Amanda Shallcross, ND, MPH (’05) has devoted her career in naturopathic medicine to researching how mindfulness interventions can help improve emotion regulation and reduce depressive symptoms in patients experiencing stress and chronic disease. In her new post at Cleveland Clinic, she’ll research new ways to make integrative interventions more accessible, affordable and culturally adaptable.
What is “mindfulness”?
“At its heart, mindfulness is a strategy people use to regulate their emotions. It’s awareness and acceptance. It’s noticing what’s there and accepting what’s there, and through that acceptance you end up kind of paradoxically experiencing less negative emotion and less physiological arousal,” said Amanda Shallcross, ND, MPH (’05).
While a student studying psychophysiology at National College of Naturopathic Medicine in Portland, Oregon, Dr. Shallcross first saw how biofeedback techniques improved the mental and physical wellbeing of patients dealing with conditions ranging from hypertension to depression.
“It was on that psychophysiology rotation where I first started using HeartMath, a biofeedback-based treatment approach that teaches people how to regulate their breathing and their sympathetic nervous system, and we were using guided imagery and EEG (electroencephalogram) neurofeedback as well,” Dr. Shallcross said.
Awed by the profound effects these self-regulation treatments had on patients, from reducing blood pressure to improving mood, Dr. Shallcross wondered why they were not part of the standard of care or covered by insurance? The experience motivated her to devote her career to exploring the ways standardized self-regulation practices could be made more accessible to a wider group of patients.
“Going into research felt like a logical next step so I could both understand how these treatments worked and also contribute to the evidence for how these stress reduction practices produce positive health outcomes,” Dr. Shallcross said.
“Dr. Steven Sandberg-Lewis and Kayle Sandberg-Lewis were the ones that started the psychophysiology rotation. I would just like to say, wow, that was a life-changing experience for me. That whole experience really helped me to start thinking about mind-body medicine in the ways that I’m thinking about it now.”Amanda Shallcross, ND (’05)
Finding mentorship in integrative medicine research
After graduating in 2005 from NCNM (now National University of Natural Medicine, NUNM), Dr. Shallcross moved back home to Denver, Colorado, where she joined a lab at the University of Denver that focused on psychophysiology and emotion regulation. There, she started working with someone who would go on to become her mentor to this day, Dr. Iris Mauss.
“Dr. Mauss basically raised me as a scientist,” Dr. Shallcross said. “She encouraged me to apply for a postdoctoral fellowship through the NIH (National Institutes of Health), which I ended up getting.”
Part of the U.S. Department of Health and Human Services, NIH is the nation’s foremost medical research agency. NIH-funded studies undergo very rigorous peer evaluation, lending credibility to the findings of research underwritten by the agency. (During the past decade, NIH has awarded NUNM’s Helfgott Research Institute nearly $6 million for its integrative medicine research programs.)
“It’s been an immense pleasure to work alongside Dr. Shallcross over the years, first as a mentor and now as a colleague. I – and our field – have learned so much from her unique combination of perspectives, uniting naturopathic medicine and psychological science. Her deep expertise and unique perspective have allowed Dr. Shallcross to make important advances in understanding mindfulness and its use in treating depression and chronic disease.”Iris Mauss, Ph.D., Professor, Department of Psychology, University of California, Berkeley
When Dr. Mauss accepted a position at the University of California, Berkeley, Dr. Shallcross applied for and accepted a position in the Department of Population Health at the NYU School of Medicine in New York, New York. The new role gave her the opportunity to build not only on her research into mindfulness-based interventions for people suffering from depression and chronic diseases, but also explore her interests – and concerns – with the field of public health. She earned a Master of Public Health (MPH) degree in 2012 while working at the University of Denver.
“In the Master of Public Health program, I started to feel bewildered that every class focused nearly exclusively on diabetes, or obesity, or cardiovascular disease – all very common physical health conditions that are indeed plaguing the country and the world, but nothing about mental health! Nothing about depression as a pandemic or an epidemic. Nothing about loneliness. Nothing about anxiety. And I thought, ‘How terribly unfortunate!’”
Since joining NYU’s School of Medicine in 2013, Dr. Shallcross has primarily conducted clinical trial research focused on mindfulness-based interventions, emotion regulation and resilience in the face of chronic mental and physical disease. She has published nearly 20 peer-reviewed papers, won a prestigious five-year Research Career Development Award from the NIH, and recently was awarded two R01-level grants from NIH to test a scalable version of mindfulness-based cognitive therapy for patients with depression and chronic disease.
Looking at mindfulness through a health equity lens
Dr. Shallcross noted that mindfulness is often portrayed visually on health magazine covers with an image of a healthy, wealthy-looking White woman sitting in a lotus position atop a cliff.
“That image does not engender much comfort or familiarity, especially if you are living in a poor community of color and there aren’t a lot of resources there,” she said. “Many people have never sat in a lotus position; they have no connection to Buddhism or Eastern religions and philosophy. I mean, all of this is sort of alienating.”
Furthermore, most clinical trials on mindfulness interventions have almost no people of color represented, she said.
“So, even if we wanted to assume that mindfulness is helpful for everyone, including marginalized communities, we don’t even really know that because they’re totally underrepresented in all of these studies.”
In response, Dr. Shallcross has incorporated health equity into her research. Her current work is focused on developing a line of research around culturally adapting mindfulness interventions for communities of color. She said there’s evidence that depression manifests differently depending on an individual’s heritage and culture.
“If depression doesn’t manifest the same way for a White person as it does for a person who identifies as Black or African American, or Latinx, or South Asian, then maybe the treatment approach needs to be different, too”.Amanda Shallcross, ND (’05)
While some people may experience mindfulness while seated in a lotus position, others may attain a state of awareness and acceptance in unlikely ways – by shelling peas, for instance.
“I’ve read some research in the African American community where shelling peas is cited as practice that elders in the community engaged in and that modeled a form of mindfulness. It really grounds you in a moment,” Dr. Shallcross said. “It’s those moments when you’re not ruminating, you’re not thinking about all the bad things that could be happening, it’s a very centering activity that’s very culturally relevant to a group of people. Mindfulness does not have to look like sitting still with your legs crossed. It can be embodied in all these different ways.”
Mentoring the next generation of researchers
Also important to Dr. Shallcross’s research on culturally adapted mindfulness-based cognitive therapy is the involvement of researchers who identify with a community of color to help spearhead this research.
“Because I am not from those communities, ethically it doesn’t feel right. I’m trying to extend the call to as many people as possible to be a part of this research. I am swimming in data and I have a keen interest in helping to mentor underrepresented junior scholars who can take this research in a direction that feels right for their communities,” she said.
For the first time in her career, Dr. Shallcross has an opportunity to build a research department of her own. She recently accepted the position of director of research and training in the Department of Wellness and Preventive Medicine at the Cleveland Clinic.
Cleveland Clinic is consistently regarded as one of the top hospital systems in the United States and the world. The clinic’s scope of medical practices includes acupuncture, primary care with specialties in preventive medicine, chiropractic care, nutritionists and integrative psychotherapy. While impressive from a clinical perspective, most of the research conducted at Cleveland Clinic has not been funded by the NIH. Dr. Shallcross’s job is basically to launch that program.
“For me, this is a big career step up. It’s a leadership position. It’s a lot of training and mentoring, while keeping afloat my own NIH-funded research program.”
Joining her at the Cleveland Clinic will be another NUNM graduate, Jacob Hill, ND (’14). A dual-degree graduate, Dr. Hill earned his Doctor of Naturopathic Medicine (ND) and Master of Science in Integrative Medicine Research (MSIMR) from NUNM in 2014.
For the past year, Dr. Hill has been working with Dr. Shallcross in a research scientist role at NYU helping lead a multi-site clinical trial on migraine and mindfulness. Next, he will be one of Dr. Shallcross’s newest mentees at the Cleveland Clinic, where he also successfully landed an assistant professor position.
“Dr. Shallcross exemplifies a holistic and mindful approach to mentoring. I feel very fortunate to have found her at NYU, and our shared background in naturopathic medicine has been helpful to see the larger field of integrative medicine through a similar lens.”Jacob Hill, ND (’14)
“The guidance and knowledge she shared has propelled my career to the next level. She produces research capable of shifting healthcare in a positive direction, and I look forward to continuing to learn and collaborate with her at the Cleveland Clinic.”
The cycle of mentorship, which began for Dr. Shallcross during her education at NUNM, keeps turning as she will now mentor a new generation of integrative medicine researchers at Cleveland Clinic.
“I feel like I’m a product of all the people who’ve helped me along the way, so I’m just grateful to now be in a position to pay it forward,” Dr. Shallcross said.