Informed Consent

Informed Consent Form
You are being asked to participate in a research study.  Please read this page thoroughly, as it contains information about the study procedures and your rights as a study participant.  Your participation is entirely voluntary, and you can refuse to participate without penalty or loss of benefits to which you are otherwise entitled.  Completion of this form indicates your willingness to participate in the current study.

Title of Research Study
Psychological Well-Being Study

Principal Investigator
Lyndsey Shimazu
Willamette University
900 State Street
Box E234
Salem, OR 97301

Faculty Supervisor
Kyle Stephenson, Ph.D.
Assistant Professor
Department of Psychology
Willamette University
900 State Street
Salem, OR 97301

What is the purpose of this study?
You are invited to participate in a study aimed at understanding attachment orientation (i.e. how your relationship with your caregivers can shape your behavior in future adult romantic relationships), mindfulness (paying attention in a particular way: on purpose, in the present moment, and non-judgmentally), and different measures of psychological well-being in college-aged students.  The associations between these factors are often complex, and the goal of the study is to better understand these patterns.  If you are interested in receiving a more thorough debriefing after your participation, please feel free to contact the principal investigator.

What will be done if you take part in this research study?
If you choose to participate in this study, you will be asked to answer a number of questions regarding your romantic relationships and well-being.  The questions you will be asked will be of a personal nature.  You are free to not answer any questions that you do not wish to answer (all answers are confidential).  Only the principal investigator and her faculty supervisor will have access to your responses.

What are the possible discomforts and risks?
Answering detailed questionnaires about close relationships and well-being may be anxiety-provoking.  In the case of unexpected distress, or if participating in this study causes you concern or anxiety at any time, you always have the option to discontinue participation in the study with no penalty.

There are no significant risks of physical harm associated with the procedures in this study.  However, if you are injured during participation, you will be responsible for your medical treatment.  No payment can be provided in the event of injury or a medical problem while you are a participant in this study. 

This research has been reviewed for the protection of human subjects by Willamette University’s Institutional Review Board.  Questions about the review process or comments about physical or psychological safety, anonymity, confidentiality, or use or storage of data should be addressed in writing to Dr. Peter Harmer, IRB chair at or Peter Harmer, The Department of Exercise & Health Science, Willamette University, 900 State Street Salem, OR 97301.  

What are the possible benefits to you or to others?
Participants will be entered into a drawing to win one of five $50 Visa gift cards.  Additionally, the results of this research will contribute to the scientific community’s understanding of attachment orientation and well-being, potentially leading to the development of more effective treatments for reports of low well-being (e.g. depression and anxiety). 

If you choose to take part in this study, will it cost you anything?
Will you receive compensation for your participation in this study?
As outlined above, if you complete the entire study, you may be financially compensated.

If you do not want to take part in this study, what other options are available to you?
Participation in this study is entirely voluntary.  You are free to choose not to participate in the study, and your refusal will not influence current or future relationships with Willamette University.  You may withdraw from the study at any time.  Your decision not to participate or your decision to withdraw during the study will not result in any penalty. 

How can you withdraw from this research study, and who should you contact if you have questions?
You are free to withdraw your consent and stop participation in this research study at any time without penalty or loss of benefits for which you may be entitled.  If you have any questions, you may contact the Principal Investigator, Lyndsey Shimazu, at, or Dr. Kyle Stephenson, at 503-370-6294.

How will your privacy and the confidentiality of your research records be protected?
If you choose to participate in this study, your responses will be confidential.  While we may ask you for your contact information for the purposes of providing compensation, only the principal investigator will have access to this information.  You do not need to give your real name or other identifying information at any time during your participation if you would prefer to use an alias.

The online surveys are administered through, a third-party company that provides on-line data collection services to researchers at major universities throughout the country.  In order to protect data and other sensitive information during transmission, SurveyMonkey uses Secure Socket Layer (SSL) 128-bit encryption technology, the same encryption technology that is used to protect credit card data and other privacy-sensitive transactions completed over the internet.

Authorized persons from Willamette University and the Institutional Review Board have the legal right to review your research records and will protect the confidentiality of those records to the extent permitted by law.  Otherwise, your research records will not be released without your consent unless required by law or a court order.  If the results of this research are published or presented at scientific meetings, your identity will not be disclosed.  

Will the researchers benefit from your participation in this study?
Your participation in this study will not directly benefit the researcher financially.

If you understand and meet the participation criteria outlined above and would like to take part in the study, please tell the researcher or click the option agreeing to participate below. You can also be sent a copy of this consent form by e-mailing

Question Title

* 1. In order to proceed with the survey, please select one of the following options:

10% of survey complete.