ANTIOCH UNIVERSITY NEW ENGLAND

DEPARTMENT OF CLINICAL PSYCHOLOGY

CONSENT FORM

Combat Research Study

My name is Warren Avery, and I am a doctoral student in psychology at Antioch University New England. As part of my studies, I am conducting a research project to better understand why some people get PTSD, and others don’t. Youare being invited to participate in this project because you are a veteran of Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) and have been relieved from active duty for at least 6 months.

You donot have to have PTSD to participate.

What you are being asked to do.

If you choose to participate in this project, you will complete an on-line survey that others have completed in about 15 minutes. The survey includes about 45 multiple choice questions, in the following sections:

  • a few questions about yourself and your military service (we will not ask for any information that would identify you).
  • 7 questions about your military combat experience.
  • 18 questions about whether and how much you experience symptoms of PTSD (Post – Traumatic Stress).
  • 15 questions about your general outlook on life and coping with stress.

Risks of participating in this study.

Thinking about their military experience makes some veterans uncomfortable, and it’s possible that this could happen to you. Sometimes this discomfort can rise to the level of really disturbing memories, like flashbacks. If you are worried about this happening to you, you can decide not to participate in this study. If you begin to participate in this study, and you become uncomfortable, you can just stop the survey at any time. If you feel you are in crisis we encourage you to call 211 and request the number for your local Emergency Services in order to obtain assistance.

Intended Benefits of this study.

The results of the survey have the potential to improve the way in which military personnel are screenedand treated for PTSD. In addition, anyone who begins the survey – whether or not they answer all of the questions – will be invited to enter a lottery for a $100 Amazon gift card.The odds of winning are 1 in 150 or better depending on participation (it is expected that it will be less than 1 in 100).Instructions for entering the lottery will be provided at the end of the on-line survey.

Your privacy will be protected.

Because this is an on-line survey, there will be no way for me to know who participated in the survey, and there will be no identifying information attached to your survey responses. My reports about this research will focus on trends from all participants, not on individual responses.

Your participation is completely voluntary.

You can choose to stop filling out the survey at any time, and doing that will notimpact any treatment you are receiving or your involvement in veterans’ activities or benefits. Even if you don’t complete the survey, you may still enter the gift card lottery by clicking on the link at the end of the survey.

If you do fill out the survey, you may leave any question blank, but please answer as many questions asyou can.

If you have any questions about the study, you may contact

Warren J. Avery, MA, MS ().

If you have any questions about your rights as a research participant, you may contact Katherine Clarke, Chair of the Antioch University New England Institutional Review Board, (; 603–283-2162).