EFT Universe Research Pre Survey

Research Pre Survey

Informed Consent to Participate in a Research Study

The Effects of Group Experiences on Psychological States

Introduction

You are invited to participate in a research study. Research studies are designed to gain scientific knowledge that may help other people in the future. You may or may not receive any benefit from being part of the study.

Why is This Study Being Conducted?

The purpose of this study is to compare psychological symptoms before and after group experiences.

What is Involved in This Research Study?

You will sign this form, and fill out a questionnaire that has been used in many other research studies, and
which can be completed in about two minutes. You will complete them before the program, and afterward.

We will contact you 3 to 6 months later to fill out a one-minute online survey again. If we cannot reach you by
email, we will contact you using your cell number. This is the only purpose for which your contact information
will ever be used.

The Benefits and Risks of the Study?

The possible benefits of participating in this study are an improvement in your psychological and physical condition. To date, research confirms that there are no known side effects. There is no guarantee that any of your current symptoms will be improved by participation in this study. Treating emotional memories can result in emotional of physical sensations of discomfort.

What About Confidentiality?

Your records are processed anonymously, and by law, researchers who process the study records are required to keep them completely confidential. If the researchers publish the information learned from this study, you will not be identified by name or in any other way.

Who Is Sponsoring This Study?

This study is being sponsored by National Institute for Integrative Healthcare (NIIH), a 501 (c) (3) public benefit nonprofit research and teaching organization (niih.org). The sponsor is providing money or other support to help conduct this study.

You agree to take part in this study and confirm that you are 18 years of age or older. You have had a chance to ask questions about being in this study and have had those questions answered to your satisfaction. By signing this consent form you are not giving up any legal rights to which you are entitled.

By Clicking this checkbox and pressing submit you are agreeing to a Research Study Informed Consent

Contact Information

First Name

Last Name

Cell Phone (optional)

Age

Anxiety and Depression Scale

Over the past 2 weeks, have you been bothered by these problems?

Below is a list of problems and complaints that people sometimes have in response to stressful experiences. Please read each one carefully, and select the number that indicates how much you been bothered by that problem in the past month.

Brief Flow Scale

Please think about the activity you did most recently, and score each item.

Score each statement from 1 to 7 based on how much you agree with the statement with 1 being not at all and 7 being very much.

Universal Experience Scale

Score each statement from 0 to 10 based on how true it is for you, with 0 being completely untrue and 10 being completely true. For the words “the universe” feel free to substitute any word that, to you, indicates the infinite reality; this might be “Nature” or “God” or “Universal consciousness” or another term.

SUBMIT