Wellborn
MICHIGAN STATE UNIVERSITY
CONSENT TO ACT AS A HUMAN RESEARCH SUBJECT
Shikantaza: The use of meditation to increase physical awareness.
Michael B Wellborn
(906) 226-8635
Graduate Student
Department of Social Work
NAME OF SUBJECT: ______
PURPOSE OF STUDY:
I have been asked to participate in a research project designed to: explore the possibility of using the shikantaza form of meditation to increase physical awareness to one’s surroundings while walking, to help empty a “busy” mind.
SUBJECTS:
I will be eligible to participate if I am an active member of a Michigan State University SW 83 Virtual University class. This initial study will include one subject.
PROCEDURES:
If I agree to participate, the following will occur: I will engage in a round-trip walk each day for a period of 7 days. I will then engage in 15 minutes of shikantaza meditation, prior to walking each day, for the next 7 days. This will be followed by 7 more days of walking. A self-administered questionnaire designed to measure physical awareness will be filled out following each walk.
The walking will take place on the Lower Harbor breakwater located in Marquette, Michigan. The subject will be required to complete each walk at 7:00 a.m. The shikantaza will take place at the Wellborn residence located in Marquette.
The round-trip walks will take approximately 45 minutes. The meditation will take 15 minutes, for a total of 17 ½ hours. The questionnaire takes approximately 2 minutes to complete.
If I decide to withdraw from the study, or if I am terminated from the study before it is completed, its possible I may be asked to complete the study at a later time.
RISKS:
The possible risks and/or discomforts associated with the procedures described in this study are: muscular soreness from sitting on the floor while engaging in meditation, dizziness upon arising from the floor, and/or loss of self-confidence from poor performance in using the shikantaza method.
BENEFITS:
Possible benefits I may experience from the procedures described in this study include increased physical stamina, increased awareness, and a less “busy” mind. It is possible that this research may lead to techniques designed to quiet the mind of others.
ALTERNATIVE TREATMENTS:
If I decide not to participate, or if I withdraw from this study before it is completed, the following alternative procedures or courses of treatment may be advantageous: relaxation techniques or stress reduction activities. I understand that an alternative to the procedures described above is to not participate in this study.
COST/COMPENSATION:
I will receive course credit for an eligible social work course through the human subjects’ pool. I will also receive $5.00 for each walk, for a total of $105.00.
I understand that if I am injured as a result of my participation in this study, I will be provided reasonable and necessary medical care to treat the illness or injury. I understand that I must report any suspected study-related illness or injury to the study investigator immediately.
CONFIDENTIALITY:
I understand that my research records will be stored in the following manner: a locked cabinet at the Wellborn residences to protect my safety and welfare. I understand that any information derived from this research project that personally identifies me will not be voluntarily released or disclosed without my separate consent, except as specifically required by law.
CONSENT & RIGHTS:
I acknowledge that I have: 1) have read and understood the relevant information; 2) understand that I may ask questions in the future; 3) give free consent to research participation by signing the research consent form 4) have the right to withdraw consent and quit the study at any time.
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