Your question: Why does my anxiety keep coming back?
By
OptimistMinds
| Reviewed by
Dr. Mark Mohan Kaggwa
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Author bio
The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter. The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.
Reviewer bio
Dr. Mark Mohan Kaggwa is a psychiatrist with experience in both clinical and research work. Major research contributions have been in forensic psychiatry, suicidology, medical education, and addiction psychiatry. He writes and reviews articles on these topics.
Brief bio
I have a wealth of expertise and experience in research and publication in psychiatry. I am a psychiatrist who has led and participated in several research projects and trainings, covering various topics such as addiction, forensic psychiatry, student mental health, and suicidology. I have a strong track record of mentoring and guiding early career researchers, especially students, to achieve academic excellence and recognition.
I have supervised and supported several students to publish their first peer-reviewed articles in high-impact journals such as the Lancet. Five of my mentees have received prestigious awards for their scientific contributions through publications, conference presentations, and travel grants. I derive great satisfaction and motivation from seeing others succeed and grow in their research careers.
Through mentoring activities, I have also enhanced my research and publication skills, resulting in over 70 publications in the past three years. My notable publications include several Lancet Psychiatry papers, widely cited and whose findings are implemented in various settings. I have also won several awards for my writing skills, such as the best journal article from the Royal College of Psychiatry Journals in August 2023.
Many of my articles have been featured on the cover pages of various journals, reflecting their significance and impact. I have also disseminated my research findings through conferences, seminars, and lectures, where I have been invited as a keynote speaker on three occasions.
I am passionate about solving real-world problems and improving the lives of people with mental health issues, especially those who are marginalized and vulnerable, through a team-based approach. I believe in training others to increase the field’s diversity of knowledge and perspectives.
I have extensive experience in data analysis, research methodology, design, and implementation science, which enables me to execute and train others effectively and efficiently. I am also a motivated team leader, an innovative problem solver, and a collaborative partner. My contribution is instrumental to this project’s success and advancing knowledge in this field.
Ongoing research projects:
- Self-harming behaviours among forensic patients in Ontario.
This project which started in December 2022, focuses on identifying the risks associated with physical self-harming behaviors and their related correlates
Role: Principal Investigator
- Suicide, all-cause mortality, and self-harming behaviours among forensic patients in Ontario.
This project is based on administrative databases to determine trends of suicide and all-cause mortality among forensic patients in Ontario. The project has been running since July 2023 to date
Role: Principal Investigator.
- Horticulture therapy’s role in reducing aggressive incidences among forensic patients in Ontario.
In this stepwise pragmatic cluster-randomized, we employ horticulture therapy in rehabilitating forensic patients in Ontario.
Role: Principal Investigator
- A preliminary study exploring the relationship between electroretinography waveforms and suicidal behaviour severity.
This project seeks to identify the waveforms that are related to suicidal behaviours among patients with depression. Recruitment for the study started in October 2023
Role: Principal Investigator
- Positions, Scientific Appointments, and Honors
| 2023 – present | American Psychiatry Association Colloquium fellow 2023, American Psychiatry Association, USA |
| 2022 – present | McMaster Forensic Psychiatry fellowship, McMasters University Department of Psychiatry and Behavioural Neuroscience, Hamilton, Canada |
| 2018 – 2021 | First Mile Fellowship (Masters support program), Massachusetts General Hospital Institute of Health Professions, USA
|
- Contributions to Science
- Suicidology epidemiology
I have been involved in projects investigating the prevalence of suicidal behaviours in various parts of the world. This work has reported the burden and associated factors among the following populations: university students, individuals affected by food insecurity, and those affected by the COVID-19 pandemic.
1) Kaggwa M.M, Akatussasira R, et. al. The global burden of suicidal behaviour among people experiencing food insecurity: A systematic review and meta-analysis. Journal of Affective Disorders. 2023. https://doi.org/10.1016/j.jad.2023.09.012
2) Nahrin R, Al-Mamun F, Kaggwa M.M, et al. Prevalence and factors associated with suicidal ideation among students taking university entrance tests: revisited and a study based on Geographic Information System data. BJPsych Open. https://doi.org/10.1192/bjo.2023.526
3) Abaatyo, J., … Kaggwa, M.Ml. Suicidal behaviour among inpatients with severe mental conditions in a public mental health hospital in Uganda. BMC Psychiatry 23, 346 (2023). https://doi.org/10.1186/s12888-023-04858-x
4) Kaggwa MM, Nuwamanya S, Ashaba S, Rukundo GZ, Harms S. An Adolescent’s Use of Veterinary Medicines: A Case Report Exploring Addiction. Journal of Psychoactive Drugs. 2021/08/08 2021;53(4):339-344. doi:10.1080/02791072.2021.1873466
5) Kaggwa MM, Muwanguzi M, Nduhuura E, et al. Suicide among Ugandan university students: evidence from media reports for 2010–2020. BJPsych International. 2021;18(3):63-67. doi:10.1192/bji.2021.13
6) Mamun MA, Al Mamun F, Hosen I, … Kaggwa MM, et al. Suicidality in Bangladeshi Young Adults During the COVID-19 Pandemic: The Role of Behavioral Factors, COVID-19 Risk and Fear, and Mental Health Problems. Risk Manag Healthc Policy. 2021;14:4051-4061. doi:10.2147/rmhp.S330282
7) Kaggwa MM, Arinaitwe I, Muwanguzi M, et al. Suicidal behaviours among Ugandan university students: a cross-sectional study. BMC Psychiatry. 2022/04/01 2022;22(1):234. doi:10.1186/s12888-022-03858-7
8) Kaggwa MM, Mamun MA, Najjuka SM, et al. Gambling-related suicide in East African Community countries: evidence from press media reports. BMC Public Health. Jan 24 2022;22(1):158. doi:10.1186/s12889-021-12306-2
9) Kaggwa MM, Rukundo GZ, Wakida EK, et al. Suicide, and Suicide Attempts Among Patients Attending Primary Health Care Facilities in Uganda: A Medical Records Review. Risk Manag Healthc Policy. 2022;15:703-711. doi:10.2147/rmhp.S358187
10) Rukundo GZ, Wakida EK, Maling S, Kaggwa MM, et al. Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda. BMC Psychiatry. Sep 12 2022;22(1):605. doi:10.1186/s12888-022-04244-z
11) Manouchehri A, Marznaki ZH, Atim LM, Mohammadian Amiri M, Kaggwa MM. The relationship between causes of suicidal attempts in Iran and individual and social variables: a retrospective study. BMC Psychiatry. Dec 12 2022;22(1):780. doi:10.1186/s12888-022-04449-2
12) Kaggwa MM, Najjuka SM, Favina A, Griffiths MD, Mamun MA. Suicidal behaviors and associated factors among medical students in Africa: A systematic review and meta-analysis. Journal of Affective Disorders Reports. 2022/12/09/ 2022:100456. doi:10.1016/j.jadr.2022.100456
13) Al-Mamun, F., Kaggwa, M.M., Hosen, I. et al. Suicide related to the COVID-19 pandemic in India: A systematic review. Discov Psychol 3, 2 (2023). https://doi.org/10.1007/s44202-022-00063-1
- University student’s mental health
Following my experience as a student and seeing many of my colleagues face vast challenges in their pursuit of knowledge. I investigated various aspects of university students’ mental health to find solutions to an ever-growing problem. I have published a few peer-reviewed articles on subjects ranging from depression, burnout, behavioural addictions, and sexual risk behaviours, among others.
1) Kaggwa MM, Devine J, and Harms S. The opioid crisis fuelled by health systems: how will future physicians fare? BJPsych International, 2023, 1-3, https://doi.org/10.1192/bji.2023.12
2) Sserunkuuma, J., Kaggwa, M. M., et al. Problematic use of the internet, smartphones, and social media among medical students and relationship with depression: An exploratory study. Plos One, 18(5), e0286424. https://doi.org/10.6084/m9.figshare.22794644
3) Kajjimu J, Kaggwa MM, Bongomin F. Burnout and associated factors among medical students in a public university in Uganda: A cross-sectional study. Adv Med Educ Pract. 2021;12:63-75. doi:10.2147/amep.S287928
4) Al Mamun F, Hosen I, Misti JM, Kaggwa MM, Mamun MA. Mental Disorders of Bangladeshi Students During the COVID-19 Pandemic: A Systematic Review. Psychology research and behavior management. 2021;14:645-654. doi:10.2147/PRBM.S315961
5) Najjuka SM, Checkwech G, Olum R, Ashaba S, Kaggwa MM. Depression, anxiety, and stress among Ugandan university students during the COVID-19 lockdown: an online survey. Afr Health Sci. Dec 2021;21(4):1533-1543. doi:10.4314/ahs.v21i4.6
6) Kaggwa MM, Kajjimu J, Sserunkuma J, et al. Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis. PLoS One. 2021;16(8):e0256402. doi:10.1371/journal.pone.0256402
7) Kaggwa MM, Arinaitwe I, Nduhuura E, et al. Prevalence and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study. Front Psychiatry. 2022;13:842466. doi:10.3389/fpsyt.2022.842466
8) Kihumuro RB, Kaggwa MM, Kintu TM, et al. Knowledge, attitude and perceptions of medical students towards mental health in a university in Uganda. BMC Med Educ. Oct 20 2022;22(1):730. doi:10.1186/s12909-022-03774-0
9) Kihumuro RB, Kaggwa MM, Nakandi RM, et al. Perspectives on mental health services for medical students at a Ugandan medical school. BMC Med Educ. Oct 25 2022;22(1):734. doi:10.1186/s12909-022-03815-8
10) Kaggwa MM, Muwanguzi M, Najjuka SM, et al. Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment. PLoS One. 2022;17(11):e0277129. doi:10.1371/journal.pone.0277129
11) Muwanguzi, M., Kaggwa, MM., et al. Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations. BMC Psychology, 2023/01/13.
- Influence of family caregivers and peer influence on patient’s mental health
From the unique perspective of using caregivers in caring for mental health patients in Mbarara Regional Referral Hospital. I embarked on understanding their roles, burdens, and significance in patients’ recovery. I continued to explore this in different populations, such as those involved in the criminal justice system. In this adventurous journey, I published a few peer-reviewed articles.
1) Kaggwa, M.M, Olagunju, A.T, Prat, S, Harms, S, and Chaimowitz, G. Peer support mental health teams in correctional settings in Uganda. Lancet Psychiatry, January 2023. https://doi.org/10.1016/S2215-0366(22)00431-X.
2) Kaggwa MM, Najjuka MS, Kesande C, et al. Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver’s presence. Discover Mental Health. 022/07/04 2022;2(1):15. doi:10.1007/s44192-022-00018-x
3) Kaggwa, M.M, Najjuka SM, Mamun, MA, Griffiths, MD, Nyemara, N, and Ashaba, S. Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma. BMC Psychiatry. January 2023. http://dx.doi.org/10.1186/s12888-023-04553-x
4) Nuwamanya S, Nkola R, Najjuka SM, et al. Kaggwa MM. Depression in Ugandan caregivers of cancer patients: The role of coping strategies and social support. Psychooncology. Oct 26 2022;doi:10.1002/pon.6057
5) Najjuka SM, Iradukunda A, Kaggwa MM, et. Al., The caring experiences of family caregivers for patients with advanced cancer in Uganda: A qualitative study. Plos One, October 2023.
- Mental healthcare and psychiatry epidemiology in Uganda
I have also contributed to understanding Uganda’s mental healthcare system through written commentaries, perspectives, reviews, and primary research.
1) Kaggwa MM, Harms S, Mamum M, A. Mental health in Uganda. Lancet Psychiatry; 2022. Oct;9(10):766-767. doi: 10.1016/S2215-0366(22)00305-4.
2) Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One. 2022;17(10):e0276552. doi:10.1371/journal.pone.0276552
3) Abaatyo J, Kaggwa MM, Favina A, and Olagunju AT. Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda. BMC Psychiatry, 23, 474 (2023). https://doi.org/10.1186/s12888-023-04960-0
4) Abaatyo, J., Favina, A. & Kaggwa, M.M. Absconding among admitted patients with bipolar affective disorder diagnosis in Uganda. BMC Psychiatry 23, 318 (2023).
5) Anyayo L, Ashaba S, Kaggwa MM, Maling S, Nakimuli-Mpungu E. Health-related quality of life among patients with bipolar disorder in rural southwestern Uganda: a hospital-based cross-sectional study. Health and Quality of Life Outcomes. 2021/03/10 2021;19(1):84. doi:10.1186/s12955-021-01729-5
6) Kaggwa MM, Namatanzi B, Kule M, et al. Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse’s Unemployment, Extramarital Relationship, and Substance Use. Int J Womens Health. 2021;13:869-878. doi:10.2147/ijwh.S323636
7) Kaggwa MM, Acai A, Rukundo GZ, Harms S, Ashaba S. Patients’ perspectives on the experience of absconding from a psychiatric hospital: a qualitative study. BMC Psychiatry. 2021/07/26 2021;21(1):371. doi:10.1186/s12888-021-03382-0
8) Kaggwa MM, Najjuka SM, Harms S, Ashaba S. Mortality Among Patients Admitted in a Psychiatric Facility: A Single-Centre Review. Clinical Audit. 2021 2021-06-17 2021;13:21-28. doi:10.2147/CA.S308757
9) Kaggwa MM, Nkola R, Najjuka SM, Bongomin F, Ashaba S, Mamun MA. Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System. Risk Manag Healthc Policy. 2021;14:2789-2795. doi:10.2147/rmhp.S314451
You can view some of my scholastic work from the following
eRA COMMONS: ORCID ID: https://orcid.org/0000-0002-4733-154X
Scopus Author ID: https://www.scopus.com/authid/detail.uri?authorId=57221518864
Researchgate ID: https://www.researchgate.net/profile/Mark-Kaggwa
Loop profile: https://loop.frontiersin.org/people/926359/overview
Semantic Scholar Link: https://www.semanticscholar.org/author/Mark-Mohan-Kaggwa/2046806840
Google scholar: https://scholar.google.com/citations?user=pPNqr_AAAAAJ&hl=en
My reply:
Hi, I hope this message finds you well. My name is Cesar Guedez, a psychologist trained in cognitive behavioral therapy.
Anxiety is a universal experience. All of us at various times in our lives will feel anxious to a lesser or greater extent. Although it sounds strange, in a way anxiety is necessary, since it is a kind of alert from our brain to warn us that something is wrong, and that we are facing a situation, thing or person that could put us in danger.
However, anxiety is not necessarily rational, and it can become too recurrent and intense generating problems in daily functioning. When this happens, your anxiety has become chronic, and therefore, you need strategies to learn to control it and decrease the bothersome symptoms associated with it.
Your anxiety can “keep coming back” for a multitude of reasons. Naturally you may go through periods of “quiet” without feeling anxious, until an event triggers your anxiety and makes you feel worried and overwhelmed again.
If there have been no recent stressful events in your life that would cause your anxiety to “come back”, it is likely that your anxiety problem is related to automatic thoughts that overwhelm you and make you feel constant discomfort. It’s not that your anxiety goes away and then comes back, it’s that when you feel it, you are distracted or busy with day-to-day activities and chores.
Therefore, by learning specific strategies and getting professional help from a psychologist or therapist, you will be able to control your anxiety and prevent it from taking power over your life. You have the strength to do this, and the first step is to know the source of your anxiety.
Why does your anxiety “come back” constantly?
There are different situations that keep anxiety present in people’s lives. All of these are related to your coping strategies and external pressures. Basically anxiety is a process in which the body and mind become dysregulated because the demands and pressures from the outside are greater than the coping strategies. Some of the most common causes of anxiety are:
Stressful changes
It is normal to feel your anxiety constantly returning if you have recently experienced changes. A move, new job, love breakup and the death of a loved one are the changes that usually produce more anxiety in people. You are in a process of adaptation, learning and unlearning things to adapt to a new lifestyle, therefore, it is common to feel that your anxiety appears constantly.
Work and economic problems
Job stress is one of the main causes of anxiety, depression and other mental health problems. If you are in a job that is constantly demanding, it is common that your anxiety appears recurrently, especially in periods when you have more demands and work activities to perform, for example, the Christmas season for workers in shopping malls. On the other hand, if you are going through economic problems, you will be constantly anxious thinking about the debts you need to pay off.
Health problems
People who have recently suffered accidents or medical diagnoses may experience recurrent episodes of anxiety. This is due both to the adaptations that the person must make because of their medical problem, as well as the worrisome thoughts that invade the person regarding their health.
Identity and self-esteem
Anxiety is also related to your perception of yourself and your identity. You may experience anxiety because there are things you don’t like about your body or personality or because you feel that you are generally dissatisfied with your life in more ways than one.
Interpersonal relationships
Whether they are family relationships, friendships or couples, socialization causes anxiety because it often involves conflict and natural arguments between human beings. Interpersonal relationships are the cause of your anxiety when you have experienced many stressful encounters, which make you feel frustrated, annoyed, frightened or sad, with important people in your life.
Automatic thoughts
If there is no specific cause that makes your anxiety appear constantly, then the origin of everything is automatic thoughts. These are thoughts that arise spontaneously at any time of the day, bringing negative emotions and annoying physical symptoms, thus provoking anxiety. You can be calm during the afternoon and out of nowhere, you have a thought about your work or your family. That thought overwhelms you and leaves you feeling worried for the rest of the day. That way the automatic thoughts cause your anxiety to keep coming back, even at times when you were feeling calm.
What does it feel like to have anxiety?
Psychology(1) has studied anxiety as a complex phenomenon, which has specific characteristics that affect people in different areas. Some characteristics of anxiety are:
Cognitive symptoms: fear of losing control; fear of death; fear of “going crazy”; fear of negative evaluation by others; frightening thoughts.
Physiological symptoms: increased heart rate, palpitations; shortness of breath, rapid breathing; chest pain or pressure; choking sensation; dizziness.
Affective symptoms: nervous, tense, wound up; frightened; sadness; irritability.
What can you do to prevent your anxiety from recurring?
Anxiety cannot be completely eliminated, you must learn to control it and prevent it from taking power over your life. For this, it is important that you first learn to identify what is causing your anxiety to be recurrent, to eventually employ techniques to reduce these symptoms and confront the automatic thoughts. It is also important that you see a psychology professional for support and even more specific strategies to deal with your anxiety symptoms.
Question your thoughts
Anxiety is inevitably related to your way of thinking, so you need to modify it in order to reduce anxious symptoms. When you have automatic thoughts that overwhelm you, you should question them and modify them for a positive and functional one. For example, if during work you have an abrupt thought that tells you “you are useless”, you should respond to it internally by saying “I do the best I can to improve in my work, and although I am not perfect, I learn to be better every day”. In this way every negative and hurtful thought that appears during the day, you must confront it and replace it with a more positive and functional one.
Physical exercise
Physical activity is necessary because it allows you to train both your body and your mind. Whether in a gym, playing a sport or from the comfort of your home, physical exercise helps you release hormones and neurotransmitters related to happiness, allows you to feel more focused and helps you drain negative emotions.
Breathing and relaxation
Inhale through your nose for three seconds, exhale through your mouth for another three seconds. This while you close your eyes and feel how slowly the tension in your body decreases. You can apply this exercise for at least 10 minutes a day at different times, and just after experiencing an episode of anxiety.
5, 4, 3, 2, 1
This technique consists of using your senses to dissuade emotional discomfort at a given moment. It is useful when you experience a lot of physical agitation or when you feel you have a lot of unpleasant thoughts, and you find it difficult to control your emotions. Wherever you are, you will focus on identifying 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste. This will allow you to focus your attention on specific things during the period of anxiety, and slowly, the feeling of intense worry will diminish.
In my experience…
Anxiety is recurrent when people have multiple pressures and situations that make them feel constantly worried or when their automatic thoughts take over and make them feel that there is always something they should be worried about. While this may overwhelm you, there is a solution. You have the power to control your anxiety and stop it from ruining your life. Anxiety will never go away completely, but by employing these strategies and consulting with a professional, the next time it appears, you will have better tools to cope with it.
I believe you have the ability to improve and heal these feelings of discomfort you are experiencing now. The fact that you are seeking professional help through this medium proves it to me, and I applaud you for making that decision and being on track to improve your mental health and overall, your physical health
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References
Take Control of Your Anxiety Today: Personalized Counseling with BetterHelp
