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
900 State Street
Salem, OR 97301
Kyle Stephenson, Ph.D.
Department of Psychology
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 email@example.com 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?