Please read the information sheet below. If you decide to participate,
please check the box at the bottom of the page.
University of
Southern California
Brain and Creativity Institute
3641 Watt Way, Suites 126 and B-17
Los Angeles, CA 90089-2520
INFORMATION SHEET FOR NON-MEDICAL RESEARCH
******************************************************************
CONSENT TO PARTICIPATE IN RESEARCH
Neural correlates of emotions induced by music– Online
Portion
You are asked to participate in a research study
conducted by Benjamin Paul, B.A., and Dr. Antonio
Damasio, from the Brain and Creativity Institute at the
University of Southern California because you have
stated that you have certain emotional responses to
music, and are of normal mental and physical health. A
total of three hundred participants may be recruited from
the Southern California area. You must be at least 18
years of age to participate. Your participation is
voluntary. You should read the information below, and
ask questions about anything you do not understand,
before deciding whether or not to participate.
PURPOSE OF THE STUDY
This is a research study. We are inviting you to
participate in this research study because you are
healthy, have no history of a neurological or
psychiatric condition, and because you have normal or
corrected normal hearing. You have also stated to us
that you have had certain emotional responses to music.
The purpose of this research study is to gain an
understanding of particular emotions elicited by music.
Completion and submission of the questionnaire will
constitute consent to participate in this research
project.
PROCEDURES
If you volunteer to participate in this study, we
would ask you to do the following things:
You will be asked to fill out a pre-screening
questionnaire regarding your history of particular
emotions in responses to music, and which pieces have
triggered these experiences. We will also ask about your
religious background. We estimate that the questionnaire
will take approximately 30 minutes.
If your questionnaire results are suitable to the
experiment, you will then be invited to participate in
the second portion of the experiment. In the second
portion, you will be asked to listen to a compilation of
music a certain number of times, at your leisure.
Afterwards, you will come to the Dana and David Dornsife
Cognitive Neuroimaging Center at the University of
Southern California's Brain and Creativity Institute.
There, you will be asked to listen to several short
musical excerpts played through headphones while
situated in a Magnetic Resonance Imaging scanner. Your
brain activity, heart rate, skin conductance,
respiration, will be monitored. You will then be asked
to complete a short form concerning your ethnicity,
musical background, educational background, and
emotional responses to music. The entire process should
take approximately 2.5 hours to complete.
If you agree to participate in the second phase, you
will be given another consent form to review and sign.
The second consent form, which you may view
here, fully describes the second portion of the
research study.
POTENTIAL RISKS AND DISCOMFORTS
There are no anticipated risks to your participation in this study.
POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
You may not directly benefit from your
participation; however, you may experience the enjoyment
of both new and familiar music.
Potential benefits to society include a better
understanding of emotions elicited by music.
PAYMENT/COMPENSATION FOR PARTICIPATION
You will not be paid for your participation in this
first portion of the research study. If you enroll in
the second portion, you will be paid $10 per half hour in
that portion. More details are available in the second
consent form, which you may view
here.
CONFIDENTIALITY
Any information that is obtained in connection with
this study and that can be identified with you will
remain confidential and will be disclosed only with your
permission or as required by law.
You will be assigned a number to help protect your
confidentiality. Data will be kept in a
password-protected computer in a locked office, or, if
it is too large in size for that computer, it will be
moved to a locked desk or file cabinet within a locked
office.
Any identifiable data will be stored for five years
and then destroyed (your name, contact information,
etc.) The non-identifiable data (survey responses, etc.)
will be stored indefinitely and may be used for future
experiments. You will not be contacted for your
permission, since we will not know who the data belongs
to.
When the results of the research are published or
discussed in conferences, no information will be
included that would reveal your identity.
PARTICIPATION AND WITHDRAWAL
You can choose whether to be in this study or not.
If you volunteer to be in this study, you may withdraw
at any time without consequences of any kind. You may
also refuse to answer any questions you don’t want to
answer and still remain in the study. The investigator
may withdraw you from this research if circumstances
arise which warrant doing so.
ALTERNATIVES TO PARTICIPATION
Your alternative is to not participate.
RIGHTS OF RESEARCH SUBJECTS
You may withdraw your consent at any time and
discontinue participation without penalty. You are not
waiving any legal claims, rights or remedies because of
your participation in this research study. If you have
questions regarding your rights as a research subject,
contact the University Park IRB, Office of the Vice
Provost for Research Advancement, Grace Ford Salvatori
Hall, Room 306, Los Angeles, CA 90089-1695, (213)
821-5272 or upirb@usc.edu.
IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about the
research, please feel free to contact:
Benjamin Paul
(847) 977-0688
benjamip@usc.edu
Brain and Creativity Institute
3641 Watt Way, Suite B-17
Los Angeles, CA 90089-2520
Date of Preparation: 6/11/2008 – Non-Med ICF
USC UPIRB # UP-08-00148
SIGNATURE OF RESEARCH
SUBJECT
