Informed Consent

This form is intended to describe to you, The Participant, the purpose of this research, expected duration and procedures, risks/benefits, limits of confidentiality, and incentives for participation.

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* 1. Informed Consent:
You have a right to decline to participate and to withdraw from this research project now, and at any time once the research has begun. There are no foreseeable consequences to the Prospective Participant declining, or to the Participant withdrawing. If the Participant decides to partake in this study, they reserve the right to decline specific suggestions and/or recommendations made by the researchers within the study’s protocol. The purpose of this research is to explore the user experience of participating in The Phone Zone Challenge. 

Question: The purpose of this study is to explore user experience.

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* 2. Duration & Procedure. The research project will take 30 days to complete from the first day the Participant begins the program, will require between 20-60 minutes per day, and will ask the Participant to complete a variety of reading, writing, and activity-based exercises. Three of the activity-based exercises involve other people, and the Participant reserves the right to refuse to participate in these particular exercises as well; Alternative Exercises are offered within the protocol should the Participant refuse the aforementioned activities, and there are no consequences to opting into the Alternative Exercises. A Participant can even opt out of an exercise entirely (including the Alternative Exercise) and remain in the study. Participants will be asked to complete a pre- mid- and three post-surveys: at time of completion, six months, and 12 months. 

The period in which the researchers will be gathering data will be between April 15th, 2020, and June 30th, 2021.

Question: This program will take how many days to complete?

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* 3. Question: This program will require between how many minutes per day?

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* 4. Question: The participant has the right to refuse to participate in any of the program’s activities (including Alternative Exercises) without being removed from the pilot study

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* 5. Risks. There are potential risks in agreeing to participate in this study, primarily emotional discomfort and stress. You may experience withdrawal symptoms like cravings, anxiety, agitation, sadness, frustration, and other emotions unrelated to withdrawal not listed here. 

Question: What emotions might a participant experience in this program? 

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* 6. Benefits. As this research project is born of other evidence-based practices, there are also potential benefits to participating in this study; primarily increased psychological flexibility with specific attention to the Participant’s phone use patterns of behavior.

Question: How might a participant benefit from this program? (select all that apply)

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* 7. Limits of Confidentiality. While this study requests information of the Participant in a way that is not anonymous (i.e. initial recruitment requests Participants emails, and to sign this form), all information gathered will remain confidential and safeguards are in place to protect the privacy of all Participants. Pre- and post-surveys will be requested via an anonymized online format and researchers will be unable to identify or link survey results to particular participants.

Question: Researchers will be able to link my name to my survey results.

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* 8. Incentives. Participants who are interested in submitting their email will be entered into a raffle to win one of four $50 Amazon gift cards being raffled off at the end of this research project. The raffle will take place on July 1, 2020, and winners will be notified via email before July 4, 2020. To be entered into the raffle, please email Kate@seattleanxiety.com. You are not required to enter the raffle to participate in the study, but you are required to enter the raffle in order to win. 

Question: I am required to enter the raffle.

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* 9. Questions/Concerns: If you have any questions about this research project, or your rights as the Participant, please contact the study’s research assistant, Kate Willman, at kate@SeattleAnxiety.com. Questions can be answered either by phone or virtual conference depending on both parties availability. Asking questions about this informed consent form will have no impact on your ability to participate in this study.

Question: If I have questions about this informed consent, I should contact the research assistant before signing this form.

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* 10. Please type out the following statement and your corresponding answer in the grey box 
"I have read the informed consent document and..."

A) I understand and do not consent to participate in this research project, The Phone Zone Challenge. 

B) I do not understand or I have questions about this informed consent document. Please contact me to set up a consultation.
Preferred method of contact is: (please provide contact)

C) I understand and consent to participate in this research project, The Phone Zone Challenge. Please contact me to set up the Initial Screening. 
Name: (Fill in your name. This acts as your signature for this form)
Date: (Fill in date)
Preferred method of contact: (please provide contact)


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