What Is Examined Here, and in What Order
This article answers a question that in recent years has regularly made the rounds of the feature pages: Are clever and gifted people more anxious? The way to the answer leads through eight steps, and it helps to know them in advance.
Step one: the popular claim, together with its source. Step two: why that source cannot answer the question at all, for a reason any reader can follow in two minutes. Step three: the data that can answer it, and an interim conclusion that turns out to be the opposite of the headline. Step four: the finding that remains after this cleanup—a reversal of direction that is easy to read past and that explains everything else. Step five: the mechanism behind it, namely that worry is a verbal process, which is why verbal ability, of all gifts, is the decisive one. Step six: the blueprint of a clever fear, and the answer to the question that is truly interesting—why does an intelligent person gain nothing from three hundred refutations of his fear? Step seven: a procedure of four simple moves that any reader can apply on paper this very day, together with an overview of how well each claim in this article is supported. Step eight: what follows for treatment, why giftedness can nonetheless become a handicap, where the line runs beyond which a physician is needed, and how much of all this holds up.
The Popular Claim: Giftedness as a Risk Factor
In 2018 the journal Intelligence published a study that quickly made its way into the popular press. A research group led by Ruth Karpinski had surveyed 3,715 members of American Mensa, the high-IQ society; admission is granted to anyone who scores in the top two percent on a recognized intelligence test, which corresponds roughly to an IQ of 130 or above. The members were asked whether they had been diagnosed with psychological and physical disorders, or whether they suspected they had them. The result: markedly elevated rates, compared with the national average, for every condition examined, from anxiety and mood disorders through attention disorders to allergies, asthma, and autoimmune diseases.1 The authors explained this with a theory they called hyper brain / hyper body: an especially excitable mind brings an especially excitable body in its wake, complete with a derailed immune response.
Scientific American ran its report under the headline “Bad News for the Highly Intelligent.”2 Ever since, the claim that giftedness is a risk factor has been part of the fixed inventory of popular psychology. It has the virtue of every good headline: it consoles some and flatters others.
In 2022 a European research group led by Jonathan Fries at the University of Vienna repeated the study, this time preregistered - that is, with an analysis plan fixed in advance, which rules out massaging the numbers after the fact - and with 615 Mensa members from Austria, Germany, Hungary, Switzerland, and Great Britain. The psychological findings were confirmed with impressive clarity: a relative risk of 3.82 for generalized anxiety disorder and of 4.38 for depression.3 A relative risk of 3.82 means that the disorder was reported almost four times as often in this group as in the general population.
That would seem to settle the matter. It does not, and the most interesting sentences are in the very same paper.
Why These Figures Say Nothing about Intelligence
To begin with, the same replication study did not confirm the physical half of the theory: neither asthma nor allergies nor autoimmune diseases were elevated.3 With that, the hyper body drops out, and with it the immunological explanation that had held the whole edifice together in the first place. And the authors themselves state what to make of the psychological figures: “it is possible that the effects are caused by sample selectiveness (i.e., membership in a high-IQ society) rather than high IQ itself.”3
This objection is decisive, so let us take it apart piece by piece.
First: a club is not a sample. Whoever wants to study the top two percent of the population has to survey the top two percent of the population. But the people surveyed were not those who are intelligent; they were those who are intelligent and have joined a club for the intelligent. Those are two different groups, and the second is self-selected. Self-selection always answers one question first: who selects himself. A gifted person who has a job that challenges him, friends who can follow him, and a daily life without friction has little reason to join an association whose purpose is to be among one’s own kind. Whoever does have that reason tends to be the one who lacks a good fit. A lack of fit and psychological distress go together. At this point, high intelligence is not the cause but the admission ticket.
Second: answering is self-selection, too. Not every member responded. Those who reply to a survey about their own illnesses have, on average, more of them to report than those who delete it unopened. This distortion works in the same direction as the first and adds to it.
Third: what was collected were self-reports, explicitly including suspected diagnoses. Whoever has a larger vocabulary, has read more of the professional literature, and is more inclined to self-observation is more likely to recognize something in himself and more likely to name it. It is quite possible that what was measured here was not more illness but more words for illness.
Fourth: the comparison was with national averages, not with a control group. The comparison figures come from other surveys, with other questionnaires, other diagnostic criteria, and other years. As soon as two groups differ in how the data were collected, every difference in the result is, first of all, a difference in method.
Four distortions, all pulling in the same direction. What was measured here is the psychological distress of people who join a high-IQ society and answer questions about their complaints. That is an interesting finding about this group. About intelligence, it says nothing.
What the Large Population Studies Say about Giftedness and Anxiety
The question can be answered, but only with data in which no one was selected according to whether he considers himself clever. Three studies come close to that.
The first comes from a group led by Camille Michèle Williams and Franck Ramus at the École Normale Supérieure in Paris and uses the UK Biobank, a British data collection with several hundred thousand participants who completed cognitive tests and provided information about their health. People with high general intelligence - two standard deviations above the mean, that is, the same range as for admission to Mensa - were compared with the average of the remaining participants.4 The result is diametrically opposed to the headline: the highly intelligent suffered less often from generalized anxiety (odds ratio 0.69) and less often from post-traumatic stress disorder (0.67), and they were less neurotic and less socially isolated. For depression, social anxiety, obsessive-compulsive disorder, eating disorders, bipolar disorder, schizophrenia, and substance use disorders, no difference was found. A single category was elevated: allergies.
An odds ratio of 0.69 means that the odds of being affected were about thirty-one percent lower in the highly intelligent group. What is meant is the ratio of two sets of odds, in the betting sense, not the percentage of people who are ill; for rare disorders the two values lie close together, and for the direction of the finding the distinction makes no difference. In their conclusion the authors state explicitly that the studies reporting the opposite suffered from small samples, from selection bias, or from the absence of a control group.4 Honesty requires noting that in 2025 the paper received a correction of erroneous table values, which changes nothing in its conclusions.5
The second study is a meta-analysis—the statistical synthesis of many individual studies, more informative than any one of them because random fluctuations average out. A group led by Léo Duplenne at the University of Amiens pooled 27 studies that had compared gifted individuals with comparison subjects of average ability on their level of anxiety. The effect was g = −0.14 and was not statistically significant; for depression, 15 studies yielded the same value.6 The negative sign points in the direction of less anxiety among the gifted but is too small to be called statistically relevant. The authors themselves urge caution, because the variation between studies was high and could not be resolved by any of the explanatory variables they tested.
The third study is the most recent and methodologically the cleanest. In 2025 a group led by Steffani Saß at Kiel University started not from a club but from an unselected sample of 3,918 students. From it, 100 gifted students were matched in pairs with 100 students of average ability on comparable background characteristics—a procedure that eliminates precisely the distortion on which the club surveys founder. The gifted students did better in mathematics and reading, had greater confidence in their own mathematical ability, and were rated by their teachers as less disruptive in class—what was measured was so-called externalizing problem behavior, that is, aggression and rule-breaking. In all the remaining comparisons of social and emotional well-being - as rated by parents, teachers, and classmates - there was no difference.7 This concerns students, not adults; for the question about adults, the two studies cited above remain authoritative.
These three studies are not truth machines either. The UK Biobank is itself a volunteer sample and represents the healthier half of the population; a meta-analysis with high variation ends up pooling things that are not alike; and two hundred students are two hundred students. Anyone who rejects the Mensa survey because of its selection bias must name these objections as well; otherwise he applies his standard only to the results he does not like.
Interim Conclusion: Giftedness Is Not a Risk Factor
What can be said after this first pass is brief: the claim that high intelligence increases the risk of developing an anxiety disorder does not hold up. The best available data show either no difference or a slight advantage for the clever. Whoever explains his anxiousness by his giftedness has found a flattering explanation, but not a correct one.
The article could end here. In fact it only begins here, for the data contain a second finding that is far easier to overlook and far more consequential.
The Finding That Remains: The Reversal of Direction
In 2012 a group led by Jeremy Coplan at SUNY Downstate Medical Center in Brooklyn published a small study of 26 patients with generalized anxiety disorder and 18 healthy comparison subjects. Intelligence and the severity of worry were measured. The result was a reversal of sign: among the healthy, higher intelligence went with less worry. Among the anxiety patients, higher intelligence went with more worry.8
In 2015 a group led by Alexander Penney at Lakehead University in Canada found something consistent with this, but more precise, in 126 students. It was not general intelligence that predicted the extent of worry and rumination, but exclusively verbal intelligence—the ability to handle language and concepts. Nonverbal, visual-spatial intelligence predicted the opposite: those who were strong in it turned past social situations over in their minds less.9
One should harbor no illusions about how much weight these two studies can bear, and I harbor none. Forty-four people in one case, students in the other, both times a snapshot with no follow-up over time and therefore with nothing to say about cause and effect. They are clues, not proof. They deserve attention nonetheless, because they agree so precisely with what can be seen in the consulting room, and because they resolve the apparent contradiction in the large data sets.
The resolution is this: intelligence is not a cause of anxiety but its architect. It determines not whether someone becomes anxious but how well the result is built.
This statement is to be taken literally, because otherwise it will be read as contradicting the title of this article. To call intelligence the architect does not mean that there are more anxiety patients among the gifted. It means that among those gifted people who do fall ill, the end result is a better-founded and therefore more stubborn anxiety. It is the same difference as that between the question of who builds a house and the question of how solidly its walls are laid. A good mason does not build more often; he builds to last—and if the building stands in the wrong place, that is exactly the problem.
This explains both directions in the data. A person who does not think anxiously thinks, if highly gifted, more thoroughly and is more likely to come to rest—hence the negative direction among the healthy. A person who does think anxiously thinks, if highly gifted, more anxiously, because he is better at it—hence the positive direction among the ill.
“Intelligence does not raise the likelihood of becoming anxious. It raises the quality of the reasons for staying that way.”
Why Verbal Ability, of All Things
That it is verbal rather than spatial ability looks at first like a curiosity of measurement. It is the heart of the matter.
In 1990 Thomas Borkovec and Jonathan Inz investigated what worry actually consists of. The result: mostly language. A person who worries does not primarily see images; he conducts an inner conversation in sentences.10 From this observation Borkovec developed an explanation that has remained the most influential to this day: worry is a form of avoidance. By talking about what he fears instead of picturing it, a person keeps the vivid image at arm’s length—and with it the full bodily reaction.11 The same line of research showed that a preceding period of worry dampened the cardiovascular response to fear images imagined afterward.12
From this follows something unpleasant and logically compelling. If worry dampens anxiety in the short term, then it is rewarded. It feels like problem solving, it keeps one busy, it keeps the images away—and precisely by doing so it prevents the feared outcome from ever being thought through to the end and tested. The worrier has the impression of working while in truth he is evading. That is not laziness. It is a highly effective procedure whose only flaw is that it preserves the problem.
Here, too, the evidence is not uniform, and that needs to be said: with more sensitive measurement methods, the assumption of physical dampening has repeatedly failed to be confirmed; there, worry was even accompanied by an increase in arousal.13 What all sides share is the other part: that worry is predominantly verbal thinking, more abstract and poorer in imagery than other thought processes.
The observation is not new. Seneca put it into a single sentence in the first century: there are more things that frighten us than things that truly oppress us, and we suffer more often in imagination than in reality.14 The better-known version - “My life has been full of terrible misfortunes, most of which never happened” - is attributed variously to Montaigne, Mark Twain, or Churchill and cannot be traced to any of them. In an article about untested claims, that deserves mention.
And with that, Penney’s finding no longer looks curious but logical. If worry is a verbal process, then verbal ability is the tool with which it is carried out. A larger vocabulary, a readier command of concepts, more practice in formulating conclusions: none of this makes the worrier calmer. It makes him more productive. Worry consists of sentences, not images. Whoever formulates better has more sophisticated worries.
How a Clever Fear Is Built
First, a distinction that has belonged to the stock of philosophy since Kierkegaard and has been lost in everyday speech: fear has an object; anxiety has none. Whoever fears the dog can avoid the dog; whoever is anxious does not know what he is anxious about—Kierkegaard called it the dizziness of freedom.15 Psychiatry does not go along with this distinction; it uses the umbrella term anxiety disorder for both, and this article follows it in that.
For treatment, the philosophical distinction is nonetheless valuable, because pathological anxiety lies exactly between the two: it has an object, but a misidentified one. The bodily sensation is real; the heart really is racing. What is false is only what the person concludes from it. That is precisely why this anxiety is treatable—and precisely why the object must be named first, before anything else happens.
What becomes of this in the consulting room can be shown most precisely with panic disorder, because there the chain of thought is shortest and best studied.
In 1986 the British psychologist David M. Clark formulated the model that has shaped the treatment of panic disorder ever since: a panic attack arises when harmless bodily sensations are misinterpreted as signs of an imminent catastrophe—palpitations as a heart attack, dizziness as fainting, a feeling of unreality as the beginning of losing one’s mind.16 The misinterpretation produces anxiety, the anxiety produces stronger bodily sensations, and these confirm the misinterpretation. A closed loop that leads from perception to mortal terror in three minutes.
The decisive point for our subject: this loop needs a justification. It works only as long as the misinterpretation seems plausible. And this is where the clever fear parts company with the simple one. One patient says: “I thought I was going to die.” Another says: “I felt a premature beat. I know that premature ventricular contractions are of prognostic significance in structural heart disease, and I also know that a normal resting EKG does not rule out an intermittent arrhythmia.” The second statement is not more anxious than the first. It is better built. It contains correct medical knowledge, a valid form of inference, and a true objection to the reassuring finding.
That is exactly what makes it so hard to attack. Whoever thinks well produces, for every counterargument, a “yes, but” that is factually correct. The fear thereby reaches a state for which the philosophy of science has a precise name. Karl Popper first called the devices by which a theory is shielded from contrary experience “conventionalist twists”; later he expressly adopted the more apt term immunization from Hans Albert and added the sentence that applies to every anxiety patient: “Any theory can be immunized against criticism.”17,18 A claim that can explain every conceivable event forbids none—and what forbids nothing can be refuted by nothing. The intelligent anxiety patient has, without meaning to, set up an irrefutable theory about his own body. His intellect built it, and his intellect defends it against everyone who means well.
Incidentally, this explains why reassurance does not work with these patients but wounds them—regardless of whether it comes from relatives, physicians, or psychotherapists. Whoever tells a clever person not to worry falls short of his level of thinking. The patient notices at once. He concludes that the person across from him has not understood the problem—and that conclusion is usually correct. After a few such experiences he stops asking. That is the point at which intelligent anxiety patients stop letting themselves be treated and start reading up on their own.
Why Three Hundred Refutations Do No Good
Now the question on which everything turns. A person with panic disorder has, let us say, three hundred attacks behind him. In not a single one did the feared catastrophe occur: no cardiac arrest, no fainting, no loss of mind. He possesses three hundred refutations of his own hypothesis. Why does he believe it anyway?
The answer was given by Paul Salkovskis in 1991, and it is the most practically useful insight in all of anxiety research. Whoever believes a catastrophe is imminent does everything he thinks will prevent it. He sits down when he fears fainting. He avoids exertion when he fears a heart attack. He gets off at the next station. He carries a pill with him. Salkovskis called this safety behavior and showed what it does: it prevents refutation. For when the catastrophe fails to occur, the person attributes its absence not to the harmlessness of the situation but to his precaution.19 In this way an event that could have destroyed his fear becomes evidence for it.
That this is not merely a pretty theory was shown by a study of patients with panic disorder and agoraphobia: those who gave up their safety behavior during a brief exposure afterward had markedly less anxiety and weaker catastrophic beliefs than those who kept it—with identical duration and in an identical situation.20 So it is not the exposure that works. It is the refutation, and safety behavior prevents it.
Logically, this is one of the oldest fallacies there is: post hoc ergo propter hoc—after this, therefore because of this. Because the rescue followed the measure, the measure is taken to be the cause of the rescue. The history of medicine supplies the costliest example: bloodletting. For two thousand years it was considered effective because the sick recovered after being bled; whether they would have recovered without it as well, no one checked. What shook this error was not a better argument but a simple count. In 1835 the Paris physician Pierre-Charles-Alexandre Louis took the case histories of 77 patients with pneumonia and tallied how they had fared. Of the 41 patients who had been bled early, about forty-four percent died; of the 36 bled later, about twenty-five percent.21 Those who had received the treatment earlier, then, died more often than those who received it later.
What this finding does not show must be added, because inferring it would be the same error of reasoning: Louis did not compare treated with untreated patients but those treated early with those treated late. It does not follow that bloodletting does harm. What does follow is far more uncomfortable for the medicine of the day, namely that the treatment worked in the direction no one had expected—and that in two thousand years of experience no one had noticed, because no one had counted.
Two further aspects of this episode deserve attention. First, Louis called his own result astonishing and seemingly absurd—and stood by it nonetheless instead of explaining it away. Second, he made of it not a crusade but a qualification: he continued to regard bloodletting as justified in severe inflammations. The error therefore did not vanish overnight; bloodletting persisted for decades. What Louis left behind was not the end of a treatment but the beginning of a method. He called it the méthode numérique, the numerical method. It is exactly the method recommended below, and it has the advantage of not needing to take anyone’s word for anything.
That such counting so rarely happens of its own accord was demonstrated long before psychology by a godless man—it was explained only much later, by an Englishman.
Cicero tells of Diagoras of Melos, who was shown in a temple the votive tablets of sailors who, having made a vow, had escaped the storm: proof enough of the power of the gods. Diagoras disputed nothing and refuted nothing. He asked a single question: where were the tablets of those who had drowned despite their vows?22 With that he had made the imbalance visible without explaining it: the rescued donate tablets; the drowned donate none.
The explanation came a good sixteen centuries later from Francis Bacon, who made the same example an object lesson about the human understanding: it remembers what comes to pass and forgets what fails to happen.23 Applied to anxiety, this means: the tablets of the threatening moments hang in the temple without exception, each one labeled and dated. The three hundred trips on which nothing happened, no one has hung up. Whoever looks at the wall therefore sees a danger—and sees it even if he is the cleverest person in the room.
This also makes clear why cleverness is no help at this point. It is the bookkeeping that is wrong, not the arithmetic. Whoever is more intelligent merely keeps the wrong books more neatly.
The Tool Any Reader Can Use Today
From the foregoing follows a four-step procedure that requires no training, only paper and the willingness not to spare oneself.
First, the prediction. Write down exactly what is supposed to happen. Not “I’ll have a panic attack”—that is the name of a state, not an event. Rather: What does my body do, what do I do, and what would a stranger present see? As long as the fear remains nameless, it is irrefutable, and that is no accident but the way it is built.
Second, the criterion. How exactly would one recognize that the prediction had come true? Whoever cannot answer this question has not a fear but a mood.
Third, the count. How often have you predicted it, and how often has it occurred by the criterion just established? In anxiety disorders the second number is, as a rule, zero. A prediction that has failed to come true three hundred times is called an error in every other area of life. Only in one’s own head is it called experience.
Fourth, the bookkeeping. To what have you credited the absence? The pill in your bag, the seat by the door, getting off in time, the person accompanying you? Each of these attributions is a claim you sign with your behavior. You cannot say “it’s harmless” and memorize the escape route at the same time. One of the two is insincere, and the body believes the behavior.
| Claim | What it rests on | Assessment |
|---|---|---|
| Gifted people develop anxiety disorders more often | Surveys of members of high-IQ societies | Untenable; the selection of respondents explains the finding |
| High intelligence does not increase the risk of an anxiety disorder | UK Biobank, meta-analysis of 27 comparison studies, Kiel comparison study of 2025 | Well supported; all three studies point in the same direction |
| Beyond that, high intelligence protects against generalized anxiety | Only the UK Biobank analysis; the meta-analysis and the Kiel study find no difference | Single finding, not confirmed; subject to the caveats of any volunteer cohort |
| Among anxiety patients, more intelligence goes with more worry | Two small studies (44 and 126 people) | Plausible but weakly supported; no statement about cause |
| Worry is predominantly verbal thinking | Experimental studies since 1990 | Well supported; the assumption of physical dampening is disputed |
| Safety behavior prevents the refutation of anxiety | Experimental test in panic patients | Well supported and of immediate practical use |
Why Gifted Anxiety Patients Are the Best Patients for Cognitive Psychotherapy
This is the point at which a research review turns into a treatment decision.
If an intelligent person’s anxiety is so stubborn because it was built with his best tool, then there are exactly two ways of dealing with it. One is to bypass the tool: to urge the patient to feel, to relax him, to accompany him psychotherapeutically, to take the work of grappling with it off his hands. This option has the drawback of shutting down the patient’s strongest ability and sparing him precisely where he is resilient. It produces patients who feel understood and go on thinking wrongly, unchanged.
The other is to turn the same tool in the opposite direction. Whoever can set up an irrefutable theory about his body can also examine why it is irrefutable. Whoever turns an unanswered message into a law of nature in a second and a half has a remarkable speed of thought; it can be directed at examining his own thinking and its results. That is precisely the subject of cognitive psychotherapy24: the elimination, by the patient himself, of the errors of reasoning that produce his suffering.
It is therefore not the same thing as cognitive behavioral therapy. Cognitive behavioral therapy intervenes at two points: on thinking and, in addition, with exercises of its own, on behavior. Cognitive psychotherapy intervenes at a single point, namely the one on which the other depends. Because behavior is the result of thinking, behavior changes along with it as soon as the errors of reasoning have been eliminated; a separate exercise program thereby becomes unnecessary.
Lawyers know the principle from their everyday practice: whoever gets a wrongful judgment set aside need not also contest every single enforcement measure, because without the judgment the enforcement has no basis. A pathogenic conviction stands in exactly this relation to behavior. Whoever is convinced that he will collapse on the train enforces this judgment by getting off. Once the judgment is set aside, there is nothing left to enforce; whatever habit remains, everyday life clears away. The difference between the two methods is thus not one of wording but one of the point of intervention, and therefore of efficiency: not two interventions, but the one right one. It is described in detail where cognitive psychotherapy and cognitive behavioral therapy are compared side by side25.
For a gifted anxiety patient this difference carries particular weight. What he lacks is not practice in dealing with situations—he has come through three hundred attacks without anyone holding his hand. What he lacks is the correction of a single pathogenic conviction, a belief such as “when my heart races like this, I’ll collapse.” Once this conviction has been examined and replaced, his everyday life is the space in which the new routines are practiced, from morning to night and without witnesses. Why, for this reason, psychotherapist-accompanied exposure exercises can be dispensed with is the subject of a separate article: “Why Cognitive Psychotherapy for Anxiety Is a Pleasure.”26
A word on the time required, because it tends to be overestimated. Klaus Grawe, professor of clinical psychology at the University of Bern, demonstrated as early as 1994, in his analysis of the entire body of outcome research then available, that the cognitive methods are highly significantly superior to the long-term methods that purport to uncover hidden causes, and at a fraction of the number of sessions.27 In thirty years nothing has changed in this ranking. What has changed is only how little it impresses the health care system—and that the Health Directorate of the Canton of Zurich, headed by Natalie Rickli, a member of the cantonal government for the Swiss People’s Party (SVP), presumes to declare officially that the international treatment standard, “that anxiety disorders could be cured in eight to ten hours,” is “misleading and therefore impermissible.”28
Gabriela Rüttimann, President of the Association of Swiss Psychotherapists (ASP): “We are particularly annoyed by … the claim that anxiety disorders can be cured in as little as eight to ten hours, or that life can be fully worth living again after just a few hours of therapy.”28 This is cognitive warfare by the Association of Swiss Psychotherapists (ASP) against effective psychotherapy.
What effective cognitive psychotherapy looks like in practice is illustrated by the story “The Woman Who No Longer Takes the Train—Until She Heals Her Panic Disorder with Agoraphobia in Four Hours,” which follows a woman who has not set foot on a train in three years and demands that her psychotherapist ride with her.29
The Special Case: When Giftedness Becomes a Handicap
This leaves the group the Mensa survey was really about. The fact that gifted people are not statistically more anxious does not mean there are no gifted people whose gift makes life hard for them. It means only that the cause lies not in the gift itself but in how well it fits its surroundings: in being underchallenged, in the experience that one’s trains of thought regularly fail to land, in the isolation that follows, and not infrequently in diagnostic assessments that mistake speed and openness to stimuli for a disorder. Anyone wishing to follow this connection more closely will find it in the account of giftedness as a handicap.30
For treatment, the same follows as above, only more sharply: a method that relieves a gifted person of his thinking takes from him the one thing in which he surpasses everyone. A method that demands it of him gives him, for the first time, a task at his level.
When a Physician Is Needed After All
Everything above holds under one condition, and it is not negotiable: physical causes must be investigated before anyone talks about errors of reasoning. Cardiac arrhythmias, an overactive thyroid, anemia, low blood sugar, side effects of medication—all of these can trigger anxiety attacks, and all of them can be checked quickly. Whoever begins the cognitive work without this workup may be treating a correct thought as an error of reasoning. That is the only mistake in this field that is truly dangerous.
Likewise: anyone who has actually lost consciousness needs a medical examination, not counseling. And in a severe depressive episode with considerably impaired capacity to think, or where there are thoughts of suicide, all self-treatment ends; the situation must then be placed without delay in the hands of a physician or of a psychiatric emergency service near where one lives.
A note for those who fear fainting, because it disposes of a whole catalog of fears: fainting requires that blood pressure drop and too little blood reach the brain. During an anxiety attack, pulse and blood pressure rise. In an anxiety attack, then, the body does exactly the opposite of what fainting would require. Whoever fears fainting in an anxiety disorder is thus afraid of the opposite of what his body is doing at that very moment.
The well-known exception is blood-injection-injury phobia, blood phobia for short: there the initial arousal is regularly followed by a second phase with a drop in blood pressure, and the fainting is real and well studied.31 It is the only phobia in which this reliably happens. An isolated faint can occur in other circumstances too, for instance after very prolonged hyperventilation or with low baseline blood pressure; it remains the exception and, like every faint that has actually occurred, is a matter for medical investigation, not for counseling.
Core Assessment
Six statements sum up what the research reliably supports.
First: the claim that giftedness is a risk factor for mental disorders comes from surveys of members of high-IQ societies and does not withstand methodological scrutiny. It measures who joins such clubs and answers surveys about illness.
Second: large population data show the opposite or nothing at all. The highly intelligent suffer less often from generalized anxiety; in the meta-analysis and in the most recent comparison study, gifted people do not differ significantly from comparison subjects in their level of anxiety.
Third: what remains empirically is a reversal of direction. Among the healthy, more intelligence goes with less worry; among anxiety patients, with more. The evidence for this is thin and permits no statement about cause and effect.
Fourth: the obvious explanation for this reversal is that worry is a verbal process. Verbal ability is thus not the cause of anxiety but the tool with which it is carried out—and the very same tool that would have to accomplish the correction.
Fifth: the reason intelligent people keep their anxiety despite having it refuted a hundred times over lies not in a deficit of thinking but in a bookkeeping error: the absence of the catastrophe is credited to one’s own safety behavior instead of to the harmlessness of the situation. That is the fallacy post hoc ergo propter hoc, and a good mind merely carries it out more neatly.
Sixth: for treatment, it follows that with gifted anxiety patients every method that bypasses their thinking is a waste. What must be corrected is a pathogenic conviction—a belief such as “if I don’t get off, I’ll collapse.” Whoever has examined and replaced it practices the new pattern in his own everyday life, without an escort and without a program.
Whoever wants to draw advice from this arrives at a piece of advice that sounds less flattering than it is: your anxiety is not the price of your intelligence. It is its product—and that is why you can take it back.
Dr. Dietmar Luchmann, LLC, the publisher of this journal, itself offers cognitive psychotherapy via video — with a written summary of every session, for self-pay patients, in German or English.
1. Understand the Method
2. Check Your Suitability
3. Apply for Admission
1 Karpinski, R.I.; Kinase Kolb, A.M.; Tetreault, N.A.; Borowski, T.B.: High intelligence: A risk factor for psychological and physiological overexcitabilities. Intelligence, 2018, 66, 8-23.
2 Hambrick, D.Z.; Marquardt, M.: Bad News for the Highly Intelligent. Scientific American Mind (New York), March 2018, 29(2), 12.
3 Fries, J.; Baudson, T.G.; Kovacs, K.; Pietschnig, J.: Bright, but allergic and neurotic? A critical investigation of the “overexcitable genius” hypothesis. Frontiers in Psychology, 2022, 13, 1051910. [In the original: “However, it is possible that the effects are caused by sample selectiveness (i.e., membership in a high-IQ society) rather than high IQ itself.”]
4 Williams, C.M.; Peyre, H.; Labouret, G.; Fassaya, J.; Guzmán García, A.; Gauvrit, N.; Ramus, F.: High intelligence is not associated with a greater propensity for mental health disorders. European Psychiatry, 2023, 66(1), e3, 1-8.
5 Williams, C.M.; Peyre, H.; Labouret, G.; Fassaya, J.; Guzmán García, A.; Gauvrit, N.; Ramus, F.: High intelligence is not associated with a greater propensity for mental health disorders — CORRIGENDUM. European Psychiatry, 2025, 68(1), e136, 1.
6 Duplenne, L.; Bourdin, B.; Fernandez, D.N.; Blondelle, G.; Aubry, A.: Anxiety and Depression in Gifted Individuals: A Systematic and Meta-Analytic Review. Gifted Child Quarterly, 2024, 68(1), 65-83.
7 Saß, S.; Köller, O.; Zimmermann, F.: Smart But Maladapted? Differences in the Psychological Functioning of Intellectually Gifted Students Compared With Average-Ability Students. Gifted Child Quarterly, 2025, 69(3), 219-236.
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