Chronic conditions such as cancer and heart disease can be difficult to deal with under the best circumstances.
Amanda J. Shallcross, DNM, MPH, assistant professor of population health, is working with Olugbenga G. Ogedegbe, MD, MPH, director of the Center for Healthful Behavior Change, to investigate whether interventions such as mindfulness-based cognitive therapy might help break the negative cycle.
Such interventions use meditation and other cognitive techniques to teach patients how to become more aware and accepting of difficult emotions, such as sadness and fear. By helping people pay close attention to their bodily sensations, thoughts, and emotions, instead of avoiding them, these “awareness skills,” Dr. Shallcross says, could help reduce the stress and anxiety that would otherwise exacerbate a patient’s physical illness.
While a student at the National College of Naturopathic Medicine in Portland, Oregon, Dr. Shallcross saw how basic mindfulness techniques improved the mental and physical wellbeing of some of her patients. Peer-reviewed studies have since bolstered the evidence for the approach’s effectiveness in conditions such as depression and chronic pain. After receiving her doctorate in naturopathic medicine, Dr. Shallcross began measuring physiological indicators of stress and using mindfulness techniques to help address mood disorders as a postdoctoral researcher at the University of Denver.
“When I finished my postdoc, I wanted to be in an environment where I could ask similar questions, but of patients who not only had mood struggles but also had chronic diseases,” she says.
She found the perfect opportunity to launch that effort under the mentorship of Dr. Ogedegbe, a leading expert on community-based health interventions.
Given Dr. Shallcross’s unusual background in naturopathic medicine, Dr. Ogedegbe was impressed with her desire to develop new research skills and delve into whether her mental health–aiding strategies could be applied to patients with physical diseases. “She was curious, she was bold, and what she was proposing was quite ambitious,” Dr. Ogedegbe says. He sensed a passion for her work that he calls “fire in the belly” and concluded that investing in the effort to help her hone her skills would be well worth the risk. “Taking a risk and investing in people are two things that go hand in hand,” he says.
So far, he says, he has been richly rewarded by Dr. Shallcross’s maturation as an independent researcher. Since her arrival as a postdoctoral fellow in 2013, she has published 16 peer-reviewed papers, including 7 as first author. With Dr. Ogedegbe’s assistance, she won a prestigious five-year Research Career Development Award from the National Institutes of Health. She was promoted to assistant professor in 2015, has developed several lines of research, and has launched clinical trials to test her technique’s effectiveness.
When Dr. Shallcross first arrived at NYU Langone, Dr. Ogedegbe suggested that she work closely with Tanya M. Spruill, PhD, associate professor of population health and medicine at the Center for Healthful Behavior Change. Dr. Ogedegbe and Dr. Spruill had initiated a collaboration with Orrin Devinsky, MD, professor of neurology, neurosurgery, and psychiatry, and director of the Comprehensive Epilepsy Center at NYU Langone. For epilepsy patients, Dr. Ogedegbe says, “there’s a huge amount of stigma. They have psychosocial stress, they have issues with taking their medication, and they have issues with following up with clinic appointments.”
The collaborators began testing whether behavioral interventions, which Dr. Ogedegbe and colleagues have shown can help patients with hypertension, might likewise benefit epilepsy patients.
Dr. Shallcross joined the team and added her expertise in mindfulness interventions to the toolkit of techniques. The joint project has flourished with Dr. Spruill as the lead investigator, and a recent grant from the Centers for Disease Control and Prevention has allowed the collaborators to translate their mindfulness-based therapy manual into Spanish to help increase access.
As a faculty member in the Center for Healthful Behavior Change, Dr. Shallcross is forging her own partnerships as a go-to specialist for clinicians who are interested in applying mindfulness-based interventions to their own patient populations. “The conversation is almost always around the influence of psychological distress as some kind of risk factor for deleterious health outcomes in their patient populations, and the desire to explore ways to target and reduce suffering through that mechanism,” she says.
For one of her own projects, Dr. Shallcross is distilling the core ingredients of an in-person mindfulness therapy protocol into a telephone-delivered version in a bid to improve access for chronically ill patients with hypertension and depression.
For a separate project, she is investigating the effectiveness of mindfulness-based cognitive therapy for breast cancer patients who have recently completed their cancer treatment. These patients often struggle with pain, fatigue, and other side effects, as well as worry and anxiety over whether the cancer will return.
Eventually, Dr. Shallcross hopes to establish a training center that helps clinicians like her pursue academic research careers. Dr. Ogedegbe has shared the ups and downs of his own career trajectory, which has helped her understand the skills needed to run a center while conducting innovative research. “There are many different paths that a person can pursue with their research career,” she says. “But no matter where you go, I think learning some of those leadership skills is incredibly helpful.”
The Meaning of Mentorship
The art of collaboration is best taught by example, according to Dr. Ogedegbe. “If you’re not collaborative, your mentees will not be collaborative,” says Dr. Ogedegbe. After he forges partnerships with other research groups, his mentees often become the bridges that maintain and build on those relationships. Protégé Dr. Shallcross credits her mentor with fostering such collaborations by seeing connections between his center’s researchers and other scientists throughout the institution and beyond. “He is a master matchmaker on the scientific front,” says Dr. Shallcross.