Informed Consent to Participate in a Research Study
The Effects of Group Experiences on Psychological States
Dawson Church, Ph.D., Principal Investigator

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 ( 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.