff members, the longer term mental health impacts for these individuals along with the negative performance possibilities for organizations should not be overlooked. It is therefore important that workplace managers are routinely informed about the mental health risks associated with overloading staff who are experiencing anxiety through the issuing of unreasonable work demands. Managers should also be advised about the possible need of anxious staff members to receive individualized workplace accommodations. As Employee Assistance Programs (EAPs) are designed to assist in addressing issues which are impacting or potentially impacting upon an individual’s work performance [37], workplaces should recognise EAPs as an important source of this managerial advice.

4.2 Quality and perfectionism

According to news reports and representing a further neurodiversity-oriented performance attribute, anxiety can positively influence work quality. To this end, news texts suggest that anxiety can translate into work efficiencies and achievements [16, 20, 27]. The literature too supports this potential through pressure to uphold a standard of excellence and to avoid defeat [36, 38]. Furthermore, the literature raises prospects of perfectionism being present within families with histories of obsessive compulsive disorder [39]. Still, it is important to note that links between anxiety and work function are not always anticipated at the outset of research investigations. In a study involving 530 Japanese workers, Tsuchiya et al.[40, p.144] described as ‘unexpected’ the association of generalised anxiety disorder with improved work performance. Moreover, the Waghorn and Chant [41] study utilising Australian Bureau of Statistics household data informed by 37,580 persons reported depression as being more represented in the self-reporting of reduced work performance in comparison to that of anxiety. Nonetheless, representing a feasible anxiety-based performance challenge, news reports also suggest that aspirations to consistently achieve high standards in the workplace or elsewhere can come at a heavy price. In this regard, Patel [16] recognises that many hours and much effort can be channelled into perfecting one’s work. However, the internal distress experienced upon returning home is the time when the suffering happens [16]. Williamson [27] also cautions that misplaced understandings concerning self-value may override a person’s accomplishments. Still, another possibility exists to help explain a penchant towards perfectionism apart from that of negative self-image. American psychologist Abraham Maslow suggested that people have a tendency to shrink back from their greatest potentials [27]. Future research is thus needed to examine the extent to which persons who identify with the HFA concept might move against this trend and instead persistently strive to attain their best. Nonetheless, news reported personal costs associated with consistently striving for excellence in the workplace hold academic underpinnings. That is to say, the scholarly literature also talks of challenges aligned with anxiety and perfectionism. Examples include frantic work efforts, pressures to be seen as perfect, being less inclined to commence tasks in attempts to sidestep the chances of failing, along with the view of having to meet the high expectancies of other people [30 , 42]. These are the sorts of potential anxiety-related, high performance challenges that EAP service designers, human resource managers and workplace supervisors need to be aware of.

4.3 Creativity, overthinking and challenges in verbally communicating ideas

Signifying yet another news acclaimed anxiety-related work performance strength, anxiety is said to enhance creativity [27, 28]. Shorr [26] reports on potential for the anxious mind to extensively identify risks. Such potential is supported within literature coverage of a generalised anxiety disorder case presentation. In this instance, creative thinking is signified through the ease with which options are identified along with risks following an incorrect decision [30]. Plasier et al. [43] also recognise that some persons who are experiencing anxiety may be capable of creating a functional workplace setting by avoiding anxiety triggers. Future research should therefore examine the degree to which the development and successful application of such anxiety avoidance strategies within the workplace reflects a need for creativity. There is nothing fundamentally wrong with having a capacity to quickly identify various scenarios along with their inherent risks. Indeed, in some professional endeavours, this ability should be welcomed. However, representing a corresponding anxiety-related work performance challenge, news texts also warn of a tendency for anxious persons to overthink issues [16 , 29]. This news reporting is not without scholarly foundation. The literature also notes that persons with generalised anxiety disorder tend to report being engulfed with worry while the level of anxiety experienced can be disproportionate to the risk at hand [30, 36]. In certain instances, anxiety can leave people housebound [44, 45]. Indicating an additional potential challenge related to anxiety inspired performance, it is one thing to be able to quickly come up with a plethora of ideas and yet another to be able to effectively express them. In this context, news texts report of anxiety-related physical and psychologically-oriented constrictions to verbal communications [28, 29]. Importantly, these kinds of anxiety-based communication challenges are endorsed within the literature. Skocic, Jackson and Hulbert [36] provide an example of the extreme level of anxiety that may follow a request for public speaking. Other scholarly examples suggest the possibilities of some anxious persons desiring alternatives to face-to-face office interactions and not wishing to communicate at all with people when anxiety is peaking [31, 35]. Hence, while anxiety might potentially encourage creative thinking, managers should nevertheless be aware of the prospects of accompanying communication challenges together with the evidence-based support measures which might offer assistance in the workplace.

4.4 Anxiety management support measures

News texts raise prospects (with qualifiers in place) for a variety of anxiety management support measures to which EAP service designers, human resource professionals and workplace managers should be aware. Crucially, this study reveals that such news reported measures hold a sound basis in the literature. Starting with medical treatment, it is suggested by news reports that medications can assist anxious people in their daily activities [25, 26]. Indicating a capacity for balanced news reporting on this topic, Harden [25] qualifies this support by recognising that the decision to use medication must be up to the individual. Highlighting this need for individualised choice, Williamson [27] provides the case of Edvard Munch, the artist behind the classical piece, ‘The Scream’. Munch was quoted to say, “my fear of life is necessary to me, as is my illness... their destruction would destroy my art” [27, n.p.]. Hence, it is conceivable that some employees who identify with the concept of high functioning anxiety might perceive medication as potentially extinguishing or at least dampening their work performance ‘gift’. The scholarly literature while recognising medical capacity to treat anxiety [1, 46] also offers notable caveats. Such qualifiers encompass possible non-compliance as well as potential safety issues and addiction concerns [34 , 48]. News articles also report on behavioural supports for anxiety [20, 25]. A broad backing of various anxiety therapies can be found in the literature. These include cognitive behavioural therapy [49], mindfulness and acceptance-oriented therapies [50 –52], stress management [53], and attention bias modification [54]. Further, news texts raise physical measures in the forms of exercise and yoga as ways to help manage anxiety [17 , 29]. As support for yoga and exercise (e.g. walking activity) is evidenced-based [30 , 56], the promotion of these options to anxious staff might help to advance mentally healthy workplaces. Finally, news texts offer anxiety management messages that are compatible with the availability of flexible and accommodating workplaces. Persons with anxiety are encouraged to reach out for support, while understanding is also promoted around a need for balanced lifestyles, as well as the reality of mental illness [17, 20]. The literature too encourages a culture of individualised understanding and support within the workplace [33 , 57] as well as promoting the availability of accommodations [31], greater employee power in the use of sick leave [40], along with adjustable workloads [47]. Crucially, as anxiety-related challenges are experienced on an individual basis, managers should not automatically assume that all anxious employees will necessarily require support measures.

5 Limitations of the study

This exploratory study holds notable limitations to which the author openly acknowledges. With regards to the second study aim, the scope of this investigative study is purposefully constrained to determining whether anxiety-related work performance themes as identified from a purposive sample of news texts reporting upon the concept of high functioning anxiety are evidence-based (i.e. supported by journal articles). Themes revealed by this research are therefore limited to those identified within news texts whose sample representation is confined to the databases and inclusion criteria applied. Future research utilising additional scholarly databases and expanded inclusion criteria is thus needed to examine possibilities of locating: a) additional evidence supportive of the themes revealed by this study; b) evidence challenging the themes revealed by this study; and c) evidence-based themes which might exist beyond those revealed by this investigative study. Furthermore, it is recognised that the thematic analysis as undertaken within this study was conducted by a single researcher. Responding to this restriction, the author has promoted data validity and transparency by availing analytical tables comprised of themes, their coding rules and supporting quotations (as derived from news texts and journal articles) to the reader.

6 Conclusion

Smart workplaces, both private and public, should want to recruit, retain and promote persons who have a neurological predisposition towards attaining high performance. This is the first study to explore work performance possibilities aligned with a concept that to date has escaped explicit research attention (i.e. the concept of high functioning anxiety). This investigative review reveals that anxiety-related work performance strengths, challenges and support measures as identified within news text reporting of the HFA concept have at least some basis in the literature. It might therefore be the case that organizations who invest in supporting employees who identify with high functioning dimensions of their anxiety disorders (where such assistance is needed and wanted) are the ones who are ultimately rewarded with work performance advantages. This investigative study supports future research being conducted on this interesting prospect.

Conflict of interest

None to report.

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Strength theme:	Quantity.
Coding rule:	anxiety supported high volume workloads.
News text quotes:	“It is the gnawing sense that if you don’t check off everything, you’re doomed to live a life of failures” [17, n.p.].
	“However, a key difference between anxiety and depression is that anxiety can actually act as a motivator” [27, p.14].
	“when controlled, my anxiety is also what pushes me to be diligent and hardworking” [28, n.p.].
	“All the while, anxiety appears perfectly calm because most of us are always looking for a way to channel that never ending energy in the forms of tasks that continuously keeps us busy like writing, painting and meditating” [29, n.p.].
Journal quotes:	“his anxiety about work leads him to feel guilty whenever he is not working, which has led him to give up on many of his personal hobbies” [30, p.274].
	“I feel my disorder pushes me to exceed expectations in my work environment” [31, p.77].
	“the increased sense of responsibility that OCPD can produce could result to individuals with this condition becoming “workaholics” [32, p.136] citing [58].
	“None of the mental disorders included in this study were significantly associated with absence days” [40, p.142].
	“People with depression and anxiety disorders are also at risk of over working” [59, p.260].
Strength theme:	Quality.
Coding rule:	HFA supported excellence.
News text quotes:	“For people who label themselves with this term, it is described exactly what it sounds like: a high functioning person with anxiety who often doesn’t have any problems doing their job or socializing with others” [16, n.p].
	“Anxiety means straight A’s. It means Editor-in-chief, internships and making the Dean’s list” [20, n.p.].
	“she had achieved, and was still achieving much in life as an executive at a multinational firm” [27, p.14].
Journal quotes:	“She recalls that the pressure to maintain a high standard developed after she won an achievement award for a particular project she led her team in” [36, p.14].
	“Individuals with high levels of negative perfectionism would be expected to work toward the avoidance of failure and disappointment” [38, p.321].
	“She reported a family history of OCD, with both her father and brother exhibiting symptoms involving meticulousness and checking tendencies” [39, p.243].
	“On the other hand, generalized anxiety disorder (b = 0.8, 95% CI 0.3 to 1.3) and intermittent explosive disorder (IED) (b = 1.2, 95% CI 0.5 to 1.9) were associated with an increase in work performance” [40, p.142].
	“It was unexpected that the 30-day prevalence of GAD and IED was associated with increased on-the-job work performance” [40, p.144].
	“depression produced more self-reported impaired work performance than anxiety” [41, p.630].
	“only 3.6% of those with anxiety and no employment restrictions reported reduced work accomplishment” [60, p.901].
Strength theme:	Creativity.
Coding rule:	HFA supported creative thinking.
News text quotes:	“It doesn‘t matter how many times you tell me it will be fine – my brain has already formulated a million comebacks to tell you why it won‘t be” [26, n.p.].
	“The 19th Century Danish philosopher Soren Kierkegaard said the more creative a person, the more potentially anxious he is” [27, p.14].
	“more often than not, creative geniuses suffer from an anxiety disorder of some kind” [28, n.p.].
Journal quotes:	“When William thinks about initiating an outing or working around the yard, he easily imagines all the options available to him (like where he could go for lunch, or which fertilizer is best), as well as all the possible consequences of making the wrong decision” [30, p.268].
	“Some anxious people might be able to avoid possible triggers at work, by creating a predictable workplace or keeping away from crowded places or social situations, which therefore lead them to have a rather functional work environment” [43, p.204].