dps dr Consensus Informedconsent .pdf
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CONSENT TO PARTICIPATE IN RESEARCH
Experiences with Depersonalization/Derealization
I would like to invite you to participate in a research study conducted by Eduardo Duran, Department of
Sociology, UCLA. I am asking you to be part of this study because you are an active member of an
online support group for people who experience depersonalization/derealization. Your participation is
What is the purpose of this study?
I am studying the experiences of people with depersonalization/derealization and how these experiences
affect people’s everday life.
What will I be asked to do?
If you volunteer to participate in this study, I would like to audiotape an interview over the phone. The
interview will take about thirty minutes to one hour.
Will participating put me at any risk or cause me any inconvenience?
The interview recordings from this study will be used for research purposes only. You have the right to
ask me to turn off the recorders at any time during. You have the right to review the transcripts to decide
whether or not they should be partially or completely erased.
What are the potential benefits to me and to society?
While there is no direct benefit to you from being part of this study, the results may help provide insight
about the experience of depersonalization/derealization and how it affects people’s lives.
Will I be paid to participate?
Participants in this study will not receive payment for doing so.
Will the information I give be confidential?
Any information that is obtained in this study and that can be linked to you will remain confidential and
will be disclosed only as required by law. The tapes will be transcribed by the principal investigator,
Eduardo Duran, and all personal names and identifying details will be excluded from the transcript. You
will not be identifiable from the transcriptions. The audio files and transcription will be kept indefinitely
in a password protected computer file. Only Duran will have access to the file where the data is kept.
Information obtained in your individual interviews will not be shared with anyone else.
Can I change my mind about participating?
Participating in this study is completely voluntary. If you choose to be in the study, you can change your
mind at any time. You can also refuse to answer any questions you do not want to answer and still
remain in the study.
How can I get in contact with the investigators?
If you have any questions or concerns about the research, please feel free to contact Eduardo Duran at
(626)-384-9637 (or via email: email@example.com). Department of Sociology, Haines Hall, UCLA, Los
Angeles CA 90095.
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 about your rights while taking part in this study, or you have concerns or suggestions and
you want to talk to someone other thatn the researchers about the study, please call the OHRPP at (310)
825-7122 or write to: UCLA Office of the Human Research Protection Program, 11000 Kinross Avenue,
Suite 211, Box 95164, Los Angeles, CA 90095-1694
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